Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.229
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.
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.