Hip Operation-Was due to have hip surgery on 31st July- My pre-op tests confirmed PMR-started on 40MG now down to 15MG.

[hoganjohn]

Was told I cannot have surgery while on steroids. Can anybody advise me I nned a new hip

[DorsetLady PMRGCAuk volunteer]

Hi,

There are a good few people on here who have had replacement operations whilst being on Pred - but obviously the surgeon and anaesthetist would probably prefer you to be lower - but a few would entertain doing it at 10mg.

Who told you you can’t have it?

I feel for you, I had mine replaced in January this year - absolute nightmare before - but I had been off Pred for some time.

Hope you find a solution - and quickly.

[hoganjohn in reply to DorsetLady]

Thank you for your reply. My G.P told me last thursday I would have to be of steroids before the operation. Please to note that others got it done on 10g

[DorsetLady PMRGCAuk volunteer in reply to hoganjohn]

Yes I know - that’s why I said your medical team would like you to be lower than you are at the moment.

But for your GP to dismiss it completely is wrong. It’s the surgeon’s view that counts, not the GP.

If you are “in the system” for a replacement then you need to speak to the surgical team.

Please do contact them, and let us know the outcome.

I don’t think GPS always realise how debilitating a hip or knee can be - whereas the surgeon does.

[PMRpro Ambassador]

Some years ago on another forum there was a lady who was also told she couldn't have the desperately needed hip replacement op because of being on pred - she had delayed seeking help previously because her GP had told her she would be too young at 60, no-one would operate until she was nearer 80! We told her that was rubbish and to contact other orthapedic surgeons and ask for their opinion. She was told she needed the op, that it was done on the basis of need not age and that pred did not pose an obstacle to surgery so they would do it asap before her fitness deteriorated as she couldn't walk,

It's a long time ago so I can't remember all the details but I think she saw someone privately for the original assessment and because it was so bad they put her onto their NHS waiting list. By the time the op was due she had reduced a bit further, she had an uneventful op and recovery. After she had the op she found it much easier to reduce the pred dose - it was as if the hip pain had fed the PMR. I know of several people who have had hip replacements while on pred and others on this forum who are waiting for surgery.

All I can suggest is that you contact other surgeons and ask the question - you have the assessment it is at a stage that requires surgery. Is a single private consultation an option as almost all private surgeons will also have an NHS practice.

Good luck. Out of interest - where are you?

[hoganjohn in reply to PMRpro]

Living near Dublin, Ireland. Yes I need a new hip as xray showed up bone on bone and my surgery date was 31st July.

[suzy1959]

I agree with PMR pro's advice.

There will be surgeons and anaesthetists who have no problems with you being on Pred. You just have to find them!

I have had 2 hip replacements and a knee replacement whilst being on 11mgs. Pred. The anaesthetist has to put you on a steroid infusion before and after to help your body get over the shock of the operation (it is a bit brutal!) but that has never been a problem with my operations.

[hoganjohn in reply to suzy1959]

Thank you so much for your reply-so pleased to hear you got 3 ops on 11mg. Will defnitely make further enquiries

[scats]

I had my hip replaced 2 years ago on 10mg. My anaesthetist made no allowences for the pred whatsoever!

[hoganjohn in reply to scats]

Thanks

[Baileyw06]

I had a dropped bladder operation at 15 mg and had no problems.In fact they gave me more when operated on and a pack after for 10 days.The only problem that I had was it took me longer to taper after.

I would get a second opinion. I am in the states so I don’t know if that would make a difference.

[hoganjohn in reply to Baileyw06]

Thanks -that's what I am on at the moment 15mg- you have made my day!

[Baileyw06 in reply to hoganjohn]

You welcome

[PMRCanada]

Sorry to hear of your quandary with your surgeon and your medication.

I am awaiting a total knee replacement and have seen 3 ortho surgeons finally settling with one that has a shorter waiting list (9 months opposed to 2 years!).

ALL three were willing to operate while I’m on pred (currently on 10/9.5mg daily alternating). All mentioned that I would receive a high dose of a hydra type of pred before and after the operation to replicate what the body’s adrenal system when it undergoes surgery. My current ortho said the average person has a 1-2% chance of infection, however while on long-term pred that percentage goes up to 3-5% (due to impacts of medication on our immune system and ability to fight infections). Lastly he mentioned that we will work with pred in my system as we cannot control or forecast what dose I’ll be on when surgery time comes around. He said what I could more be able to adjust is my weight....so I’ve been asked to lose another 15 pounds (I’ve already lost 30 while on pred...not an easy task).

Shop around, I did (for different reasons), and found someone who meets my identified needs). Btw, I’m 57, and all the surgeons I met with were ok performing a tkr on someone “so young”😃

[hoganjohn in reply to PMRCanada]

Thannk you so much will defnitely shop around

[Mary63]

I have had 4 knee ops culminating in a total knee replacement 8n February. Also one gut op. All since PMR hit, and all while on varying doses from 15mg to 7mg. 3 different surgeons. Anaesthetist in all cases gave me hydrocortisone cover during the op.

[hoganjohn in reply to Mary63]

Thank you Mary its very encouraging to note that you had 3 different surgeons

[Pat9442]

Absolute rubbish. I fell over and smashed my hip to pieces. There was never any suggestion that it could not be replaced because of Pred!

[Hidden in reply to Pat9442]

Yikes!! 😱

[hoganjohn in reply to Pat9442]

Thanks Pat

[georgedog]

I was able to have both hip and knee done while on low doses of 4/d.{the U.S.}

all surgeons are different and the patients overall health is considered. MM

[hoganjohn in reply to georgedog]

Thank you so much

[piglette]

My surgeon said he would not operate unless I was on zero pred, in the end I negotiated with him on 5mg. They are worried about the possibility of infection which can be a problem as pred can slow down healing and during the op the incision causes the bone to meet outside air. This is also a major worry in trauma cases such as traffic accidents. I think if they have come across problems in the past they are less keen than if things have gone OK for them.

[Amanda_iona]

How unfair! I had a hip replacement 2 weeks ago on 15 mg. The anaesthetist may have taken that into accounts during the op, otherwise I continued as normal. The surgeon was completely ok about the pred.

Clips out today, they were pleased with the healing.

PS I am in Bedford

Best of luck with finding a friendly surgeon.

[hoganjohn in reply to Amanda_iona]

Amanda that is amazing. You have given me new hope and other replies have made my day-It could be two years before I am off Pred and I unable to walk at the moment so its looking like I will get a surgeon to operate if I shop around.

[hoganjohn]

That must be the reason -worry about infection- thanks

[Brubeck in reply to hoganjohn]

I feel your pain, hoganjohn. My hip replacement surgery was cancelled nearly two years ago when I was diagnosed with GCA. My surgeon would like me completely off the prednisone before he considers the surgery, primarily because of the increased rate of infection. According to him, if the new joint becomes infected, it must be replaced with a temporary joint that’s infused with antibiotics. Eventually that temporary joint is replaced. Perhaps he’s overly cautious or trying to keep his success rate high, but he does paint an unpleasant picture. So onward I hobble, having just been increased to 15 mg of prednisone for a recent flare. I wish you all the best. I’ll be thinking about you.

[hoganjohn in reply to Brubeck]

Thanks I will keep you informed. It appears to me now that it all depends on the Surgeon

[Daisy-daisy]

I had a hip replacement in July. I was on 4mg. It was commented on and I was told the anaesthetist would need to make adjustments. All was well and I couldn't be happier with my new hip. I have only just started to taper down as didnt want to push it. I do think the wound healing was slower than normal but all ok in end. Good luck.

[hoganjohn in reply to Daisy-daisy]

Good for you at least you were on a low dosage at the time -thanks

[Mimma]

Hello hoganjohn,

I need a full knee replacement and the surgeon advised that he would not be happy to operate unless I was on 5mg or less of pred.

Something to do with possible infection and slow healing.

Hope this information helps.

[hoganjohn in reply to Mimma]

Thanks, that seems to be the way with some of the Surgeons

[firesetter]

Good Morning,

I have just returned home from hospital after having had an operation to remove a pituitary Adenoma ,I was on 15mg of prednisolone before the operation, this has been completely stopped as I have been on 20mg of Hydrocortisone since the op, this will be tapered going forward I believe ,Not been told as yet if I will restart the pred again but have appointments with my GP and Endocrine team next week so will keep you posted.

[hoganjohn in reply to firesetter]

Please keep me informed - thanks