Knee Replacement

[Kyrenia]

Hi I was diagnosed with GCA//PMR in October 2017. I started on 40 mgs and have with difficulty and the DSM reduced to 4mmgs. It is planed that I have a knee replacement next week and I am terrified. Additionally I am unsure what to do regarding my steroids. I am concerned that the operation which will be stressful and painful and will cause a flare. I am aware that I will be at an increased risk of infection, May I please ask you very lovely and knowledgeable people has anyone been in this situation.

Thank you

[DorsetLady PMRGCAuk volunteer]

Hi,

First of all, stop worrying.

The op is common (me - July 2018 albeit off steroids by then) and although it’s a bit uncomfortable and cumbersome for the first week or so at least the constant pain has gone.

Stick with the dose you are on, the anaesthetist will probably give you an extra shot to get you through the operation - but this will all be discussed before the op.

You will be on fairly hefty painkillers for the first week or so anyway, so probably no need to change your Pred. There is a slightly higher risk of infection, but at 4mg it’s minimal - many have had the same op on higher doses.

Just make sure you do the exercises, pre and post operation and you’ll be fine.

[PMRpro Ambassador]

Speak to the anaesthetist - and make sure your medication history is documented. They will give you steroids by infusion during the op itself to cover you and probably also post-op if required. Judging by others who have had joint replacement surgery the infection risk at 4mg is minimal. But a flare IS a possibility and your surgeon needs to be prepared to approve more pred if it does happen.

It will be fine - try not to worry because that will make it worse.

[SheffieldJane]

Oh Kyrenia! Of course you feel terrified! I have so many friends that have had this operation and are matter of fact about it and completely skippity hoppity after recovery. I know that I would be scared. Even though I get shooting pains in my knees, coming downstairs that make me scream.

It is one of the better operations. The knee is a badly designed joint. Your surgeon must advise you about your steroids before the op. Ensure that you remind everybody involved! Good luck! It won’t be as bad as you fear.

[Brantuk]

Hi Kyrenia - your knee operation will be a doddle compared to the operation that I had last year which was considerably biggger. You have nothing to worry about - really. I started on 40mgs pred much like yourself a couple of years before. By the time of my op I had reduced to 7.5mg daily. The surgeon put me back up to 10mgs for the op to help reduce the inflammation, but I had to stop the Mtx a week or two before cos he wanted my white blood cells working properly (I've had GCA since 2015). I did get a chest infection after the op and they did pump me full of antibiotics, but I responded well and I recovered in due course. So long as the surgeon and everyone involved know exactly what drugs and doses you are on there should be no need for any worry.

[suzy1959]

I have had 2 new hips and a new knee ( in the last 15 months )and waiting for the other knee to be done. Without tempting fate, I have not had any complications with any of these ops, although I think my body is very tired of having them! I have been on 11mgs pred. throughout. I did have a flare after one of the ops but having a flare is not the end of the world! It is better to sort out a defective joint and be able to walk better afterwards.

[Hidden]

Hi, I’m sorry you have to go through this... I have GCA and PMR and had a full knee replacement in February. The Rheumy said I had to be below 15 mg by the surgery date, which I was... the Ortho was aware of my Pred (as was the hospital staff) and made their own adjustments post surgery. Everything went fine! No flare, no issues. Try to get your head under control... it’s not going to help that your “terrified.” Think how amazing it will be to walk again without pain! You can do this!

[El50]

I had a total knee replacement at the end of June this year when I was on 5mgs.of Prednisolone with no post op.problems -- was only in hospital for 3 days. From my experience -well worth having done.