Need Shoulder Replacement Surgery

[Darkchocolate1]

My shoulder is destroyed from osteo arthritis and is painful 24/7. My surgeon won’t operate until I am “low enough” on prednisone. How low is low enough? I have been on prednisone for 17 months for PMR now down to 12.5 mg and tapering. I flared at 10.5 last taper. Advice?

[DorsetLady PMRGCAuk volunteer]

General consensus of opinion is in single figures, but it really depends on surgeon…..so I think you need to ask him what he considers low enough. That way you have a figure to aim for…

Have you been prescribed any painkillers to help you until you can get it replaced.

Have every sympathy - had mine done a couple of years ago… fortunately after GCA so no longer on Pred.

[Darkchocolate1 in reply to DorsetLady]

I thought it would be in single digits for prednisone. I will ask my rheumatologists when I see him in late June. I have Tylenol and Hydrocodone with acetaminophen. They help some and I am getting steroid injections in the shoulder for now. Thanks for your reply.

[DorsetLady PMRGCAuk volunteer in reply to Darkchocolate1]

By all means speak to Rheumy, but at end of day it’s the surgeon’s decision. Good luck.

[MrsNails]

That is really a question for your Consultant - many Doctors are unhappy performing Surgery when Patients are on Prednisolone due to the risk of not healing well, so you need to find out what he considers a low enough dose. You could take a Second Opinion to see if a different Surgeon would be prepared to do it at a higher dose.

Good Luck 🍀

[Darkchocolate1 in reply to MrsNails]

Thank you but I don’t see my rheumatologist until late June and I just wondered about others experience. Patience isn’t easy for me.

[MrsNails in reply to Darkchocolate1]

It would be down to the Surgeon so you could ring his Secretary to find out what dose he’d prefer you to be on…..

Sometimes they have to operate in Emergency Situations no matter what dose of Pred the Patient may be on.

Good Luck 🍀

[piglette]

My surgeon wanted me down to zero but we negotiated 5mg in the end. I would have thought you could negotiate up to 10mg, although some surgeons are not happy operating on people taking steroids it seems. As the others say ask him at what level will he operate. Good luck.

[Darkchocolate1 in reply to piglette]

Thank you for your response to my question about the prednisone dose and surgery. I did ask the surgeon what dose he required and he said it was up to my rheumatologist and primary care GP. Thanks for your input it gives me a goal to work toward.

[piglette in reply to Darkchocolate1]

How amazing your surgeon did not mind. I would have thought in that case you could carry on as normal.

[PMRCanada]

I saw two separate orthopaedic surgeons when I was having OA related pain in my right knee. Knee replacement was discussed with both however no specific pred dose was set prior to surgery. Both just encouraged me to lose weight and lower my pred dose as best as I could, and they shared information on infection risk when healing due to taking pred.

In the end I lost (and kept off) 30 pounds and my knee pain subsided, perhaps in part due to my pred consumption (9mg at that time). OA won’t disappear so I may have to eventually go ahead with a knee replacement down the line.

Do hope you are getting some pain relief in the interim. I have heard of different requests from different surgeons, prior to surgeries, however I would feel pressured and worry if I couldn’t attain a dosage they expected. You are already in pain, and worry/stress is not best for PMR/GCA patients. Hopefully you get some clarification accordingly from your surgeon.

[Darkchocolate1 in reply to PMRCanada]

Thank you for writing about your experience. I had both my knees replaced long before PMR and they have been pain free since. I hope your knee continues to feel better. I am on a super low carb eating plan for weight loss and am using pain pills as needed to sleep. Injection in my shoulder every 90 days is helping during my taper. Everyone has been so helpful and encouraging. I wish you all freedom from pain.