China has entered an aging society with an increasing incidence of osteoporosis and its related complications. There is a great similarity between primary osteoarthritis and osteoporosis in terms of age of onset. Therefore, among patients with osteoarthritis requiring artificial joint replacement, the proportion of combined osteoporosis is high. An in-depth study of the perioperative bone density changes in this population will not only help to improve the success rate of joint replacement and patient satisfaction with functional recovery, but also help to prevent and treat osteoporosis, improve bone mass, and reduce the occurrence of complications. The prevalence of osteoarthritis is high in the Chinese population, and a large sample epidemiological survey by Xu Ling et al. showed that the prevalence of radiographic osteoarthritis of the knee in elderly women in Beijing was as high as 46.6% and the prevalence of clinical osteoarthritis was 15.4%, higher than that of American women of the same age. By measuring the bone density of the lumbar spine and hip in patients with osteoarthritis, Zhou Yixiong et al. found that the mean bone density of the lumbar spine in patients with grade 4 osteoarthritis was significantly higher than that of grade 2 patients, whereas the mean bone density of the hip did not differ significantly with increasing Kellgren’s grading level. osteoarthritis is more affected. In this study, all 36 patients with osteoarthritis underwent preoperative bone mineral density testing of the hip and lumbar spine. According to the international diagnostic standard of osteoporosis and the “Chinese recommended diagnostic standard of osteoporosis (2nd draft)”, bone density is expressed as T value (the standard deviation SD of the measured bone density and the peak value of the same sex in people aged 20-40 years), and osteoporosis can be diagnosed if the bone density value of one or more parts is lower than the following values, i.e., women -2.5 SD was used as the diagnostic criterion, and men (reference) ≤ -2.5 SD were considered osteoporotic. All patients in this study were diagnosed with osteoporosis, the reason for which may be related to the decrease in activity due to increasing age and decreasing joint function. In osteoporosis, patients have a significant decrease in whole body bone mass and a significant decrease in bone mineral density compared to that in prime age. At the same time, due to changes in the microstructure of bone tissue (bone mass), bone trabeculae become thinner, bone cortex becomes thinner, and microfractures occur in individual areas. Patients have significantly higher bone fragility and many mechanical stimuli of daily life can lead to fractures. Arthroplasty in these patients is very difficult. First of all, intraoperative fractures can occur due to careless positioning, improper traction methods or rough handling when performing joint replacement. According to statistics, the incidence of intraoperative fracture after osteoporosis is 5 to 8 times higher than that of normal organism. In addition, patients have significantly reduced the thickness and number of bone trabeculae, increased trabecular separation and thinner cortical bone, which bring many unnecessary troubles for prosthesis fixation. The use of bone cement can provide a certain degree of fixation, but the side effects of bone cement should not be ignored. It has been found that bone cement particles stimulate osteoclast proliferation and activation. This causes more severe bone resorption to occur due to the large number of osteoclasts concentrated in the bone around the cement. This is undoubtedly worse for patients with osteoporosis, and the result is often loosening of the prosthesis. Third, for patients with bone defects, bone grafting is often essential to improve the fixation of the prosthesis and reduce the amount of bone cement, but osteoporotic patients have poor bone quality and lack suitable bone sources. In many cases, allogeneic bone has to be used. In China, the current tissue banking technology is not yet sound, and there is a lack of safe and effective regulations and testing standards, resulting in the existing products being of varying quality and putting patients at risk of contracting infectious diseases. In order to improve the success rate of total knee replacement in patients with osteoporosis, our team developed a practical perioperative treatment plan for each patient through careful design. First of all, we understand the osteoporosis of the patients through bone density testing and administer anti-osteoporosis treatment one month before surgery, which provides a strong guarantee for the smooth operation. In addition, we performed precise micro-CT scans and 3D reconstructions of all affected limbs before surgery, performed adequate intraoperative rehearsals, and fully prepared patients who might need bone grafting during surgery. We conducted in-depth communication with patients and their families to eliminate their concerns about bone grafting, and ordered in advance homogeneous bone products from the most authoritative manufacturers in China to ensure the safety of the donor. Thirdly, we adopted a high flexion artificial total knee joint and operated gently during the operation to avoid damage to the collateral and patellar ligaments. We also improved the technique of bone cement use so that the bone cement could penetrate as deeply as possible into the bone interface to enhance the fixation strength and be able to increase the stability of the prosthesis. Fourth, continuing to take anti-osteoporosis drugs after surgery and enabling the patient to move down to the ground early through rehabilitation training reduces the incidence of disuse osteoporosis and will also avoid the occurrence of early postoperative prosthesis loosening.