Background: Severe deformity resulting from Paget disease is not uncommon. Malalignment of the extremity may lead to intractable pain, mechanical overload of the neighboring joints, limitation of motion and function, and dysmorphic appearance. Although corrective osteotomy has been used to treat osseous deformities, the outcome of corrective osteotomy for long-bone deformities resulting from Paget disease remains largely unknown.
Methods: The results after twenty-five corrective osteotomies (twenty-two patients), performed between 1975 and 1995, in sixteen tibiae, eight femora, and one radius were evaluated. There were thirteen men and nine women with a mean age of sixty-seven years. The indication for osteotomy was pain in twenty limbs, recurrent stress fractures in three, and limitation of function in two. A variety of osteotomies and fixation methods were used. Two patients underwent simultaneous total hip arthroplasty and proximal femoral osteotomy.
Results: Twenty-three of twenty-five osteotomies healed with an average time to union of six months. Both nonunions were in patients who had been managed with intramedullary fixation. The time to union was significantly shorter in metaphyseal osteotomies fixed with plates than in diaphyseal osteotomies (p < 0.04). There was a substantial improvement in the deformities. Satisfaction was rated excellent or good by fourteen patients, fair by six, and poor by two. Complications included a pin-track infection in two patients, peroneal nerve palsy in one, and loss of fixation following external fixation in one. Disease activity, as measured by serum alkaline phosphatase level, and medical treatment with calcitonin and/or bisphosphonates did not have a significant impact on time to union.
Conclusions: Corrective osteotomy for the treatment of severe deformity in Paget disease can be challenging and yet rewarding. A higher prevalence of complications was observed following intramedullary nailing and external fixation. Fracture-healing seems to be particularly protracted in diaphyseal osteotomies.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
Javad Parvizi, MD, FRCS; Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107
Mark A. Frankle, MD; Florida Orthopedic Institute, 4175 East Fowler Avenue, FL 33614
Robert D. Tiegs, MD; Franklin H. Sim, MD; Departments of Endocrinology (R.D.T.) and Orthopedics (F.H.S.), Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905. E-mail address for F.H. Sim: firstname.lastname@example.org