Our Summary

This research paper discusses concerns about a type of knee replacement surgery, known as cementless total knee arthroplasty (TKA), in patients with low bone mineral density (BMD). Low BMD, often caused by osteoporosis, can potentially lead to complications like the implant not properly attaching to the bone or becoming loose over time. Some experts believe recent advancements in cementless implants can lower these risks, but there’s no long-term data to support this yet. The study aims to broaden our knowledge about the frequency and causes of osteoporosis in TKA patients, how well cementless implants work in patients with low BMD, the role of bone-altering medications, and when and how to use cementless TKA in these patients. This is done by reviewing existing research and expert views on these topics.

FAQs

  1. What are the potential complications of cementless total knee arthroplasty in patients with decreased bone mineral density?
  2. How do advances in cementless prostheses affect the risks of complications in patients with decreased bone mineral density?
  3. What is the role of bone-modifying agents in cementless total knee arthroplasty for patients with decreased bone mineral density?

Doctor’s Tip

A doctor might recommend that a patient with decreased bone mineral density who is considering a knee replacement procedure should discuss the potential risks and benefits of cementless total knee arthroplasty with their orthopedic surgeon. They may also suggest exploring options for bone-modifying agents or other interventions to improve bone density before undergoing surgery. It is important for patients to be well-informed and actively involved in the decision-making process to ensure the best possible outcome for their knee replacement surgery.

Suitable For

Patients who are typically recommended for knee replacement surgery are those who have severe knee pain and dysfunction that interferes with their daily activities and quality of life. This includes patients with osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and other degenerative joint diseases. Additionally, patients who have not had success with conservative treatments such as medication, physical therapy, and injections may also be candidates for knee replacement surgery. Other factors that may influence the recommendation for knee replacement surgery include age, overall health, and the presence of other medical conditions that may affect the success of the surgery.

Timeline

  • Before knee replacement:
  1. Patient experiences chronic knee pain and difficulty in performing daily activities.
  2. Patient consults with an orthopedic surgeon who recommends knee replacement surgery.
  3. Patient undergoes pre-operative assessments including imaging tests and blood work.
  4. Patient meets with a physical therapist to discuss pre-operative exercises and rehabilitation.
  • After knee replacement:
  1. Patient undergoes knee replacement surgery and stays in the hospital for a few days for post-operative care.
  2. Patient starts physical therapy to regain strength and mobility in the knee.
  3. Patient may experience some pain and swelling initially after surgery.
  4. Over the next few weeks and months, patient gradually improves in mobility and pain levels.
  5. Patient continues with physical therapy and follow-up appointments with the surgeon to monitor progress.
  6. Patient may need to make lifestyle modifications to protect the new knee joint, such as avoiding high-impact activities.
  7. In the long term, patient experiences improved quality of life and ability to perform daily activities without pain.

What to Ask Your Doctor

  1. What are the potential risks and benefits of a cementless total knee arthroplasty (TKA) compared to a cemented TKA?
  2. How will my bone mineral density (BMD) impact the success of a cementless TKA?
  3. What is the prevalence of osteoporosis in TKA patients and how does it affect outcomes?
  4. Are there specific bone-modifying agents or treatments that can improve the success of a cementless TKA in patients with decreased BMD?
  5. What are the indications for choosing a cementless TKA in a patient with decreased BMD?
  6. What technical considerations should be taken into account during surgery for a cementless TKA in a patient with decreased BMD?
  7. What is the long-term survivorship of cementless implants in patients with decreased BMD?
  8. Are there any additional precautions or follow-up care that I should be aware of as a patient with decreased BMD undergoing a cementless TKA?

Reference

Authors: Deans C, Zitsch B, Kildow BJ, Garvin KL. Journal: Orthop Clin North Am. 2024 Jul;55(3):333-343. doi: 10.1016/j.ocl.2024.02.003. Epub 2024 Mar 23. PMID: 38782505