Once someone has knee replacement complications or continued pain after knee replacement they usually have limited choices moving forward. One choice is to live with the knee pain as best as they can. A second choice is medications, unfortunately for some this means long-term opioid usage. Physical therapy may help in some cases. In other cases, another surgery is necessary. In our office, we see women who have had a knee replacement.
They are here visiting us because they continued to have pain after the surgery. In many cases, before these women come in for a consultation for treatment, we screen them on the phone for realistic treatment candidacy. I do not treat hardware failure or problems with the implant. I treat instability in the surviving ligaments in the knee. For some, knee instability and damage to the remaining natural structures of the knee is something that we may be able to help with. Let’s get then to the question, do women have more knee replacement complications then men?
“The time before surgery was marked by the experience of constant pain, which affected the women negatively in their everyday lives.”
A recent study (1) surveyed women who had a knee replacement and the researchers used this data to help nurses identify what happens to women after the knee replacement. Further, the data was used to see what prompted the women to have the knee replacement in the first place.
Before the surgery, the women were miserable and in chronic pain. When they finally decided to have the knee replacement there was a great deal of relief and trust in the surgery and the medical staff. Here is what the study authors wrote:
“The time before surgery was marked by the experience of constant pain, which affected the women negatively in their everyday lives. During surgery, the information provided by the staff gave each woman a sense of security; the women handed over responsibility to the staff and experienced a sensation of relief.”
After the surgery the women experience relief that the surgery was over. But, feelings would change during the rehabilitation process. Here is what the study authors wrote:
“The postoperative period was characterized by a feeling of joy when the surgery was over, although a rough and tedious rehabilitation phase then began . . .(Post-surgery) challenges in everyday life were a factor for motivation and confidence, although postoperative pain was experienced as discouraging.”
Motivation and confidence, as soon in the above study are important factors to a woman’s recovery. In another recent study (2) investigators explored why women appear to have worse outcomes, more pain, and poorer functional outcomes following total knee replacement than men and what may have caused these outcomes. What they found were
- Female patients had significantly worse pre-surgery pain, limited function, depression, were more likely to be obese, and had pain in more than four joints.
These researchers concluded: “Women appear to have worse outcomes than men possibly due to a putative pre-operative profile across many factors. Consideration of total knee replacement when impairments in pain and function are less severe along with interventions that address mood and comorbidity may improve outcomes for women having total knee replacement.”
Knee replacement complications from weak bones
In a recent study (3) doctors showed that for postmenopausal women to have successful knee replacements, they need to have strong bones to hold the implant in place and to prevent loosening. Here is what they wrote: “Osteoporosis and osteoarthritis commonly coexist in the elderly. In patients undergoing (total knee replacement), the bone quality around the knee joint may affect the safety of prosthetic implantation and consequently satisfaction with the surgical outcome.” The researchers also suggested that declines in bone volume, density, and strength were significantly associated with postoperative pain.
Clinicians often ignore monitoring the treatment of Osteoporosis in the perioperative management of total knee replacement
A 2021 study (4) cited this research and added: “Osteoporosis and osteoarthritis commonly coexist in postmenopausal females. The decrease in bone density and increase in bone resorption in postmenopausal females with Osteoporosis may consequently affect the surgical outcome of total knee arthroplasty (total knee replacement). However, clinicians often ignore monitoring the treatment of Osteoporosis in the perioperative management of total knee replacement. Bone turnover marker can timely and accurately reflect bone metabolism to monitor the treatment of Osteoporosis.”
The growing prevalence of osteoporosis in patients undergoing total joint replacement
An October 2020 study (5) which stated:
“Clinical studies have not only demonstrated the growing prevalence of osteoporosis in patients undergoing total joint replacement but may also indicate a significant gap in screening and treatment of this comorbidity. Osteoporosis negatively impacts bone in multiple ways beyond the mere loss of bone mass, including compromising skeletal regenerative capacity, architectural deterioration, and bone matrix quality, all of which could diminish implant fixation. Recent findings both in preclinical animal models and in clinical studies indicate encouraging results for the use of osteoporosis drugs to promote implant fixation. Implant fixation in osteoporotic bone presents an increasing clinical challenge that may be benefitted by increased screening and usage of osteoporosis drugs.”
Is it Anemia?
An August 2023 study (6) suggested that women suffer from more knee replacement complications than hip replacement complications, and that their joint replacement complications may be traced to low hemoglobin level (anemia) and need for blood transfusion. The researchers further suggested that a “higher focus should be placed on chronic anemia and iron deficiency in especially female patients with hemoglobin level below 13 g/dl. (Anemia treatment) may help to avoid perioperative blood transfusion.”
Do you have questions? Ask Dr. Darrow
At the top of this article I discuss who would be a possible candidate for treatment after knee replacement. Again, I treat instability in the surviving ligaments in the knee. For some, knee instability and damage to the remaining natural structures of the knee is something that we may be able to help with.
References
1 Engström Å, Boström J, Karlsson AC. Women’s experiences of undergoing total knee joint replacement surgery. Journal of Perianesthesia Nursing. 2017 Apr 1;32(2):86-95.
2 Mehta SP, Perruccio AV, Palaganas M, Davis AM. Do women have poorer outcomes following total knee replacement?. Osteoarthritis and cartilage. 2015 Sep 1;23(9):1476-82.
3 Huang CC, Jiang CC, Hsieh CH, Tsai CJ, Chiang H. Local bone quality affects the outcome of prosthetic total knee arthroplasty. Journal of Orthopaedic Research. 2016 Feb;34(2):240-8.
4 Ma R, Wu M, Li Y, Wang J, Yang P, Chen Y, Wang W, Song J, Wang K. The use of bone turnover markers for monitoring the treatment of osteoporosis in postmenopausal females undergoing total knee arthroplasty: a prospective randomized study. Journal of Orthopaedic Surgery and Research. 2021 Dec;16(1):1-8.
5 Anderson KD, Ko FC, Virdi AS, Sumner DR, Ross RD. Biomechanics of Implant Fixation in Osteoporotic Bone. Current Osteoporosis Reports. 2020 Jul 30:1-0.
6 Koettnitz J, Migliorini F, Peterlein CD, Götze C. Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty. BMC Musculoskeletal Disorders. 2023 Dec;24(1):1-7.
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