Increase pred before hip replacement?

[PenelopeVita-Finzi]

I am due to have a hip replacement operation on the 23rd of April. I believe I have read on this forum that it is a good idea to increase the dose of pred before an operation. I am now down to 1 mg after a long journey of nearly 5 years with GCA. I have been on 1 mg for 6 weeks. I have recently had a lot of stress with my sister dying after a long illness and have had the odd twinge in my temple so I have been on the verge of going back to 2 mg.I would be grateful for advice from anyone who has had this operation.

[jinasc]

Before an op you have a pre-op appointment..............make this query with them as some surgeons seem to say up it other stay stop it and others say just carry on...........

This diverse information I have gathered from previous postings on this question.

[Hidden]

Hi Penelope

I’m sorry to hear about your sister, it must have been very hard on you & your family.

As jinasc says you will have a Pre Op Assessment where they go over everything with you, including seeing a Pharmacist, in my case l didn’t met the Anaesthetist until the day of my Surgery but she was already well aware of my PMR/Prednisolone & dose from the Pre Op Assessment.

I was given 100mg of Hydrocortisone in Theatre & again during the night.

The following day they consulted my Rheumatologist & she requested an increase to 10mg from 7.5mg for two weeks then return to 7.5mg

My surgery was different to yours, not orthopaedic but the principle is the same.

Good Luck with your Surgery 🍀

[PenelopeVita-Finzi in reply to Hidden]

Thank you for replying so promptly and helpfully.

[DorsetLady PMRGCAuk volunteer]

Hi,

Agree with jinasc...discuss at pre op assessment.

If I were to increase, it would be for the stress of bereavement - so sorry to hear that.

Good luck with your hip - you will be truly amazed with the result! Me - January 10th and almost forgotten about it! And it’s not as painful as you think it’s going to be.

[PenelopeVita-Finzi]

Thank you for your very encouraging reply!

[Mary63]

I had a knee replacement 6 weeks ago. I have been on 7mg since last November, and decided not to reduce cos of Christmas and then a Southern Hemisphere holiday and op. I mentioned to surgeon about prednisolone. He said stay on same dose for op and recovery. Anaesthetist gave me extra hydrocortisone during the op.

Bearing in mind the stresses you have been under and the twinges it may be worth going up to 2mg anyway. Do you have permission to fiddle with your dosage?

You could ask at pre op appointment, but in my experience the nurses doing ECGs etc don’t know the answer.

If concerned you can always phone consultant’s secretary.

Good luck

[PenelopeVita-Finzi]

I am not sure that I do have permission but have a GP appointment tomorrow to ask.

Thank you for asvice to ring consultant’s secretary. I will do that if I don’t get an answer at the pre-op assessment on Friday.

Thank you so much for replying.

[PMRpro Ambassador]

Have you had a synacthen test done to assess your adrenal function? It sounds as if you are OK but one lady felt fine on 2mg but the synacthen test showed she had no adrenal function at all! Maybe worth asking while you are there.

They will monitor you for signs of adrenal crisis anyway and some surgeons/anaesthetists prefer to do that in line with current thought rather than automatically increasing the general pred dose around the time of the procedure. They do still usually give i.v. hydrocortisone intraoperatively I think though.

[suzy1959]

I agree entirely with Mary63.

I have had a hip and a knee replaced whilst on 11mgs. I did not try to reduce before or after and had extra infusions after the ops. Your body does have to deal with quite a physically traumatic operation. They are cutting our bones after all! The nurses at both my pre-ops couldn't answer questions about the Pred. but they relayed them to the anaesthetist who directed which meds to stop, when to take the last dose on the day etc. When I had my knee done in March, they told me not to take the Pred. the day after the op. because of the infusion, but the next morning I woke with the familiar aches and pain, so took an extra dose which seemed to work. Four weeks later, I did also have a flare which I am still dealing with. It is not that surprising really.

The Hip op was really quite easy but I have found the knee more challenging! One more knee to go.......

[PenelopeVita-Finzi]

Thank you for taking the trouble to reply so fully. That is all very helpful and reassuring. Having taken so long to reduce to 1 mg, I hope I don’t have to increase the dose.

[piglette in reply to PenelopeVita-Finzi]

In fact surgeons in general prefer patients to be on as low a dose of pred as possible they are worried about slow healing and infection. Mine wanted me on zero for my hip op but we agreed on 5mg in the end. Did you mention to the surgeon you had PMR and were taking steroids? At the pre op I was told I could not take glucosamine for a while and also Methotrexate, although I don’t take it anyway.

[PenelopeVita-Finzi]

I did mention to the surgeon that I was on pred for GCA and on Methotrexate. He said that the anaethetist would tell me what

I should take but I probably won’t see her or him until just before the operation. I will talk about it when I have the pre-op. Thank you for your help. I do appreciate it.

[Hidden in reply to PenelopeVita-Finzi]

My Methotrexate was stopped a full week before, that was the Surgeons Preference, the Pharmacist said it wasn’t necessary to stop.....