Hip Replacement while on treatment??

[laurieq]

My husband, who is in a Clinical Trial at MDA for Richter's, needs a hip replacement badly - such that his severe arthritis is a bigger deal to his quality of life than the Richter's.

He saw an orthopedic pain management specialist last week who had nothing to offer, stating that a steroid injection in the joint might "kill" him and would offer very little long-term relief. He stated that a hip replacement was the next line of treatment, but he doubted it would be approved while he was on treatment for this.

We see his team at MDA for a monthly check on Tuesday and we will ask if the hip replacement is an option and when. He is currently on V + Pirtobrutnib - completed Obinutizimab several months ago. He is uMRD currently with fairly good labs.

My question to the group is: has anyone had a big orthopedic procedure while on these meds? Elective? How was the recovery phase and were any adjustments needed in CLL treatment.

Thanks in advance for any thoughts on this.

Laurie

[Tommays56]

I had a reverse left shoulder replacement 3 years ago this September with a white count around 20,000

Getting a good recovery out any replacement really requires a physical therapy assessment before the replacement so they can hopefully get you in good shape Before

After the replacement it’s a lot of physical therapy to get a good outcome and the whole process is going to expose the patient to a lot of respiratory infection risks

[laurieq in reply to Tommays56]

Were you under treatment at the time? Hope you did well with the shoulder replacement - I hear those can be brutal!

[bkoffman CLL CURE Hero]

Infection risk is higher and maybe risk of a blood clot, but joint replacements are usually successful in CLL patients.

[Megrosegod]

Hi, I had a hip replacement in July 2023 having been on Alcalabrutinib for 1 year. My bloods were normal except platelets at 84. I aso had my first hip replacement in Feb 2022 three months prior to starting treatment. Both ops were a total success and have transformed my quality of life.

The risks are regarding infection and I followed all the consultants recommendations. By eating healthily, following the exercise routine etc. My bloods 2 weeks after the second op were stable.

The only adjustment made was to stop Alcalabrutinib for 10days.

I think you quite rightly identified quality of life is the deciding factor. Good luck

[athena12]

My husband, who is on his fourth CLL treatment -- venetoclax as a single agent -- was forced to have surgery to repair an intertrochanteric hip fracture last July. I was very worried about the possibility of infection and blood clots, particularly because this was an emergency surgery in a community hospital not known for successful hip surgery outcomes. It went OK: no infection and no blood clots. I am not a physician, but would think that a planned hip replacement would be lower risk. I am sure you will check with his CLL docs about stopping pirtobrutinib for a time before & after surgery. Best wishes to you & your husband.

[Nurseq in reply to athena12]

That is very encouraging- thanks for your response.

I wondered what would happen if it had to be done on an emergent basis rather than elective.

How long did your husband stay off meds after?

Laurie

[athena12]

My husband's CLL doc was unavailable during this time, so we had to deal with the fellow on call. He told us and the orthopedic surgeon, erroneously, that my husband should stop taking venetoclax for 3 days. After the second day, the fellow called me, noted his error and said that my husband should resume taking venetoclax, which he did, the day after the surgery. Happily, my husband's CLL apparently stayed at bay despite his discontinuing venetoclax for two days.

[Nurseq in reply to athena12]

Good to know. We see his oncologist tomorrow and would like to proceed with a hip replacement. Thanks for the reply.

[thompsonellen2]

I have nothing to add that's helpful but I am so sorry your and your husband are going through so much at once. Was O + V + pirto the regimin for Richter's or what he's on post treatment?

[Nurseq in reply to thompsonellen2]

Yes- O + V + Porto is the clinical trial. He is on Cycle 8 of 13.

Thank you for your concern

[thompsonellen2 in reply to Nurseq]

I've done O + V + I in 2016. Obin first day was no fun. I hope the clinical trial wipes it out. :))

[Ashlar677]

Get that hip fixed!! also have Vitamin D checked. I was off CLL meds for 7 days prior to surgery--until 4 weeks after surgery for hip replacement. It was great to get rid of that hip pain!!! I suffered with it for a years and half, I had no steroid shot. I had no problems or issues except the surgery pain, don't forget to stay ahead of the pain with pain pills and ice packs. I had the front type surgery (Anterior) just a 4 inch incision and it healed quick. I am still doing good with hip and my CLL dosage was cut from 480 to 240 aburtnib. Great hip doctor-- Chattanooga, Tenn. Luck Joe

[CycleWonder]

I had my hip replacement early on in W &W. I can say that the hip replacement was fairly easy to recover from, far easier than a knee replacement

[BeckyLUSA]

I had hip replacement in June 2022. The only concerns my oncologist had were with bleeding and infection. I was off my Ibrutinib for about 10 days. 5 days before and 5 after the surgery.

I might add, as mentioned above, ask the surgeon if he is doing the an anterior or posterior surgery. The anterior ( front ) approach is less invasive, thus less chance of infection and the recovery time is shorter and there are less problems getting back to a normal gait. There is usually less pain immediately after surgery. And finally , per my surgeon, the anterior procedure results in a more stable hip without the need for as many hip precautions post surgery.

I would definitely ask the question.

Do your physical therapy and you will be fine!

Becky USA

[Nurseq in reply to BeckyLUSA]

Thank you Becky!