Orthopaedic Nurses Certification Board (ONCB) Metabolic/Inflammatory/Tumors Practice Exam

What is an increased bleeding risk associated with a patient who has Paget's disease undergoing total hip arthroplasty?

1. Removal of osteolytic lesions

2. Hypervascularity of affected bone

3. Diminished bone activity

4. Calcification of involved bone

The correct answer is: Hypervascularity of affected bone

The increased bleeding risk associated with a patient who has Paget's disease undergoing total hip arthroplasty primarily stems from the hypervascularity of the affected bone. Paget's disease is characterized by abnormal and accelerated bone remodeling, which often leads to an increase in blood flow to the areas of affected bone. This hypervascular state results from the increased number of arterioles and capillaries that form in the region as the bone undergoes remodeling processes. During total hip arthroplasty, the surgical procedure involves significant manipulation and potentially cutting through this highly vascularized bone. As a consequence, the risk of significant intraoperative bleeding increases, because blood vessels can be inadvertently damaged during the surgery. This requires careful management of hemostasis and may lead to more complicated surgical procedures compared to patients without Paget's disease. The other options do not adequately explain the increased bleeding risk in this context. For instance, removal of osteolytic lesions refers to bone defects but does not directly address vascular factors, while diminished bone activity, often seen in conditions like osteoporosis, would generally lower the risk of bleeding. Calcification of involved bone might suggest harder, less vascular bone, which again does not correlate with the increased bleeding phenomena observed in Paget's