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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.