pred & surgery

[Tapestry1057]

Morning everybody! I am in the early stages of needing a hip replacement. Could anyone explain why some surgeons want you off pred completely before they operate while others don’t. I am currently on 1/2 mg. All the advice on this site has been a lifeline to me over the last three years. Many thanks.

[MrsNails]

Some Surgeons are very ‘iffy’ about the dose of Pred we are on as some people don’t heal as well or as quickly. You’ll find many on this site who’ve had successful Joint Replacement Surgery & there is a New Post in FAQ’s on the subject.

healthunlocked.com/pmrgcauk....

[Tapestry1057 in reply to MrsNails]

Many thanks Mrs Nails…..the advice you give, as always is invaluable.

[MrsNails in reply to Tapestry1057]

DorsetLady has only recently put this information together - she is a ‘Veteran’ of Joint Replacements & will be along later with some sage advice.

For nearer the time there is a Post on Preparing for Surgery in FAQ’s it’s with Sick Day Rules.

[DorsetLady PMRGCAuk volunteer]

Hi

MrsNails has kindly linked my post on replacements-but have to say I was off the Pred whenI had them.

But if you are down to 0.5mg I’m guessing you will be in same situation by the time your operation is scheduled.

[Tapestry1057 in reply to DorsetLady]

Thanks ‘Titanium Lady’!! Has taken me three years to get to 1/2 mg with a few ups & downs and lots of advice from this wonderful forum. I suppose in a silly way I’m bothered if I can eventually come off pred I might have a flare and have to go back on a higher dose of pred which could affect me having my hip replacement….silly of me perhaps.

[PMRpro Ambassador in reply to Tapestry1057]

In which case - I wouldn't be rocking the boat!!!!!

[DorsetLady PMRGCAuk volunteer in reply to Tapestry1057]

As PMRpro says just take it easy…and you’re on such a small dose as you are now -I doubt very much a surgeon would be panicking…So just keep doing what you’re doing - and as you say, early days for hip anyway!

[PMRpro Ambassador]

It is the personal preference/opinions of the particular surgeon. Obviously not being on pred is preferable for all sorts of reasons - but some of them are a balance. If you have been on long term pred as we are, the surgeon can't demand you stop to suit them - so the question turns to how much you need the surgery and when,If you have been on pred for a long time, even if you are at a low dose like you are, the adrenal function factor remains and remains for at least a year after stopping pred altogether. If you are currently on pred to manage the inflammation of PMR, however low the dose is, there is a possibility that it is still keeping low disease activity in check as far as developing inflammation and resulting symptoms is concerned. Returning symptoms because of premature discontinuation of pred will interfere with post-op recovery and rehab. In that case, a low dose of pred is preferable to no pred.

Any surgeon who protested at the dose you are on would be a bit silly and it is worth shopping around. One lady on another forum some years ago was really struggling but her GP told her that a) she wouldn't get offered a hip replacement until she was about 80 (she was in her early 60s) and would have to be off pred anyway. We were pretty forthright about THAT opinion. She was in the position to pay to see a surgeon and shopped around first to find one who didn't rule out surgery because of pred. In fact she found one locally and saw him - he immediately put her on his emergency NHS list. The state of her hip was such she was about to start to deteriorate because of disability - the fitter the patient pre-op, the better the recovery.

I have no idea what the GP was thinking - but then, that questions arises on a regular basis! However - although she had had to go back to a higher dose pre-op to cope at all, post-op she was able to reduce the dose steadily. It was as if the pain of the hip had fed the PMR. If the first response is no - don't give up.

[Tapestry1057 in reply to PMRpro]

Thanks PMRpro….the conversations with you all have been so helpful. It’s good to “talk”.

[PMRpro Ambassador in reply to Tapestry1057]

Why we are here!

[autumnlass in reply to PMRpro]

and are truly grateful to you all as well. 🌺🫶

[piglette]

I think it is very much being ultra careful. If you are only on 0.5mg I am sure your orthopaedic surgeon will be OK. If you are having your hip done on the NHS you will probably be off pred by then anyway!!!

[Tapestry1057 in reply to piglette]

Thanks piglette….that’s what I was thinking …just needed some reassurance.

[piglette in reply to Tapestry1057]

Have you seen a surgeon yet? Have they OKed a hip replacement?

[Tapestry1057 in reply to piglette]

Saw first surgeon in 2019 just before I got PMR. He then said he didn’t want to see me until I was off pred. Getting desperate a few months ago so pushed NHS and was told he had retired so was referred to someone else. Saw the new surgeon recently who said my hip was in a bit of a state and really needed doing. Hurray thought I…but then he told me he was moving away from the area and would refer me to a third surgeon….still waiting but going to start pushing again. You couldn’t make it up!! Just unfortunate I think as my previous experience with NHS could not be faulted. Fingers crossed I’ll hear soon. Best wishes.

[piglette in reply to Tapestry1057]

Perhaps they will see that you have been waiting since 2019 and you should not have to wait too long. Can you still get around OK?

[Tapestry1057 in reply to piglette]

Yes ….the surgeon advised on using a stick which really helps. I don’t give in easily!!

[piglette in reply to Tapestry1057]

My surgeon said I would be in a wheelchair if I did not have a hip replacement within six months.

[Tapestry1057 in reply to piglette]

Hopefully you are OK now…and I’m remaining positive that I won’t have to wait too long.

[PMRpro Ambassador in reply to Tapestry1057]

Don't minimise your pain - whinge loudly ...

[Tapestry1057 in reply to PMRpro]

Good advice…as always!!

[piglette in reply to Tapestry1057]

Yes I am happy. I cannot believe that the hips are not my own.