Simultaneous Total Hip Arthroplasty Research Articles

Perioperative Operating Room Efficiency Can Make Simultaneous Bilateral Total Hip Arthroplasty Cost-effective: A Proposal for a Value-sharing Model.

Increasing demand for total hip arthroplasty (THA) and rising health-care costs have led hospitals to improve operating room (OR) efficiency. We compare the cost-effectiveness of a simultaneous bilateral THA to that of staged unilateral procedures following the implementation of OR efficiency strategies. Between 2017 and 2019, 446 simultaneous and 238 staged bilateral primary THA patients (mean age 61.3 ± 12.0 years; 41.8% males/58.2% females; mean body mass index 27.2 ± 4.8 kg/m2) were treated by a single surgeon using an efficient, standardized workflow for efficient direct anterior approach THA on a standard operating table. There were no differences in inclusion criteria between both groups. From this cohort, 16 simultaneous bilateral THAs and 34 unilateral THAs were prospectively compared for cost-effectiveness using detailed timestamp measurements and data on personnel and material usage. Outcome was assessed based on complication and reoperation rate and patient-reported outcome measures. There was a complication rate of 1.2%, without a difference between patients who underwent a simultaneous THA vs those who underwent a staged primary THA (5/446; 1.1% vs 3/238; 1.3% P= .386). The mean OR time (patient in/out and turnover time) was 109.4 ± 19.8 minutes for bilateral THAs and 133.8 ± 12.8 minutes for 2 unilateral THAs (P < .001). An 18% time-saving and 14% cost-saving was achieved per procedure. Sharing 5% of the cost-saving with the surgeon brings benefit to both the hospital and surgeon. Implementing OR efficiency improves cost-effectiveness of simultaneous bilateral THA compared to unilateral procedures. A new value-sharing model could be a solution to align incentives.

Two Teams Simultaneous Bilateral Total Hip Arthroplasty via Direct Anterior Approach in an Ordinary Table -A Comparative Study with Matched Pair of Consecutive Bilateral Total Hip Arthroplasty

Introduction: The Direct Anterior Approach (DAA) has regained its popularity in total hip arthroplasty (THA). We conducted a pilot study to compare the outcome of two team simultaneous bilateral THA by DDA with a control cohort of patients who underwent single stage bilateral THA by DAA in consecutive fashion. Methods: Group A consisting of patients who underwent two team simultaneous bilateral THA by DAA in ordinary table were matched with a cohort of patients in Group B who underwent consecutive (one after the other) bilateral THA in same sitting by DAA. The parameters compared were Surgical time, Blood loss, Blood Transfusion, Opioid requirement, Length of hospital stay, complication, and the cost. Results: The mean operating time was 99 ± 20.9 minutes in group A as compared with 211.5 ± 27 minutes in group B. This difference was highly significant. The mean intraoperative blood loss in group B (1260 ± 397 ml) was greater than that in group A (930 ± 344 ml). However, this difference was not statistically significant. There was no significant difference between two groups in terms of fall in hemoglobin, blood transfused and opioid requirement. Two team simultaneous THA reduced the duration of operation by an average of 112.5 minutes which equates to approximately Rs.77,287.5 (US$ 1033.77) saved per patient as per our institutional report. Conclusion: Our study suggests that 2 team simultaneous bilateral THA by DAA is equally safe rather less costlier than the consecutive procedure in patients with bilateral hip disease and adequate medical condition.

Bilateral simultaneous total hip arthroplasty in ankylosed hips with and without computer navigation: a case report

Lynch, Daniel BSa; Vajapey, Sravya P. MD, MBAb; Li, Mengnai MD, PhDb Author Information

Clinical and Radiological Outcome of Patients Undergoing Bilateral Simultaneous Total Hip Arthroplasty in Patients with Ankylosing Spondylitis with Bony Ankylosis of Both Hips and Spinopelvic Deformity Using 3D Model Based Protocol vs Conventional Technique: A Single Blind Cluster Randomized Controlled Trial

Clinical and Radiological Outcome of Patients Undergoing Bilateral Simultaneous Total Hip Arthroplasty in Patients with Ankylosing Spondylitis with Bony Ankylosis of Both Hips and Spinopelvic Deformity Using 3D Model Based Protocol vs Conventional Technique: A Single Blind Cluster Randomized Controlled Trial

Curative effect analysis of ipsilateral total knee and hip arthroplasty at stage I

To explore clinical results of ipsilateral total knee and hip arthroplasty at stage I for the treatment of ipsilateral hip and knee diseases. From January 2008 to September 2016, 7 patients with ipsilateral knee and hip disease were treated by simultaneous total knee and hip arthroplasty at stage I, including 4 males and 3 females aged from 47 to 68 years old, the courses of disease ranged from 6 to 29 years; 3 patients with rheumatoid arthritis, 3 patients with ankylosing spondylitis, and 1 patient with senile hip and knee arthritis. Operation time, intraoperative blood loss and local wounds during hospitalization were observed and recorded, and Harris hip score and HSS knee score were used to evaluate therapeutic effects. Seven patients were followed up from 6 to 24 months, operative time ranged from 297 to 362 min, blood loss ranged from 300 to 780 ml. Harris hip score before operation ranged from 27.67 to 39.11, 75.32 to 85.10 at 6 months after operation; 3 patients were good and 4 patients moderate. HSS knee score before operation ranged from 40.90 to 51.36, and 73.56 to 85.33 at 6 months after operation; 1 patients were excellent and 6 patients good. No periprosthetic fracture, aseptic loosening and periprosthetic infection occurred in 7 patients. Ipsilateral total knee and hip arthroplasty at stage I for the treatment of hip and knee disease could restore hip and knee function as soon as possible and recover function of hip and knee to the maximum degree, make patients get down the bed earlier, effectively reduce the complications caused by long-term bedridden, and improve patient's quality and satisfaction of life. While the quality of double-joint arthroplasty at stage I need higher technical requirements which should strengthen the management of the perioperative period, and strictly grasped indications.

Simultaneous total hip arthroplasty and revision total knee arthroplasty with extra articular deformity — by using 3D template and CT-free Navigation —

Simultaneous total hip arthroplasty and revision total knee arthroplasty with extra articular deformity — by using 3D template and CT-free Navigation —

Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral Total hip Arthroplasty in patients with Osteonecrosis of the femoral head

BackgroundThe optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months.MethodsA total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group.ResultsThe mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery.ConclusionsWe suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.

Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty.

Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years) treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips) were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d'Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up). No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d'Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial.

This study aimed to evaluate whether the combination of erythropoietin (EPO) and tranexamic acid (TXA) exerted any additional benefits on the number of blood transfusions required and haematological parameters compared with TXA alone following primary bilateral simultaneous total hip arthroplasty. We conducted a single-centre, prospective, randomised, and controlled trial at our hospital. Group EPO + TXA (n = 30) received daily subcutaneous injections EPO (10,000 IU) on preoperative days 1-4 and postoperative days 1-3. Additionally, these patients were administered TXA (15 mg/kg) 10 min prior to the incision. Group TXA (n = 32) received only TXA (15 mg/kg) 10 min prior to the incision. The primary outcomes were the haematological parameters and number of blood transfusions required. The secondary outcomes were total blood loss, drainage volume, and postoperative complications. The total amount of blood transfusion and mean blood transfusion per patient was lower in group EPO + TXA than in group TXA (p = 0.039, p = 0.023; respectively). In the postoperative period, patients in group EPO + TXA had higher haematological parameters (haemoglobin, haematocrit, and reticulocyte count) than patients in group TXA. No significant differences were found in total blood loss, drainage volume, and DVT or PE between the 2 groups. This study showed that administrating EPO + TXA in combination can increase haematological parameters and reduce the need for blood transfusion without increasing the risk of DVT or PE compared with TXA alone.

Comparison of patient satisfaction after unilateral or simultaneous bilateral total hip arthroplasty through a direct anterior approach: Evaluation using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire

The aim of this study was to compare patients' perception of treatment outcome after unilateral or simultaneous total hip arthroplasty (THA) using the newly developed Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). This study included 429 patients treated with primary THA using a direct anterior approach, namely 304 cases of in the unilateral THA (58 males and 246 females; mean age, 62.3 years) and 125 cases of in the simultaneous bilateral THA (24 males and 101 females; mean age, 58.3 years). Items for evaluation included clinical outcomes and all four aspects of the JHEQ score, namely visual analog scale (VAS), pain, movement, and mental status. The mean operative time per hip was 51.3±19.4min (range, 22-180min) in unilateral group and 46.2±15.1min (range, 26-106min) in simultaneous bilateral group. The mean operative blood loss per hip was 421.2ml±232.1ml (range, 70-1300ml) in unilateral group and 200.8±149.8ml (range, 30-1040ml) in simultaneous bilateral group. The total JHEQ score (pain/motion/mental status) improved from 26.5±13.6 (preoperative, 10.1/6.8/9.6) to 69.4±14.8 (1 year postoperatively, 25.1/20.5/23.8) in unilateral group and from 21.0±8.2 (preoperative, 11.9/2.3/6.9) to 74.9±9.5 (1 year postoperatively, 27.2/22.6/25.0) in simultaneous bilateral group. These results demonstrated a significant improvement before and after surgery for patients in both groups. There were not major complications such as dislocation, bone fracture, nerve palsy or symptomatic pulmonary embolism were observed. In this study, we observed greater improvement in JHEQ in patients treated with bilateral simultaneous THA than in those treated with unilateral THA. These findings demonstrated that bilateral simultaneous THA was related to high patient satisfaction as well as high safety.

Revision Total Hip and Total Knee Arthroplasty for Massive Bone Loss and Periprosthetic Fracture Using a Total Femur Prosthesis: A Case Report

The number of complex total joint arthroplasties being performed each year is continually rising. Patients are undergoing primary and revision total joint arthroplasties at a relatively younger age and face a greater possibility of multiple revision procedures during their lifetime. Surgeons are often faced with significant osteolysis and bone loss and must find ways novel ways to deal with this difficult problem. Total femur arthroplasty using a megaprosthesis is a rare procedure and has been mainly described in the orthopaedic oncological literature, however it has not been described in aseptic, non-tumour related, revision procedures addressing massive bone loss, component loosening and periprosthetic fracture involving ipsilateral hip and knee joints. We present the case of a simultaneous revision total hip and total knee arthroplasty for massive femoral bone loss, aseptic loosening, periprosthetic fracture and functional leg length discrepancy using total femur megaprosthesis. We will briefly review the relevant literature, present the clinical presentation, imaging and surgical procedure as well as the early post-operative course. To our knowledge, total femur replacement for this indication has not been previously described.

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required. J Med Cases • 2013;4(12):803-810 doi: http://dx.doi.org/10.4021/jmc1524w

Simultaneous and staged bilateral total hip arthroplasty: a Danish nationwide study

Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days readmissions and 90 days mortality after BSTHA and BTHA on a nationwide basis. All bilateral primary total hip arthroplasties performed in Denmark from January 1, 2010 to June 31, 2011 were identified using data from the Danish National Patient Registry. The staged procedures were divided into early staged BTHA (0-6 months) and late staged BTHA (6-18 months). 103 patients underwent BSTHA, 370 underwent BTHA (0-6 months) and 207 underwent BTHA (6-18 months). Median total LOS was 4 days (IQR 3) after BSTHA vs. 6 days (3) after both BTHA (0-6 months) and BTHA (6-18 months) (p < 0.001). There were no deaths in the BSTHA group vs. 1 death in each BTHA group ≤90 days postoperatively (0.3 and 0.5 %, respectively) (p = 0.755). The readmission rate ≤30 days was 1.9 % after BSTHA vs. 8.9 % (cumulated) after BTHA (0-6 months) and 15.9 % (cumulated) after BTHA (6-18 months) (p < 0.001). If patients are carefully selected for BSTHA, the procedure appears to be safe when combined with a fast-track protocol in Denmark. We found significantly lower readmission rates and shorter total LOS in the BSTHA group compared with the BTHA groups, potentially reflecting selection bias. The results should stimulate to evaluate BSTHA in a randomised controlled trial or a detailed prospective, large multicenter study with a fast-track protocol regarding morbidity, convalescence and mortality.

Simultaneous Bilateral Cementless Total Hip Arthroplasty: a Minimum 17-year Follow-up Study - Comparison Study with Unilateral Cementless Total Hip Arthroplasty -

목적: 양측성 무시멘트 고관절 전치환술을 동시에 시행한 환자와 편측성 고관절 전치환술을 시행한 환자를 대상으로 장기 추시 결과를 비교한다. 대상 및 방법: 양측성 인공 고관절 전치환술을 동시에 시행한 환자 중 17년 이상 추시 가능한 48예, 편측성 환자 49예를 대상으로 하였다. 평균 연령은 69.1세, 66.7세이었고 평균 추시 기간은 21.5년, 22.4년이었다. Harris 고관절 점수와 전후면 및 측면 방사선 사진을 촬영하여 분석하였다. 결과: 양측성군에서 평균 Harris 고관절 점수는 술 전 44.3점(표준편차 3.78) 최종 추시 시 81.2점(10.75), 편측성군에서는 46.5점(3.27), 80.1점(12.05)이었다. 비구컵의 안정도와 대퇴주대의 고정도는 두군 모두 최종 추시 시 안정적 위치를 보였다. 비구컵 주위의 골용해는 26.3%, 31.4%에서 발생 하였고, 대퇴주대 주위의 골용해는 16.6%, 17.1%, 폴리에틸렌 연평균 마모율은 0.17 mm/yr, 0.16 mm/yr으로 계측되었고 비구컵 및 대퇴주대의 17년 생존율은 양측성군 78%, 89%이고 편측성군은 78%, 86%이었다. 결론: 동시에 시행한 양측성 고관절 전치환술은 편측성과 비교할 때 17년 이상 장기 추시 시에도 임상적 방사선학적으로 유의한 차이가 없었다.

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required. J Med Cases. 2013;4(12):803-810 doi: https://doi.org/10.4021/jmc1524w

Increased Risk of Bilateral Infection

Hypothesis: Simultaneous bilateral endoprosthetic total hip or knee arthroplasty (as in the current article) is in theory inevitably associated with an increased rate of bilateral infections. Reasoning: A department specific risk of infection due to surgery—for example, 5/1000—for endoprosthetic total hip or knee arthroplasty means that even for simultaneous bilateral surgery, such a risk of infection exists (if not even a higher risk, which we will not consider here). If one furthermore assumes that in case of surgery both surgical sites may be affected—the current article does not provide any information in this respect—then the risk of bilateral infection may be 5/1000 if all cases of infection are always bilateral or, for example, 5/10 000 if only one in 10 cases of infection is bilateral. In two-stage surgery (with an interval of several weeks between procedures) the risk per intervention is 5/1000. Both interventions combined have a risk of infection of 2×5/1000=10/1000 for an infection to affect one joint. The probability that in a two-stage procedure (with an interval of several weeks between procedures) both joints become infected is 5/1000×5/1000=25/1000 000. In order to be able better to balance these very divergent surgical risks it would be necessary to obtain detailed data on the bilateral proportion of infections in the group of patients having had simultaneous surgery. Unrelated to that, statistical probability in simultaneous bilateral surgery works against the surgeon, which is why I personally do not recommend this procedure to my patients.

Bilateral Simultaneous Total Hip Arthroplasty in a Fast Track Setting

Simultaneous bilateral hip arthroplasty has been reported to have varying results in the literature when performed using conventional postoperative care. Unilateral hip and knee arthroplasty as well as bilateral simultaneous knee arthroplasty may be associated with reduced length of stay and low complication rates when performed in a fast-track setting. We believed it would be useful to assess hip arthroplasty in this context, and we report 50 consecutive fast-track simultaneous bilateral hip arthroplasty procedures. The median length of stay was 4 days. Mortality within 90 days was 4% and 8% required a further operative procedure. The overall complication rate was 22%. 55% of the complications were considered to be caused by failures in surgical technique and 45% by other factors. Bilateral simultaneous hip arthroplasty may have a high complication rate in a fast-track setting and further evaluation may be warranted.

Comparison of Primary Total Hip Arthroplasties Performed with a Minimally Invasive Technique or a Standard Technique: A Prospective and Randomized Study

The purpose of this prospective randomized study was to compare the early results of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique. A consecutive series of 70 patients who underwent primary bilateral simultaneous total hip arthroplasties was studied. All procedures were performed through a posterolateral approach. Operative times and duration of hemovac drains were significantly shorter in the group with a minimally invasive technique ( P < .05). However, there was a risk of infection when using this technique. There were no any late transfusions in any of our patients postdischarge. This minimally invasive technique did not offer any advantages because the results were not different, and in our hands, it increased our infection rate.

Poster 32: Rehabilitative outcome after simultaneous bilateral hip replacement: a case report

Setting: Acute Midwestern medical center and university-based rehabilitation hospital. Patient: 55-year-old postmenopausal woman with a medical history remarkable for L4-5 laminectomy. Case Description: Bilateral total hip arthroplasty (THA) was performed. Postoperative course was complicated by anemia and pain. The patient was admitted to acute rehabilitation 4 days after surgery. We report on the rehabilitation outcome after simultaneous bilateral THA. Assessment/Results: On admission, the patient ambulated 50ft using a standard walker at a maximum assist level and total assistance for stairs. She did quite well and had a rather short inpatient course. On day 7 of rehabilitation admission, the patient was discharged and was ambulating 400ft using a rolling walker with supervision and was climbing 6 stairs with maximum assistance. At 1-month follow-up, she was ambulating with a cane approximately 0.5 mile daily. At 6 months, she is ambulating without a cane over 1 mile daily, swimming 1 mile daily, and participating in low-impact aerobics twice weekly. Discussion: Osteoarthritis is a major cause of pain and disability in the United States with hip involvement often leading to significant functional impairment. THA, undertaken after conservative management failure, involves invasive surgery followed by a long and demanding rehabilitation program. THA is invariably performed unilaterally and sequentially if both hips are involved. Orthopedic surgical literature reports cases of simultaneous bilateral THA, but provides little information about rehabilitation outcome. Conclusions: This case illustrates that simultaneous THA can be performed with favorable surgical and functional outcome. Our patient had an excellent outcome and this could be attributed, in part, to her age, limited comorbidities, and good physical conditioning prior to surgery. Further prospective research needs to be performed to help determine exact patient criteria, surgical approach, and rehabilitative techniques when performing simultaneous bilateral THA.

Corrective osteotomy for deformity in Paget disease.

Severe deformity resulting from Paget disease is not uncommon. Malalignment of the extremity may lead to intractable pain, mechanical overload of the neighboring joints, limitation of motion and function, and dysmorphic appearance. Although corrective osteotomy has been used to treat osseous deformities, the outcome of corrective osteotomy for long-bone deformities resulting from Paget disease remains largely unknown. The results after twenty-five corrective osteotomies (twenty-two patients), performed between 1975 and 1995, in sixteen tibiae, eight femora, and one radius were evaluated. There were thirteen men and nine women with a mean age of sixty-seven years. The indication for osteotomy was pain in twenty limbs, recurrent stress fractures in three, and limitation of function in two. A variety of osteotomies and fixation methods were used. Two patients underwent simultaneous total hip arthroplasty and proximal femoral osteotomy. Twenty-three of twenty-five osteotomies healed with an average time to union of six months. Both nonunions were in patients who had been managed with intramedullary fixation. The time to union was significantly shorter in metaphyseal osteotomies fixed with plates than in diaphyseal osteotomies (p < 0.04). There was a substantial improvement in the deformities. Satisfaction was rated excellent or good by fourteen patients, fair by six, and poor by two. Complications included a pin-track infection in two patients, peroneal nerve palsy in one, and loss of fixation following external fixation in one. Disease activity, as measured by serum alkaline phosphatase level, and medical treatment with calcitonin and/or bisphosphonates did not have a significant impact on time to union. Corrective osteotomy for the treatment of severe deformity in Paget disease can be challenging and yet rewarding. A higher prevalence of complications was observed following intramedullary nailing and external fixation. Fracture-healing seems to be particularly protracted in diaphyseal osteotomies.