Osteoporosis is a condition that weakens the bones, making them far more likely to fracture. Find out how it can have an impact on knee replacement surgery.
What is osteoporosis?
As we age, bones naturally lose some of their density and ability to regrow, but if you have osteoporosis your bones are far more fragile than they should be, making them likely to break even after a minor fall or accident. These are referred to as fragility fractures.
Who is at risk of osteoporosis?
Anyone can develop osteoporosis but it is most common in postmenopausal women and people over the age of 50. Smoking also increases your susceptibility as does having a family history of the disease.
Some health conditions increase the likelihood of developing osteoporosis, including autoimmune disorders that affect the bones (such as rheumatoid arthritis and ankylosing spondylitis), certain gastrointestinal diseases like inflammatory bowel disease and coeliac disease, and blood disorders or cancers that affect the blood. Also, taking some kinds of medications or having certain surgical procedures can also increase your risk of osteoporosis.
A special type of X-ray called a dual-energy X-ray absorptiometry (DEXA) test may be used to measure bone mineral density (BMD) and assess whether you are at risk of osteoporosis.
Can I have knee replacement surgery with osteoporosis?
Having osteoporosis doesn’t prevent you from having knee replacement surgery but it can increase the risk of complications so you may need additional preoperative and postoperative care to manage these risks.
Knee replacement surgery is normally offered to people with severe osteoarthritis. It is common for such patients also to be affected by osteoporosis and osteopenia (an early warning sign of osteoporosis, where bone density is starting to reduce). Estimates suggest that as many as one in five people undergoing knee replacement surgery for osteoarthritis also have osteoporosis. Postmenopausal women, in particular, are likely to be affected, as shown in a study published in January 2022[1].
How does osteoporosis affect outcomes after a knee replacement?
Having osteoporosis can negatively impact surgical outcome. It may increase the risk of fragility fractures, implant migration and aseptic loosening. It also increases the chances of needing revision surgery in the future, according to a 2024 literature review published in the journal Arthroplasty[2]. Researchers found that osteoporosis was associated with a two-fold increase in the chances of needing revision surgery for a periprosthetic fracture in the five years following a total knee replacement.
Measures that can reduce poorer outcomes
If you have osteoporosis and are due to have knee placement surgery, there are measures that can be taken to lower the chances of you developing complications and having poorer post-surgical outcomes.
Screening for bone mineral density (BMD) prior to surgery can identify people with low BMD who may benefit from medical management. According to a 2019 case series review in The Journal of Arthroplasty[3], a quarter of all medical charts reviewed showed that people would benefit from osteoporosis medication prior to surgery. However, only 5% received any preoperative or postoperative management. Some research suggests that osteoporosis medication can help to reduce post-operative BMD loss and periprosthetic fractures so this could be a helpful measure for patients, although more studies are needed to fully understand the impact of medication after knee replacement surgery.
Pre-operative screening may also help to identify certain factors that are associated with poorer outcomes following joint replacement surgery. These include: obesity, malnutrition, vitamin D deficiency, anaemia and opioid use. If low vitamin D levels are identified, taking supplements prior to surgery may help. A programme of weight-bearing exercises can also help to strengthen the bones – for example, leg exercises and exercises to build upper body strength in preparation for using walking aids post-surgery. If you are carrying excess weight, losing weight prior to surgery can reduce stress on your new knee joint.
Following surgery, it is important to take steps to reduce the risk of injury, including removing trip hazards at home and using a walking aid to help you move around. A programme of exercises can help you rehabilitate and restore function, balance and range of motion to the affected leg. Attending regular appointments in the weeks and months after surgery can help to ensure that recovery is taking place as expected.
If you have osteoporosis and are due to undergo knee replacement surgery, talk to us for advice. We offer Mako robotic-arm assisted total knee replacements and partial knee replacements, as well as customised knee replacements using implants that are sized and shaped to your exact anatomy.
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We are always happy to provide information and guidance about the various treatment options, both surgical and non-surgical, including Mako Robotic Arm Assisted Surgery and conventional surgery.
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