Paget's disease is a chronic, nonmetabolic bone disorder characterized by increased bone resorption, bone formation, and remodeling. This unbalanced process may lead to osseous deformities, structural weakness, and altered joint biomechanics, all of which can make surgical reconstruction difficult. Although few patients with Paget's disease require surgical treatment, successful surgical management of severe orthopaedic complications has improved the quality of life for these patients. Surgical options include osteotomy to correct long-bone deformity and arthroplasty to restore altered joint mechanics. Patients are at increased risk for surgical complications, such as blood loss and heterotopic bone formation. Issues relating to the surgical management of patients with Paget's disease include appropriate preoperative diagnosis, technical challenges of surgery, and strategies to improve the long-term outcome of surgical intervention.