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Abstract：
BACKGROUND: Total hip arthroplasty (THA) in patients with Paget\'s disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications.
METHODS: Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed.
RESULTS: In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1-6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day.
CONCLUSIONS: THA surgery in Paget\'s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.
METHODS: Level III.
METHODS: Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed.
RESULTS: In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1-6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day.
CONCLUSIONS: THA surgery in Paget\'s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.
METHODS: Level III.
摘要：
背景：Paget病患者的全髋关节置换术（THA）可能与畸形和骨力学特性改变相关的技术困难有关，血管过多导致术中出血。这项注册和单机构研究的目的是调查总体生存率和THA失败的原因，以及临床和放射学并发症的分析。
方法：基于注册表的生存和并发症分析，固定类型,术中和术后并发症，临床(药理学史，输血,哈里斯髋关节评分[HHS])和放射学(杯取向，阀杆轴向对齐，对杯子和茎周围的骨质溶解和异位骨化[HO]）数据进行了审查。
结果：总计，66例患者（男27例，女39例，手术平均年龄男性71.1岁，女性74.8岁）来自注册研究的10年生存率为89.5％。在机构研究中，涉及26名患者(14名男性和12名女性，平均69年)和29年，髋关节功能明显改善。平均杯方向为40.5°，而内翻茎对齐率为13.8%。总的来说,52％的臀部有异位骨化。髋臼周围骨质溶解在13.8％的植入物中，在茎周围发现了45％的臀部。同种异体和自体输血率分别为68.2%和31.8%,分别,平均输血2单位血液（范围1-6单位）。HHS平均提高了34分，在64.3%的患者中具有优异的结果。两个植入物失败了，一个是由于外伤后64个月的陶瓷头骨折，一个是由于手术后第二天的杯子动员。
结论：Paget患者的THA手术是一种安全的手术，植入物的存活仅部分受到骨骼重塑和固定选择的影响。手术后的功能结果与其他患者在很大程度上相似。出血相关并发症是主要并发症；应建议采取谨慎的药理学策略，以降低输血和HO发展的风险。
方法：三级。
方法：基于注册表的生存和并发症分析，固定类型,术中和术后并发症，临床(药理学史，输血,哈里斯髋关节评分[HHS])和放射学(杯取向，阀杆轴向对齐，对杯子和茎周围的骨质溶解和异位骨化[HO]）数据进行了审查。
结果：总计，66例患者（男27例，女39例，手术平均年龄男性71.1岁，女性74.8岁）来自注册研究的10年生存率为89.5％。在机构研究中，涉及26名患者(14名男性和12名女性，平均69年)和29年，髋关节功能明显改善。平均杯方向为40.5°，而内翻茎对齐率为13.8%。总的来说,52％的臀部有异位骨化。髋臼周围骨质溶解在13.8％的植入物中，在茎周围发现了45％的臀部。同种异体和自体输血率分别为68.2%和31.8%,分别,平均输血2单位血液（范围1-6单位）。HHS平均提高了34分，在64.3%的患者中具有优异的结果。两个植入物失败了，一个是由于外伤后64个月的陶瓷头骨折，一个是由于手术后第二天的杯子动员。
结论：Paget患者的THA手术是一种安全的手术，植入物的存活仅部分受到骨骼重塑和固定选择的影响。手术后的功能结果与其他患者在很大程度上相似。出血相关并发症是主要并发症；应建议采取谨慎的药理学策略，以降低输血和HO发展的风险。
方法：三级。
