Question
A 72 year old man has right hip and thigh ache. His alkaline phosphatase is raised and calcium is normal.
- What is the diagnosis and what are its radiological features?
- What are the complications and medical treatment?
- What are the considerations for hip arthroplasty?
Answer
Diagnosis
- Paget disease of bone
- Lytic, mixed and sclerotic phases
- Coarse trabeculae, cortical thickening, bone enlargement and bowing
- Blade of grass lesion in long bones and osteoporosis circumscripta in the skull
- SQSTM1 mutation in familial cases
Complications and treatment
- Fractures, arthritis, deafness, spinal stenosis and high output cardiac failure
- Sarcomatous change is rare and presents with new pain
- Single zoledronic acid infusion for symptoms, before surgery or for lytic weight bearing lesions
Hip arthroplasty
- Bisphosphonate before surgery reduces bleeding
- Hard sclerotic bone, coxa vara and protrusio make preparation difficult
- Femoral bowing may need osteotomy
- Higher rates of heterotopic ossification
- Cemented fixation is often used
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.