I started with PMR seven months ago just before I was due to have a knee replacement. I was on 15mg pred and my consultant refused to operate due to an increased risk of infection until my pred intake was 5mg or less. I am now on 5mg and doing OK and I have arranged an appointment with the consultant to decide whether we should go ahead with the knee replacement, and if so when?
I am curious whether the knee operation will itself cause a flare in my PMR, and should I wait until my PMR is in remission?
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parsifalwiz
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I had a hip replacement in June and due to have knee replacement on 1st March. I was, and still am, on 11mgs. and there was really no problem. The anaesthetist gave me a steroid infusion after the op and that made sure I didn't have a flare ( I often flare at the drop of a hat) . I am expecting the same this time. I could not possibly have waited to get down to 5mgs. because I have been on 11mgs most of the 6 years on Pred.! My surgeon is a little worried this time that I have had quite a few steroid injections in my knee, but not to the extent that he won't operate. I am also well overweight which adds a bit more risk, but otherwise, I cannot walk or exercise due to the pain.
My suggestion? Find a surgeon who will do the op. They all vary in their views of weight, steroids etc.
I guess it depends on how desperate you are! I am having to pay for it myself of course.
I am having a knee replacement on Tuesday, and I am on 7mg. Melissa(Mamici ) had hers done last week and is on something between 10mg and 15mg....can’t remember exact dose. There are many many people on this forum who have had similar ops when on much higher doses than 5mg. The anaesthetist just ensures you have enough hydrocortisone to tide you over the op.
Seems to be all up to the surgeon, they aren`t once again consistent with the rules!....I need ingrown toenail removed...the "footman" said not while on steroids (8.5mg)....another lady on here said she had hers done....so frustrating...
There have been plenty of patients on the forums who have had joint replacements done at well above 5mg. Some were able to subsequently reduce their oral pred dose more easily - as if the joint pain had fed the PMR. It pays to shop around, After all, if reducing the pred results in a flare of PMR then mobilising post-op will be harder. And if you are reducing the pred and pain is returning you will lose fitness pre-op.
I'm waiting for a knee replacement and on 9mg currently. My ortho surgeon said it did not matter what level my daily pred dose was. He was more supportive of my recent weight loss and encouraged me to maintain or lose more if I could manage (hope to reduce further as my wait for surgery could be up to two years). He also stressed the importance of pre-op exercises to strengthen my quad muscles, and stretch my hamstrings, etc. Lastly he mentioned an IV hydrocortisone flush post op, then return to my existing dose if there are no complications.
Honestly, who knows if they can even get down to 5mg, and if so, how long it would take. In the meantime, in my case, my knee cartilage continues to deteriorate due to OA, and now also knee injections over time.
Is there any way you could stabilize your pred dose to address your pain and look for a different doctor?
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