steroids and hip replacement surgery

[Holycow2]

I’m on steroids for PMR and have had to go back up to 15 for a flare. I’m due to have a hip replacement hopefully in the next couple of months. My question is will it still go ahead while I’m on them.?

[DorsetLady PMRGCAuk volunteer]

If you have followed the usual advice for dealing with a flare- see attached link - then you should be able to drop back down to just above the dose you were on previously… not sure what that was - you don’t say. But see you posted 3 months ago saying you had to return to 7mg from 1mg because of a flare…..so presumably that didn’t work. But not sure why a return to 15mg - who advised that?

healthunlocked.com/pmrgcauk...

Hopefully the surgeon knows you are on steroids and is happy to carry out procedure- but they do like you to be in singles figures usually. So it is something you need to discuss with them and the rest of the medical team pre op.

[PMRpro Ambassador]

You do seem to be swinging about on the dose - under whose guidance? Were you trying to get to zero pred in order to have the hip job?

[Holycow2 in reply to PMRpro]

No I was not.I was trying to get to lowest dose but then was in agony so upped to 7. Was ok for a while then was struggling to even walk and get out of bed. Went up to my start dose of 15mg 2 days ago hoping to get pain under control again

[DorsetLady PMRGCAuk volunteer in reply to Holycow2]

So what dose are you intending to return to then…if 7mg wasn’t sufficient?

If it were me, might be inclined to try no lower than 10mg…..certainly initially. ..but you need to give the 15mg time to work - so 7-10 days, but no longer than 14…

[Holycow2 in reply to DorsetLady]

I’m really not sure I’m just trying to stop the pain at the moment as having PMR pain AND very bad arthritis ie waiting for the op.I think maybe what you say 10 days max then taper down or go straight back to 7?

[PMRpro Ambassador in reply to Holycow2]

You wouldn't be the first to find that the hip pain was feeding the PMR. How quickly had you been reducing towards the 1mg? Had you been going quite fast? It seems strange you got that low and you are struggling to get the pain under control even with such a big increase. Has the 15mg helped at all yet?

[DorsetLady PMRGCAuk volunteer in reply to Holycow2]

Provided the extra gets the pain under control, you can probably drop back to 10mg in one step - if you're not sure then to 12.5mg for 5-7 days then to 10mg.. stay there until you are sure okay, then taper more slowly. But not directly to 7mg in one go.

[Holycow2 in reply to DorsetLady]

Thank you so much for your understanding and advice I appreciate it so much. When first diagnosed I thought just go down monthly and to be honest I’ve had no interaction with my Dr since he told me to go up to 1mg which I did but got bad so upped to 7 and was ok for a while but last couple of weeks pain I. Legs/hips has been awful so upped to my start 15mg

[DorsetLady PMRGCAuk volunteer in reply to Holycow2]

Unfortunately a lot of doctors think that's all there is to it, but its not...it's a case of managing the illness...not just take the initial dose and reduce monthly come what may.

Hopefully your current dose will get your flare under control...but then you need to reduce more slowly from 10mg...the guidelines do say 1mg every 4-8 weeks depending on disease activity and patients wishes... [many docs don't seem to read that bit!]

Good luck

[piglette]

Your orthopaedic surgeon is the one to answer your question. On what dose are they happy to operate? Some are fussier than others.

[Holycow2 in reply to piglette]

I really don’t know have not spoken to him in a few months. This may sound silly but what is the issue with operating while on steroids?

[DorsetLady PMRGCAuk volunteer in reply to Holycow2]

It may slow down the healing process of the wound…some surgeons seem more concerned than others which is why they like the patient to be on a lower dose. But there are many on here who have had replacements with no issues.

[piglette in reply to Holycow2]

As DorsetLady says some are paranoid about the healing process. Steroids can possibly delay healing, inhibit collagen synthesis, and increase the risk of postoperative infection. Also they say in UK you should not have an operation within six months of having a steroid injection.

[Bella59]

It depends on your surgeon.My first hip replacement i had to reduce to zero.My second hip op i was allowed to stay on 5mg,this was same surgeon ops were six months apart.Good luck.

[Holycow2]

thank you…… hopefully can get back down😬

[BigEric]

Hi there Holycow2 I am waiting for a hip replacement at the moment and can only share with you what I have been advised. My rheumatologist insist that my inflammatory markers are down before operating as there could be post operative problems. I have yet to establish what the acceptable levels are or what issues there could be. My orthopaedic surgeon has also told me that by having the op the inflammation levels will increase as a matter of course. My blood tests will be monitored and as soon as the powers that be deem it safe I shall have the replacement hip done. The pain I get from the ‘bone on bone’ situation in my hip is, at times, almost intolerable - especially at night time. But I will be led by the experts and just take each day (and night) as it comes over the next couple of months. Good luck!

[DorsetLady PMRGCAuk volunteer in reply to BigEric]

if you haven’t already seen -you might find this useful- and good luck -

And yes your inflammation markers will increase temporarily after procedure, but that will be due to operation not your PMR… different things.

healthunlocked.com/pmrgcauk....

[PMRpro Ambassador in reply to BigEric]

The "inflammation" marker CRP always rises when muscle tissue is damaged however that happens so the incision alone will send it up plus there is the pulling about as well. If CRP rises - so should ESR. But it isn't necessarily a sign of infection or inflammation.

[Holycow2 in reply to BigEric]

Thank you! I really feel for you as mine is also bone on bone and it’s horrendous! Goii on d luck to you!

[BigEric]

cdn.shopify.com/s/files/1/0...

I found this support very useful for my right hip replacement 11 years ago. You can use pillows etc but this gizmo doesn’t move about throughout the night.

Pre op strengthening exercises if possible - helps with recovery.

As Dame Judy suggests swimming is fantastic. I used a ‘pull bouy’ pre and post op and when I returned to the gym my upper body was really strong. Any physio exercised carried out in a warm (baby pool) are really helpful too.