Hip replacement

[Bailybiscuit]

Has anyone had a hip replaced or knees whilst on steroids. I need new of both I think and wondered if they could be done?

[piglette]

I know several people. It really depends what the dose is and also some surgeons seem to be frightened of steroids although they sometimes actually give them during the hip operation. Most surgeons would be fine under 7.5 mg. Others may operate when you are on a higher dose.

[Bailybiscuit in reply to piglette]

I am on 19mg as recently flared up again. Knees are so swollen and painful though.

[piglette in reply to Bailybiscuit]

Have you seen an orthopaedic surgeon? The best is to ask them. Are you going privately? If you are having it done on the NHS you will probably have reduced a lot by the time they get round to doing an operation anyway. Around my area people are waiting up to a year.

[Bailybiscuit in reply to piglette]

I was told by my doctor it wouldn't be a good idea as they wouldn't have access to my records and I am quite complicated. I see an orthapaedic surgeon tomorrow but hadn't thought that steroids might be too high.

[piglette in reply to Bailybiscuit]

Surely they can get over the problem of record access. It sounds a rather strange excuse. I thought the NHS were really keen on getting the private sector to do hips. Ask the orthopod tomorrow whether he would be happy to operate at 19mg. He may just shrug his shoulders and say yes.

[PMRpro Ambassador in reply to Bailybiscuit]

Sometimes GPs do say a lot of rather silly things about hip replacements. The NHS uses private beds quite often - and offer patients the option if the waiting list is too long. The only proviso I would make is that the private hospital is next to an NHS one or has its own intensive care beds just in case. Part of the reson the waits in the NHS are so long is a severe shortage of ICU beds.

[Bailybiscuit in reply to piglette]

I was told by my doctor that it wasn't a good idea as I am quite complicated and they wouldn't have access to my medical records if private. I see an orthopaedic surgeon tomorrow.

[PMRpro Ambassador]

I know two ladies with hip replacements, one was on 1mg and already over 80, the other was about 60 and on 10mg. Both had "unremarkable recoveries".

polkadotcom on this forum has had both a hip and a knee replacement in the last year or so. And I'm sure there are others.

It depends on the surgeon - some will have a canary about the patient being on pred. Others realise that with PMR the patient isn't going to be able to mobilise without pred and in some cases can't stop taking it because of the reason they are taking it.

[Bailybiscuit in reply to PMRpro]

I was on about 15mg when I had a biopsy of my hip, not sure if that is different to what would be allowed in a hip operation. The surgeon also gave me some extra steroids.

[polkadotcom]

I had a hip replacement in 2015 and a knee replacement last year in April. For the hip I was taking 10mg Pred and 7.5mg when the knee was done.

Absolutely no problems in either case and the relief from the pain of both is indescribable. I was lucky in that I did not have to wait too long for the ops and I had wonderful care.

[Bailybiscuit in reply to polkadotcom]

Would you have had it done if you had been on more than 10mg for the hip?

[polkadotcom]

Oh yes.

[Bennifred]

I have been told categorically by my orthopeadic consultant that he won't do my (desperately needed) second hip replacement until I get down to 5mg Prednisolone, despite my rheumatologist being of the opinion that being at 8mg would be fine. My shoulders also need replacing (I am riddled with AVN) and the shoulder orthopeadic surgeon is also insisting that I must get down to 5mg. I am struggling on 18mg Pred and have been put on Methotrexate as well. Of course the AVN pain means that I need pain relief until those surgeries are performed, and all my doctors are urging me to reduce the amount of morphine I take, which seems cruel when nothing is being done to solve the cause of the pain! I feel caught in a horrible trap

[PMRpro Ambassador in reply to Bennifred]

Look around for another orthopod. The person I wrote about who was on 10mg was told by one she had to be off pred - and she emailed others to investigate. She had no real difficulty finding one who would operate.

[piglette in reply to Bennifred]

I think you may find it difficult to find someone who is happy with 19mg but you never know. They are worried silly about infection nowadays and think steroids slow down healing and are worried about a reduced immune system so opening things up for infection. 7.5mg seems pretty easy to find surgeons and even 10mg, but I am sure some doctors may do a hip replacement on higher. I had lunch with a couple of medics from the US today and they were saying that they were throwing people out of hospital the same day of the hip op because they are so worried about infection, which meant no PT etc. Presumably being sued is the real reason.

[Bailybiscuit in reply to piglette]

He said "No problem, he can work around it"

[Chihuahua1]

I haven't personally, but I know one person who has. She was on pred for asthma rather than PMR but I should think much depends on the amount you take The specialist did hers after she had managed toe taper her dose to 10mg and her bloods were reading within normal limits across the full count range. It is a known fact that many if not all people heal more slowly while on steroids. Hope this helps.

[susyj]

Yes! 6 weeks ago I had a full hip replacement while on steroids. My surgeon said a lot of his patients are on steroids and usually there are no problems. My GP was concerned that it would delay the healing process and lowered my dose but there was no need.

As soon as I'm fully fit I'm in again for a new knee!

A tip for you....however much it hurts...do your exercises! Good Luck x

[Bailybiscuit in reply to susyj]

Thank you. I have exercises to do in preparation for the new hip. Good luck with the new knee.

[Perkey]

Yes I had a new right hip in August. Last year whilst on steroids the surgeon didn't seem at all worried by it and hip is fabulous

[Bailybiscuit in reply to Perkey]

What dose are you on and were you done by general anesthetic or epidural?

[Bailybiscuit in reply to Bailybiscuit]

I mean't were on

[Perkey in reply to Bailybiscuit]

I was on 5mg. I had a spinal injection

[piglette in reply to Bailybiscuit]

The majority of people have a spinal injection nowadays, which is much nicer I think than a general anaesthetic. My father had to have a GA when he fractured his hip because it was a bit of a mess. In your case this will not be true, although I am sure you can ask for a GA if you really wanted one. You can ask for different levels of sedation with a spinal. Some people want to be totally aware of what is going on, some don't!

[susyj]

My surgeon asked if I'd like to be awake for the operation.....when I stopped screaming I told him no I'd rather be completely and utterly asleep! LOL

[PMRpro Ambassador in reply to susyj]

Even when you are given an spinal in the UK they give sedation so you are not awake.

I had a broken leg screwed back together in Italy - fully awake and coaching the 4 (!) anaesthetists on English in theatre. The following year I had the metalwork removed and they were all set in Scotland to do it with a GA - I actually had to request a spinal but was given 2 diazepam before going down to theatre. I was gutted!

I assume it just means Italian surgeons have more self-confidence...

But seriously - it is SO much better than GA - the post-op pain relief is greatly improved and you don't feel ill at all.

[piglette in reply to susyj]

I totally agree with PMRPro re a spinal. They can give you a little sedation or a lot! If you have a lot you will just wake up in recovery feeling relaxed without the side effects of a full blown GA.

[Bailybiscuit in reply to piglette]

I think I haven't liked the thought of a spinal as my epidural in 1980 was horrible and didn't take for hours. I was paralised the next day though.

[piglette in reply to Bailybiscuit]

Hi Baileybiscuit

A spinal is much lighter than an epidural. A spinal is a single injection with a thin needle that puts the local anaesthetic close to the nerves, within the fluid that surrounds the spinal cord. The numbing effect lasts for about 11⁄2 to 4 hours.

With an epidural, a fine plastic tube is threaded through a needle and the tube is left in the epidural space in the back. Local anaesthetic is injected down the tube to cause numbness, which varies in extent according to the amount of local anaesthetic injected. Local anaesthetic and other pain relieving drugs may be given to prolong the effect of the numbness for more than 3-5 hours. An epidural usually stays in place for 2-3 days.

[PMRpro Ambassador in reply to Bailybiscuit]

In 1980 they were still relatively new and inexperience is not a helpful thing with epidurals! I had one in 1980 as well - so when I broke my leg and "or we could do a spinal" was mentioned as a bit of an afterthought I accepted like a shot! They seemed quite surprised I took it!

But as piglette says - it doesn't last as long and wears off quite quickly.