Surgical management of Paget's disease

Orthopedic complications of Paget's disease occur commonly and arise as a r esult of chronically accelerated bone remodeling in focal regions of the sk eleton. Complications include pathologic fractures with delayed union, prog ressive skeletal deformity, chronic bone pain and pagetic arthritis. The ne w bisphosphonates have transformed the treatment of Paget's disease in the past decade but have not yet been studied in depth for their ability to pre vent orthopaedic complications. Although few patients with Paget's disease ever require surgical intervention, successful operative management of orth opaedic complications has dramatically improved the quality of life for man y sufferers. Selected modalities with promising results include total hip r eplacement for end-stage pagetic arthritis of the hip, total knee replaceme nt for end-stage pagetic arthritis of the knee, proximal tibial osteotomy f or painful malalignment of the knees, internal fixation for pathological fr actures, and decompressive laminectomy for spinal stenosis, Complications o f surgery on pagetic bone include hemorrhage, infection, pathologic fractur e, delayed union, nonunion, and aseptic loosening of hardware. Medical, sur gical, and rehabilitative modalities provide a,vide array of options in man aging orthopaedic complications of Paget's disease and are useful in improv ing quality of life for sufferers of the condition. Prospective studies are needed to assess the ability of antipagetic medications to prevent severe long-term complications such as deformity, arthritis, and malignancy, Local ization of susceptibility genes for Paget's disease may accelerate identifi cation of targets for gene therapy and disease prevention.