Hip replacement: I am having a hip replacement... - PMRGCAuk

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Hip replacement

PenelopeVita-Finzi
PenelopeVita-Finzi

I am having a hip replacement shortly and I wonder if any of you have had this done and have any advice? I have had GCA for 4 1/2 years and have finally managed to reduce the prednisolone to 1 mg a day. The surgeon yesterday said that I would probably have to increase the dose before the operation. I don’t know by how much or for how long and if I wil have to reduce very slowly again? It has been such a long struggle to reduce down to 1 mg that the thought of doing that again is quite daunting.

Another question: is there any connection between GCA and the long-term medication and arthritis? I have no family history of it.

17 Replies
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DorsetLady
DorsetLadyPMRGCAuk volunteer

Hi,

You will get plenty of advice - lots of THR done when on Pred. I had mine down 8 weeks ago (off Pred) - brilliant!

If it were me, I’d probably take 10mg for a couple of days before, discuss with anaesthetist on the day of surgery (he’ll give you extra) - after that you can probably drop back down to 1mg, you’ll be on other painkillers for a least a week afterwards anyway.

As for connection between GCA, medication and Arthritis - not proven I think - I have/had both, my mother and sister had/have arthritis but no GCA. Me - Arthritis long before GCA.

Good luck with op.

PMRpro
PMRproAmbassador in reply to DorsetLady

Osteoarthritis isn't a/i, rheumatoid arthritis is.

DorsetLady
DorsetLadyPMRGCAuk volunteer in reply to PMRpro

Apologies! Post amended!

PMRpro
PMRproAmbassador in reply to DorsetLady

No apologies needed - there are a few people who think there might possibly maybe an a/i component to OA. As well as wear and tear...

HeronNS
HeronNS in reply to PMRpro

I suspect they might be right. I had the opportunity yesterday evening to test what a dose of aspirin would do for me as I felt very creaky and had a bit of pain at the time. So I took three extra strength, and before I went to bed was already feeling a little better. I slept very well indeed, not even four a.m. trek to the bathroom, and awoke feeling pretty much ok. I took 2 mg pred, and so far so good. So the anti-inflammatory effect of aspirin is helping something, and I assume it's not PMR, so.... We'll see how a careful taper goes over the next little while.

No, I'm not going to take aspirin every day. Only if things get to the point where I think I shouldn't taper any more to see if it helps. Certainly beats any other drug I've heard of to help people taper off pred.

Hidden
Hidden

Hi Penny?. Just to wish you good luck with your forthcoming hip replacement op. I had mine 2 years ago and the best advice for the after care is to follow the advice regarding exercising the joint every day. I was up and down from my chair (on my crutches) every hour to the back of my settee where it was easier to do them and was OK to drive and get about again after the 6 weeks and I have been fine since. I didn't have PMR at the time but was diagnosed 8 weeks afterwards so cannot advise on the Prednisolone but am sure others will be along. Bh

PenelopeVita-Finzi
PenelopeVita-Finzi in reply to Hidden

Thank for taking the time to reply. I do appreciate it.

Hi! I had a hip replacement last summer and was on 11mgs at the time. I did not have to increase my oral dose as the anaesthetist gave me a steroid infusion over 24 hours post op. and I just carried on my oral dose. The hip is working really well now but the problem was I had 2 bad knees already by then. I have just had a left knee partial replacement and will have a right total replacement as soon as I am ready. Then I think I may be able to walk again!

Anyway, the steroids can be managed well - it is up to the anaesthetist so you have to make sure they understand what you need.

Thank you for taking the time to reply very helpfully. I certainly have knee pain as well so maybe following you down your route!

The knee pain could be referred from the hip too, so you might not!

I do hope that is the case! Many thanks

re: prednisolone and damage to the bone at the hip joint. see

hss.edu/conditions_steroid-...

"Steroids, particularly at higher doses, can sometimes lead to a form of damage to bones called "aseptic necrosis" - the death of parts of bone. This can occur in a number of bones, but the bone at the hip joint is the most common.

Self-care tips:

Hip pain, especially if you have no hip arthritis, could be an early sign of this damage. Remember, your hip joint is actually in your groin - so that's where the pain would occur - not on your outer buttocks. If you develop groin pain, report it to your doctor immediately so tests can be done to detect the problem."

The need for hip replacement may be caused by the prednisolone therapy. see:

ncbi.nlm.nih.gov/pmc/articl...

"Glucocorticoid-induced osteonecrosis...................................Awareness of the need for prevention of glucocorticoid- induced fractures is growing, but glucocorticoid administration is often overlooked as the most common cause of nontraumatic osteonecrosis. Glucocorticoid- induced osteonecrosis develops in 9–40% of patients receiving long-term therapy although it may also occur with short-term exposure to high doses, after intra-articular injection, and without glucocorticoid-induced osteoporosis. "

I had a hip replacement in May 2018 and a second on the other hip in October 2018.

I was diagnosed with PMR in June 2015. Started on 15mg Prednisolone, tapered slowly but had several flares every time I got below 10mg. In December 2017, I asked GP to investigate hip pain in both hips but worse in my right hip. X-rays showed severe osteoarthritis in both hips ( worse in right where the cartilage had disintegrated) . The GP surmised that Pred had been disguising the OA pain when more than 10mg was taken. I got a referral to MSK ( muscular skeletal) specialist and an urgent hip op was booked for May. It was March, I was taking 10mg Pred per day. My surgeon requested I get down to 5 mg per day pre-op to reduce the risk of infection, which I did. During the op I was given Pred by the anaesthetist ( I think 20mg). I recovered well and did not suffer a PMR flare, and continued a slow taper. Unfortunately, my left hip liked the rest and caused great pain once it was asked to move with the replaced right hip, and I had to use a wheelchair. Another urgent replacement was carried out in November. It is unusual to carry out 2 replacements so close together, and recovery has been slow. The OA is cured.....no pain! The PMR is still there as I’ve found after a fall and later a digestive problem brought on the bilateral aches. These were dealt with by short term increases in Pred, and dropping back to original dose 3 days later. I continue to taper, between 3 and 2.5mg today. After 4 years of little exercise and 15months of no exercise my muscles are weak. I have UK NHS physio and have taken up Tai Chi, swimming and Ballroom dancing.

I had knee pain along with my hip pain, but this went away once hips were replaced....no OA in knees...thank goodness.

I would say it appears every surgeon has his own preference re Pred and operations. Have you a pre- op appointment where medicines will be discussed?

One tip, post op, be prepared for severe constipation.

All the best, Valerie

Hi there,

I also had a hip replacement, in September 2017 and suffer from GCA. At the time I was on about 5mg of pred per day. I discussed increasing the dose with my surgeon but he said there was no need and indeed I was fine. I followed the dead slow/ stop method and thankfully got off pred completely in May 18. Have had no symptoms since and touch wood that will continue. Knee is good too, remember to do what they tell you and all your exercises! Good luck, it should all be good.

Thank you very much. I have used the dead slow method to finally get down to 1 pred and was looking forward to getting off it completely. I hope this essential operation will not set me back.

Hi,

I was on 4mg Pred when I had spinal surgery in November.

Just make sure you give them all your information at your pre-op consultation and especially when you speak to the anaesthetist on the day. They will take care of it.

My anaesthetist gave me 50 mg Hydrocortisone before and during the op in 2 x 25mg shots.

On her instructions I went straight back to my 4mg the following day.

Best of luck

(I have had both hips done as well)

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