Strut Allograft Invasion by Paget’s Disease of Bone: A Case Report

Hugh U. Cameron; Victor L. Fornasier; Dirk Van Zyl

Paget’s disease of bone is a localized disorder of bone remodelling that results in disorganized woven and lamellar bone.1^–3 This leads to bone that is structurally weak and can undergo progressive deformity. If a total hip replacement is required in a femur affected by Paget’s disease, the deformity can be corrected by osteotomy and a very long stem used to prevent the redevelopment of deformity.4^–7

Case Report

A 74-year-old patient had an arthritic hip and a severely deformed femur affected by Paget’s disease (Fig. 1). The femoral deformity was corrected by an interval procedure and the osteotomy stabilized by cortical strut allografts (Fig. 2).8 At a later date, a prosthesis of intermediate stem length was used in hip replacment (Fig. 3). Six months later the cerclage wires were removed and the allograft strut was noted to have united and bled when the periosteum was stripped. Surface shaving showed new bone growing into the vascular channels of the allograft. Radiographs obtained 3 years after the struts were applied showed that they appeared to have been completely replaced by “Paget’s bone” (Fig. 4).

FIG. 1

Paget’s disease involves the whole femur. Stress fractures had occurred at the tip of the old intramedullary nail leaving the femur severely deformed.

FIG. 2

An osteotomy was carried out at the summit of the deformity and the femur stabilized with an intramedullary nail and strut allografts. The deformity of the proximal femur was ignored.

FIG. 3

Total hip replacement was carried out using a prosthesis with an intermediate stem length. The proximal deformity was corrected by osteotomy. The allograft has united over its complete length.

FIG. 4

Radiologically the strut allograft has been completely replaced by Paget’s-type bone.

Discussion

We could find no previous reports of “Paget’s bone” invading strut allografts. The findings in our case suggest that strut allografts provide only temporary strengthening for the femur involved by Paget’s disease and that reinforcement by hip replacement with a very long stem is preferable in such cases.

Accepted July 12, 1999.

References

↵
1. Hadjipavlou A,
2. Lander P,
3. Srolovitz H
. Pagetic arthritis. Pathophysiology and management. Clin Orthop 1986;208:15–9.
OpenUrl PubMed
1. Kaplan FS,
2. Singer FR
. Paget’s disease of bone: pathophysiology diagnosis and management. J Am Acad Orthop Surg 1995;3: 336–44.
OpenUrl PubMed
↵
1. Paget J
. On a form of chronic inflammation of bones (osteitis deformans). Trans Roy Med Clin Soc 1877;60:37–64.
OpenUrl
↵
1. Alexakis PG,
2. Brown BA,
3. Hohl WM
. Porous hip replacement in Paget’s disease. An 8-2/3-year followup. Clin Orthop 1998;350: 138–42.
OpenUrl PubMed
1. Cameron HU
. Use of a distally fluted long stem prosthesis in correction of angular deformities of the femur. Contemp Orthop 1990;20:159–66.
OpenUrl
1. Ludkowski P,
2. Wilson-MacDonald J
. Total arthroplasty in Paget’s disease of the hip. A clinical review and review of the literature [review] Clin Orthop 1990;225:160–7.
OpenUrl
↵
1. Namba RS,
2. Brick GW,
3. Murray WR
. Revision total hip arthroplasty with correctional femoral osteotomy in Paget’s disease. J Arthroplasty 1997;12(5):591–5.
OpenUrl CrossRef PubMed
↵
1. Emerson RH Jr.,
2. Malinin TI,
3. Cuellar AD,
4. Head WC,
5. Peters PC
. Cortical strut allografts in the reconstruction of the femur in revision total hip arthroplasty. A basic science and clinical study. Clin Orthop 1992;255:35–44.
OpenUrl