Table 24. Total knee and hip replacement for osteoarthritis in PDB.

Risk-benefit balance Total knee replacement (TKR) and hip replacement (THR) for osteoarthritis can be performed successfully in many patients with PDB with good results, although more data are available for THR. Heterotopic calcification occurs in a high proportion of patients undergoing THR and the risk of aseptic loosening may be slightly higher than in non-Pagetic patients. The benefit of surgery is likely to outweigh the risks in most cases Quality of evidence Very low Patient values and preferences Patients highly value the symptom relief and improvement in quality of life that a hip replacement may offer. Costs and use of resources The treatment costs for TKR and THR in PDB are likely to be similar to patients without PDB and this is recognised to be a cost-effective option for patients with advanced osteoarthritis Recommendation Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient evidence to recommend one type of surgical approach over another for either site.