Proximal Femoral Replacement for Subtrochanteric Femur Non- Union in Paget's Disease of the Bone: A Case Study
Paget’s disease of the bone (PDB) is a chronic skeletal disorder which occurs from overactive osteoclastic bone resorption followed by a compensatory increase in osteoblastic new bone formation that results in a high rate of bone remodeling and abnormal bone formation. The ensuing poor bone quality in PDB can predispose patients to fractures. Impaired fracture healing is also common in the setting of pathologic bone- hence; implant failure secondary to persistently high stresses in the setting of non-union is rather unsurprising. We review management of a proximal femoral non-union in a case of failed fixation for a subtrochanteric femur fracture in a Pagetic patient. When implants for proximal femur fractures fail in PDB patients, total hip arthroplasty (THA) or revision with a new implant is recommended. Not all PDB patients with previous broken hardware are good candidates for THA, based on past medical and social history, and there exist a high likelihood of failure of revision fixation secondary to impaired healing potential. We recommend proximal femoral replacement as an appropriate surgical option for PDB patients who are least suited for THA following failed internal fixation.
Acheampong DO and Forsh DA
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