Leveraging lower body negative pressure for enhanced outcomes in orthopedic arthroplasty—Insights from NASA’s bone health research

Exposure to microgravity causes rapid bone loss and muscle atrophy, posing serious challenges for long-duration spaceflight. In response, NASA developed countermeasures such as Lower Body Negative Pressure (LBNP) to simulate gravitational loading on astronauts’ lower extremities. LBNP, often combined with exercise, has proven effective in mitigating musculoskeletal degradation during bed rest analogs. This opinion paper argues that LBNP’s success in preserving bone mass and muscle function in microgravity can be translated to improve recovery after orthopedic arthroplasty on Earth. We draw physiological parallels between microgravity-induced musculoskeletal disuse and the postoperative period following total joint replacement, during which reduced weight-bearing leads to bone density loss around the implant (periprosthetic osteopenia) and muscle weakness. We propose that applying LBNP as a therapeutic adjunct, for example, in daily sessions soon after surgery – could enhance limb perfusion, promote bone remodeling and implant osseointegration, and accelerate functional rehabilitation. We review NASA’s evidence supporting LBNP’s osteogenic and anti-atrophy effects, outline potential mechanisms in the surgical context (including improved circulation, mechanical loading, and edema reduction), and present a vision for clinical implementation. While acknowledging technical and logistical challenges, we take a polemical stance that leveraging this spaceflight-derived innovation could transform postoperative care in orthopedics. Clinical studies are now warranted to validate LBNP in arthroplasty patients, bridging aerospace medicine and terrestrial healthcare for improved outcomes.