Getting my second knee scheduled and the surgeon never once asked about my osteoporosis or my bone pills. Do I bring it up or does it not matter to them?

Some of you will remember the left knee has been "wanting attention" since my right one was done two and a half years ago. Well, it's got it. Saw the surgeon last Wednesday, X-rays are bone on bone on the inside, he said I'm a good candidate and the scheduler is calling me with a date in October. Fine. Expected.

Here's what's bugging me. Between knee one and knee two I got my DEXA, got the osteoporosis word, and I've been on the weekly bisphosphonate tablet for about a year and a half now. And in a 20 minute appointment, nobody asked. Not the surgeon, not the PA, not the nurse who did the medication list, because I rattled it off and she typed and moved on. No "how are your bones," no "do we need a scan," nothing. First time around I didn't even know I had osteoporosis, so I don't have anything to compare it to.

So, really, does it not matter? Is the knee just the knee and the bone is a separate department? Or is this one of those things where I'm supposed to be the one who brings it up, because I'll do that, I just don't want to be the woman lecturing her surgeon from a website. And do I keep taking the tablet right up to surgery or is that a stop-it thing like the blood thinner list?

No knee here, you all know I'm bones only, but I can tell you what my prescriber said the day she started me on the same tablet: "any surgeon, any dentist, you tell them what you take, and you don't stop it on your own for anybody." She was very firm about it. So I'd at least not be quietly dropping it before October.

And Carol, "bring it up" is not lecturing. You said the word osteoporosis to me over a forum and it changed my whole year. Say it out loud in the room.

Nobody scanned me before either of mine, and I had them fourteen months apart. My osteopenia came up on a routine scan a year after the second knee, and my first reaction was, hang on, shouldn't somebody have looked at that before they hammered metal into my leg twice? I asked my surgeon at a follow-up and he was pretty relaxed about it, said both my knees were cemented and that's what he'd have done anyway, and that my bone had been fine to work with on the day.

That reassured me and annoyed me in equal measure. It's fine to be relaxed about it after the fact when it went well. Ask before. You've already got the diagnosis, which is more than I had.

Carol in Rockford said:

Is the knee just the knee and the bone is a separate department?

Bring it up, and bring it up as a specific item rather than a general worry. Osteoporosis is not a reason to be refused a knee replacement, and it is managed alongside joint surgery every day, so the absence of alarm in your appointment is not itself a sign of neglect. But it is information that can change parts of the plan, and a medication list that is typed and moved past is not the same as a plan that has taken it into account.

What thin bone tends to change. First, fixation: a cemented component is locked into the bone with cement on the day of surgery, while a cementless design depends on your own bone growing onto a porous surface over the following weeks, and osteoporotic bone has fewer internal struts for that to happen in. Cemented fixation is the long-established choice in older women with low density, and it is reasonable to ask which is planned for you and why. Second, the risk it most clearly raises is a fracture in the bone next to the implant, usually the lower femur, usually after a fall; reported rates sit in the low single figures per hundred knees over the life of an implant, and osteoporosis, older age, and female sex are the recurring risk factors, which is why fall prevention is part of protecting the result. Third, rehabilitation: knowing your bone status lets the physiotherapist pace the loading rather than guess. None of this changes the headline that around 8 to 9 in 10 total knee replacements last 20 years or more. The site's article on knee replacement with osteoporosis goes through each of those in more detail.

On the tablet. Bisphosphonates are generally continued around joint surgery rather than stopped, and some observational evidence associates them with lower rates of implant loosening. The treatment I would flag loudly if anyone reading this is on it is denosumab, the six-monthly injection, because its effect wears off quickly when a dose is missed. But the instruction for your specific medicine has to come from your surgical team together with whoever prescribes it, not from me. Ask directly: which of these do I continue, and is there anything I must not miss? That question, plus "have you seen my DEXA result" and "cemented or cementless for me," fits on a card and takes two minutes of a pre-operative appointment. If your last scan is more than a couple of years old, whether it should be repeated before October is also a fair question for them.

You are not lecturing anyone by stating your diagnosis and your medication and asking how they affect the operation. That is the patient half of the conversation working as it should.

Adding one thing from the other side of the desk, so to speak. My daughter works in a pre-op clinic and says the medication list nurses type is a list, it's not a review. The review happens later, if somebody flags something. Be the somebody.

Update, because I made the card. Three questions, exactly as Dr. Ellsworth laid them out, and I read them off it at the pre-op appointment yesterday like a woman ordering at a drive-through.

Answers: he had NOT seen my DEXA, it's with my regular doctor's office and had never been sent over, so that got requested on the spot. Cemented, same as the right, and he said the osteoporosis makes that an easy call for him. Keep taking the tablet through surgery, don't stop it, which matched what Linda's prescriber said. And because my scan is coming up on two years old, they're going to have it repeated before the date rather than after, so the PT has a current number to work with.

So the answer to my own question is: it did matter, and nobody was going to bring it up unless I did. Twenty minutes of nerves for a plan I actually understand. October date is the 14th, so I'll be back with the second knee versus first report in due course.