Systematic Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2018; 9(10): 229-234
Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.229
Total knee arthroplasty in patients with Paget’s disease of bone: A systematic review
Ravi Popat, Konstantinos Tsitskaris, Steven Millington, Sebastian Dawson-Bowling, Sammy A Hanna
Ravi Popat, Department of Trauma and Orthopaedic Surgery, the Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, United Kingdom
Konstantinos Tsitskaris, Steven Millington, Sebastian Dawson-Bowling, Sammy A Hanna, Department of Trauma and Orthopaedic Surgery, Barts Health NHS Trust, London E1 1BB, United Kingdom
Author contributions: Popat R and Tsitskaris K designed the research, performed the research and analysed the data; Popat R, Tsitskaris K and Hanna SA wrote the paper; Dawson-Bowling S and Millington S supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ravi Popat, MBBS, Doctor, Specialist Registrar, Department of Trauma and Orthopaedic Surgery, the Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge UB8 3NN, United Kingdom.
Telephone: +44-798-5694033
Received: April 19, 2018
Peer-review started: April 19, 2018
First decision: June 15, 2018
Revised: June 28, 2018
Accepted: July 10, 2018
Article in press: July 10, 2018
Published online: October 18, 2018

To determine the functional outcomes, complications and revision rates following total knee arthroplasty (TKA) in patients with Paget’s disease of bone (PDB).


A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 years.


All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intra-operative challenges. There were five cases (9%) that were complicated by intra-operative patellar tendon avulsion.


The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.

Keywords: Total knee arthroplasty, Paget’s disease of bone, Revision, Loosening, Paget’s disease

Core tip: Patients with Paget’s disease of the bone commonly develop significant mal-alignment, structural bone deformities and soft tissue contractures, making total knee arthroplasty (TKA) in this patient group challenging. In addition, exposure of the knee joint can prove particularly difficult, with this review demonstrating a high incidence of patella tendon avulsion. This systematic review has demonstrated that TKA improves pain and functional outcomes in patients with Paget’s disease of the bone. The rate of loosening and revision in this patient group appears comparable to other patients undergoing TKA.