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
Paget’s disease of bone (PDB) affects approximately 2%-4% of people older than 40 years. With an ageing population and the number of TKAs performed each year growing rapidly, there is a high likelihood that arthroplasty surgeons will need to perform total knee arthroplasty (TKA) in patients with PDB.
Patients with PDB can develop significant mal-alignment, structural bone deformities and soft tissue contractures. Understanding the problems and challenges associated with performing TKA in patient with PDB is key to achieving successful outcomes.
To aid appropriate consenting of patients and to assist surgeons in achieving the best outcomes for their patients, it is important to understand the outcomes that have previously been achieved following TKA in patients with PDB.
A systematic review of the literature was performed. A total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed.
All studies demonstrated a substantial improvement in function and pain following TKA in patients with PDB. The mean follow-up was 7.5 years. There were two cases of aseptic loosening, with one patient requiring a revision TKA at 10 years. Five cases (9%) of intra-operative patellar tendon avulsion were reported, suggesting that exposure of the knee joint in patient with PDB can be particularly challenging.
This systematic review supports the use of TKA to improve function and alleviate pain in patients with Paget’s disease around their knee joints. The post-operative functional outcomes appear to be similar to those experienced by patients that do not have PDB. At an average of 7.5 years follow-up, implant survival appears comparable with patients that receive TKA for primary OA. Pain scores also improve substantially in this patient group. Morphological changes that occur secondary to PDB, may require intra-operative adaptations and a high rate of patella tendon avulsion (9%) suggests additional care needs to be taken when gaining access to the knee joint, especially in case where there is Pagetoid involvement of the patella/tibial tuberosity.
Surgeons treating patients with PDB need to be aware of the particular challenges posed by this patient group, with intra-operative adaptations potentially required to avoid complications. Further studies that compare functional, pain and revision outcomes in patient with PDB around the knee, against a matched control group, with the use of modern TKA implants, will provide further information about the results that can be expected in this patient group.