RA medication & hip replacement operation

[Floridalover]

Hi, I am having a hip replacement in march. Will I be expected to stop any of my RA medication? I am on Methotrexate, Hydroxychloroquine & Folic Acid

[Amnesiac3637]

This should be discussed and determined at your pre-op. Your surgeon and rheumatologist should liaise and depending on their protocols will decide what drugs you should stop or remain on. If you are uncertain ensure you ask questions of the pre-op staff and if necessary the surgeon as you don’t want to get near to your op and not know what you should be doing.

There are many different opinions amongst medical staff and hospitals and others who have their own experiences but yours is the only one you should take notice of. All the best of luck and hope it goes well. I’ve had both mine replaced and never looked back.

[Floridalover in reply to Amnesiac3637]

Thank you I am having my pre-op next week so I will discuss it then. X

[bpeal1 in reply to Amnesiac3637]

It’s not just protocols that differ. Rheumatologists will advise differently for different patients depending on which combination of medications they are on, how active their disease is, how likely they are to flare if they stop medication and the type of surgery (ie.the infection risk from that surgery). Active disease is just as big a risk (if not bigger) for infection and wound healing as immunosuppressants which is why it all needs to be balanced.

Having said that though, at the end of the day it’s the surgeons ultimate decision whether or not surgery goes ahead so you have to do what they say. Hopefully if they are not confident in making the decision they will take advice from your rheumatologist.

When I had major foot surgery I asked my surgeon about medication. He just asked me to ask my rheumatologist and do whatever they said.

[Floridalover in reply to bpeal1]

Thank you so much for your comprehensive reply. As you say the surgeon will be the main decider.

[Runrig01]

This is a decision for your rheumatologist and surgeon. I have just had foot surgery, and had to stop my biologic 2 weeks before, and 2 weeks after. MTX was one week before and one week after, as it can delay wound healing. It seems very individual, so I’d contact your rheumatologist. My surgeon does a lot of surgery in rheumatoid patients, and has a special interest in it. so was confident in making a decision, but he said most surgeons will leave it to the rheumatologist.

[Floridalover]

Thank you for your advice. X

[BoneyC]

Your surgeon should tell you if they want you to stop MTX. Mine did in 2008/9/10.

[Floridalover in reply to BoneyC]

Thank you

[calflo]

you’ll find out on Tuesday!

[Floridalover in reply to calflo]

Thank you

[Angels54]

Hi , I think yo will have to stop it , I hope all goes well for you , I think I will need op soon just trying to not go there yet 🛌

[Floridalover in reply to Angels54]

Thank you. It looks as if that will be the case. I have been waiting since December 22, so need this op & looking forward to the recovery. X

[Mmrr]

As others have said it is best to discuss with your rheumatologist. I had a hip replacement around 6 months ago and was advised to stop my Filgotinib (JAK inhibitor) 7days before surgery and until the wound healed. I stayed on Leflunomide as it has every long half life so no point in stopping. I also take oral prednisolone every day, which was doubled for 48 hrs then over a period of a few days tapered to my normal dose.

The wound healed beautifully.

[Floridalover in reply to Mmrr]

Thank you.

[Jenniet]

Definitely ask at your pre op. Personally I am on Methotrexate, sulfasalazine, hydroxy chloroquine and folic acid and have had both knees replaced in the last six months, I didn't have to stop any of my drugs. But do ask your medical staff.

[Floridalover in reply to Jenniet]

Thank you.

[jayne17]

I too am having hip replacement in March. I have to stop MTX one week before and stop my abatacept biologic 2 weeks before according to mt rheumatologist but I am sure I had to stop biplogics at least 4 weeks before on previous times. I've gone for 3 weeks before to be on the safe side. Then restart once healed probably 2 weeks after. Good luck to you and hope all goes well.

[Floridalover in reply to jayne17]

Thank you for replying

[Nyreedw]

You need to speak to Rheumatologist. Surgeons do not have enough knowledge. It used to be 2 weeks before and after, now been told mtx week of surgery only, unless antibiotics needed x