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Does Multiple Myeloma Complicate Joint Replacements?

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Patients with multiple myeloma are at increased risk for early postoperative complications (especially surgical site infection and thromboembolic events)

David-What effect does Multiple Myeloma have on joint replacement?  I have had two surgeries on the same knee. The first was a partial and after three years and a lot of pain I had it redone.
I was diagnosed in June 2015 (72 yoa).  My symptom was anemia.  I went thru chemo and during that process, they added 35 mg Revlimid daily to my therapy and I ended up in the hospital with renal failure. As close to dying as I have ever come.
Since then I have rehabilitated my kidneys and I am in remission.  I take Revlimid 10 mg for 21 days each month.  At this point my blood work is good and my Doctor is happy.  I also take Zometa every three months. 
My doctors said that the metal piece in my lower leg was loose and had to come out.  I had a revision (total knee) in March and I am still having a lot of pain.” Peter

HI Peter-
I apologize for the jumble of studies linked below. Based on your experience and questions, I began my research with the theory that MM complicated knee replacements. Multiple Myeloma damages the bone, right? Therefore I assumed that knee replacements would be difficult for MM survivors. I suspect you thought so as well.
The challenge is that I can’t find studies that prove that theory definitively. In fact, the bottom study linked below explains that Bisphophonates (Zometa is a bisphophonate drug) actually help patients who undergo knee replacement.
The top study below does establish that MM patients experience a greater risk of “postoperative complications” but all of the complications mentioned in the study are blood and immune system related- blood clots, infections, etc.
The only indication of MM complicating joint replacement is the MM survivor below who had a knee replaced. He talks about the site being “slow to heal” but he does not talk about replacement issues the way you do.
I wish I could offer more conclusive information for you. Let me know if you have any questions.
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Early Postoperative Outcomes After Total Joint Arthroplasty in Patients With Multiple Myeloma

“Results: Patients with multiple myeloma were more likely to suffer several postoperative complications, including thromboembolic events (odds ratio [OR]: 2.97, 95% CI: 2.32-3.81), surgical site infection (OR: 2.82, 95% CI: 1.59-5.01), acute renal failure (OR: 1.93, 95% CI: 1.59-2.37), and induced mental disorder (OR: 1.57, 95% CI: 1.21-2.04). A diagnosis of multiple myeloma was also associated with higher risk for blood transfusion (OR: 2.14, 95% CI: 1.97-2.33), prolonged hospital stay (OR: 2.04, 95% CI: 1.86-2.23), and nonroutine discharge (OR: 1.33, 95% CI: 1.21-1.45) but was not associated with greater in-hospital mortality.

Conclusion: Patients with multiple myeloma are at increased risk for early postoperative complications (especially surgical site infection and thromboembolic events) and resource utilization after elective joint arthroplasty.

Re: Multiple myeloma and knee replacement

by Rneb on Mon Nov 10, 2014 6:01 pm 

Diagnosed 5/12/12. Surgery, radiation, etc. Then induction, collection, but no SCT. On maintenance. Not in full remission — but close. 10 mg Revlimid and Zometa infusions.

I underwent a right total hip in Feb. ’14. Went off Revlimid 2 weeks pre-op (aspirin too). Resumed it 2 weeks after OR. (Aspirin too) 54 years young.

Zimmer device. Stainless nail with combo cup (ceramic and nylon). Orthopod and PA both said bone was like concrete — just no cartilage left / head of femur had worn into an egg, instead of a cue ball. No myeloma lesions.

For coagulation issues, I was placed on Xarelto for 3 weeks. Switched back to Revlimid 10 mg / aspirin 81 grain daily.

Only problem has been bone healing. Revlimid (IMID) acts like a “beat cop” — swinging a night-stick at teenagers. He chases off the RBC’s (teenagers) accumulating around the device, so the bone matrix formation has been very slow to develop around the nail / acetablum. Functionally, I’m doing okay — albeit, I have not pushed things. 

On extra calcium, etc. Zometa, still ( every 3 months, now).

At 6 month check: Great placement of nail, acetablum, screws, etc--but very little bone formation around nail / acetablum. Coming up on 1 yr–in Feb. Hopefully we will then see callous formation/ bone matrixes, bone growth around nail / acetablum.

Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies


Three cohort studies and one case-control study were included in this meta-analysis. Compared with the bisphosphonate nonusers, the patients who used bisphosphonates for a long period of time had a significantly decreased risk of implant revision after THA/TKA (summary adjusted RR = 0.48, 95% CI: 0.38–0.61), and the summary adjusted RRs for the users who underwent THA and those who underwent TKA were 0.47 (95% CI: 0.36–0.61) and 0.45 (95% CI: 0.21–0.95), respectively.


Long-term use of bisphosphonates is correlated with a significantly decreased risk of implant revision after THA/TKA. However, due to limited number of the included studies, the findings of the present study should be treated with caution. More well-designed studies are required to further confirm our findings.

Oral Bisphosphonate Use and Total Knee/Hip Implant Survival

“Objective. Aseptic loosening is the most common cause of revision arthroplasty. Bisphosphonates could minimize this through their antiresorptive effects. This study was undertaken to investigate the association between bisphosphonate use and implant survival…

Conclusion. Oral bisphosphonate users have a 59% reduced risk of revision surgery. This association is only present when bisphosphonates are started after arthroplasty surgery. Confirmation in randomized con- trolled trials is urgently needed…”


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