Could surgery be required?

Successful surgical management of severe complications of Paget’s disease can reduce pain and improve quality of life. The most common surgical treatments for those with Paget’s include joint replacement (hip and knee), osteotomy, and fracture fixation.

Joint replacement

When Paget’s disease causes strain on adjacent joints, it can lead to osteoarthritis. Joint replacement, of the hip or knee, may be required, and is usually very successful. The operation itself may be more technically challenging due to deformity and the altered bone quality. Joint replacement in those with Paget’s disease is highly successful and the results are comparable to those of people who don’t have Paget’s disease. Whilst there is some evidence that blood loss during the operation is higher in patients with Paget’s disease, than those who do not have Paget’s, the overall incidence of complications is low. Careful pre-operative planning, together with the consultant caring for the patient in terms of their Paget’s disease, can ensure optimal outcomes.

Fracture (broken bone)

If a bone affected with Paget’s disease breaks, it may require either a plaster cast or an operation to stabilise the fracture.

Surgery 

Surgery to repair a fracture may be more complex in those with Paget’s disease because of the size and structure of the bone, however, in general, the results are good.

Osteotomy

Osteotomy means ‘cutting of the bone’. This may be carried out to shorten, lengthen or change the shape of a bone. The bone is then reset in a more normal position. This may be performed if there is marked deformity, such as a bowed leg, fissure fracture or pain that has not responded to painkillers. 

Spinal surgery

Rarely, Paget’s disease in the spine can press on the spinal cord causing a narrowing that may need to be corrected surgically if medical treatment is unsuccessful.

Tumour removal

Malignant tumours, associated with Paget’s disease, occur very rarely, when surgery may be used to remove them.