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Preoperative Management of Paget’s Disease

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Diagnosis and Management of Hip Disease

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Abstract

Orthopedic surgery may be necessary for the management of complications due to Paget’s disease such as treatment refractory hip pain due to secondary osteoarthritis, pathologic or impending fracture of the femur, and progressive femoral deformity and malalignment. Potential complications during and following surgery on pagetic bone include pathologic fracture, excessive bleeding peri- and postoperatively due to increased vascularity of pagetic bone, delayed union or nonunion, and heterotopic ossification. A thorough preoperative medical evaluation in patients with Paget’s disease particularly in those with polyostotic disease is necessary prior to an orthopedic procedure on pagetic bone. Prior to antipagetic therapy, vitamin D and calcium status should be assessed and managed to prevent bisphosphonate induced hypocalcemia and to optimize the response to orthopedic surgery. Antipagetic therapy with a bisphosphonate and/or calcitonin will decrease pagetic activity, prevent or diminish excess peri- and postoperative blood loss, and post-immobilization hypercalcemia.

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  1. Department of Medicine, Roger Williams Medical Center, 825 Chalkstone Avenue, Providence, RI, 02908, USA

    Joseph R. Tucci MD, FACE, FACP

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  1. Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Roy K. Aaron

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Tucci, J.R. (2015). Preoperative Management of Paget’s Disease. In: Aaron, R. (eds) Diagnosis and Management of Hip Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-19905-4_9

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