Clinical image
Radiographs and bone scan in femoral Paget disease. Source: Wikimedia Commons — Hellerhoff; CC BY-SA 4.0. Image binary is embedded locally in this package; original source and licence are retained.
This is highly suggestive of Pagets. How ever I will keep in mind the possibility of Sclerosing metastasis, Renal OD, Fibrous dysplasia, osteoporosis and Hyper pararhyroidism
Key points
This is highly suggestive of Pagets. How ever I will keep in mind the possibility of Sclerosing metastasis, Renal OD, Fibrous dysplasia, osteoporosis and Hyper pararhyroidism](Pagets_assets/slide-01-01.jpg)
Pagets
Pagets disease
- Metabolic disease of unknown ethology
- Disorganised increase in OC and compensatory OB activity
- Accelerated but chaotic new bone formation
- OC are abnormal in size, quantity and activity
- Lytic, mixed and sclerotic Phases
OC
- Hyper responsive to Vitamin D3, RANKL
- Increased RANKL,
- bcl 2, c-fos and IL6 over expression
Causes
- Viral infection: PMV, RSV, Measles
- High arsenic
- Uncertain association with cats and dogs
Radiologic features
- Diploic widening
- Picture frame vertebra
- Protrusio acetabula
- Bend long bones
- Femur lateral
- Tibia anterior
Complications
- Hydreocephalus, blindness
- Spinal fractures and Cauda ES
- High output cardiac failure
- Pathological fractures
- Malignancies
THA
- Exclude active disease: ALP, Urine hydroxyproline
- Exclude Fractures, neurology and paget sarcoma
- Active disease: Pamidronate
Technical issues
- Increased bleeding
- Hard bone
- Deformities
- Protrusio
- Intra/post operative fracture
- HO
- Increased incidence of osteolysis
Your choice
- Cemented force closed taper slip femoral stem
- Cemented acetabulum
- Parvizi et al and lusty et al have shown good medium term results with uncemented THA