Can anyone advise, please? I was put on the list for a knee replacement and also the opposite hip replacement some 3 to 4 years ago. Then diagnosed with PMR just as the first UK lockdown occurred. Because of lockdown I was not seen by my doctor, just eventually seen by an Osteo consultant who diagnosed PMR simply by blood test results. Since then I have been offered dates for both surgeries but steroid level unacceptable to both surgeons. 3 weeks ago achieved 5mg daily so date set for knee replacement on 2 November. I have gradually felt that a flare was coming, but struggled on and sadly yesterday I was in agony, barely able to move and took a further 5mg. What to do now? Apart from initial diagnosis I have not been able to see my doctor, nor referred to a rheumatologist. Scant advice received from Doctor by email etc. I'm just 74 and if knee/hip not sorted soon, I'm looking at a permanently very restricted old age. Do I ask to see knee Consultant to discuss? I know he's sympathetic and keen to get me off his list.
Knee and hip replacement hampered by Covid lockdo... - PMRGCAuk
Knee and hip replacement hampered by Covid lockdown then PMR was
I have had 2new knees and 2new hips whilst on 11mgs of pred. It is perfectly possible. Usually it is more up to the anaesthetist as they have to administer larger amounts of hydrocortisone both during and after the op as the body needs more to counteract the shock of the op.
Surgeons sometimes worry about us taking longer to heal and being more prone to infections but the risk is not that high. I had no problems healing and got no infections from all 4 operations.
The main thing is that you are in a lot of pain and the longer you leave these ops, the worse the outcome could be.
I think surgeons have got so used to only operating on low risk patients that they get a bit scared if we are not textbook ones.
My suggestion is to take whatever pred dose your body needs ,( I always had a flare after each op too), talk again to your surgeon about the evidence of the specific risks and, if they still refuse to operate, find a surgeon who will. They are out there!
As suzy says - there are plenty of surgeons who are NOT concerned about the pred dose and some even say, they have to operate on patients as emergencies every day. However - she also mentions the hydrocortisone cover - and that will be even more important for you at such a low dose.
There is no point them forcing you to reduce the pred if it leads to a flare and THAT will mean you can't mobilise post op. If he refuses to operate at the dose you are on - find another.
Can only say that I agree 100% with the previous two replies. These ops need to get done, the sooner the better - and PMR/pred should not in themselves prevent that !
Wishing you all the best
Nextoneplease x
Unfortunately pred does affect your surgeons attitude to operating on you, I assume you have not had a hip or a knee op and had to negotiate your pred dose with the surgeon. Surgeons do go for line of least resistance if they can.
They aren't renowned for being adaptable - maybe its the type that can do surgery ...
I am reading a book on psychopaths and the author reckons that surgeons have to have psychopathic tendencies as they must be totally cold towards the patient they are about to cut up. They also reckoned most lawyers were psychopaths too!
Comforting! Mind you, you must have some sort of ego to be confident you can do it ...
Psychopaths are super confident and don’t care about others. They are good conmen too. Members of the SAS tend to be psychopaths. I think a lot run companies!
I think we say ‘Con persons’ these days 🤣🤣
No piglette, you’re right, I had my knee replacement prior to PMR. However I did have to negotiate for months over my heart condition at that time, in order to get the op. I was only trying to emphasise what can be the great benefits of joint replacement surgery, on which I almost gave up , and am so glad I didn’t x
A few years ago local doctors said I had to wean off prednisone to have a hip replacement. I then saw a rheumatologist at Duke University Hospital who said that wasn't true.The local surgeon then did the operation while I was taking 15 mg. Just stopped the day before and the anesthesiologist calculated the cortisone stress dose at surgery time.
Resumed 15 mg the day after, then increased to 20 mg two weeks later to help deal with painful swelling caused by the blood thinner. The surgeon was quite pleased with how well the incision and replacement healed with no problems or delay.
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