steroids and knee replacement

[Sheilamac]

my brother has pmr and is currently on 5 mg Prednisolone. He needs 2 knee replacements but doc says he can’t have the op because he is on steroids. Has anyone else experienced this?

[DorsetLady PMRGCAuk volunteer]

Some have had similar responses from their surgeons - but likewise there are many that have successfully had replacements on 5mg and above. Also some of those on higher doses have been advised they won’t be operated until they have got down to 5mg.

Has your brother been advised why? I’m guessing it’s because surgeon is worried about the risk of infections, or the slower healing aspect.

Any chance of finding another surgeon?

Sure you will get responses from those who have successfully had operations [of all descriptions] whilst on steroids.

There are related posts - and the first one on the list has a reply from a member who nursed patients post operations…. Interesting response.-

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

There are some surgeons who won't do it - tell him to ask for a second opinion from someone who IS willing to consider it. There is an increased risk of infection and that is more of a problem with knees than hips. I don't know if you have ever seen it - but orthopaedic surgeons often wear the high level PPE to reduce the infection risk!

[Topcar]

I had my right knee replaced in June 2023 whilst on 7mg prednisolone and given extra steroids during surgery then told to increase to 10mg for recovery period which went very well, physio were very pleased with my progress considering my other ailments that may have held back recovery but luckily didn't. I do hope you find someone prepared to do the surgery but one at a time though !!

[piglette]

My surgeon was paranoid about steroids. He wanted me on zero steroids for my hip ops. In the end we negotiated on 5mg!

[suzy1959]

I had 4 joint replacements all while on 11mgs Pred. No problems with infection or healing. My surgeon explained that doctors are told in traning that steroids are dangerous and never get any further than this information . Your brother needs to find a surgeon with more than the basic knowledge of the effect of steroids. They are out there!

[PMRpro Ambassador in reply to suzy1959]

Sometimes feels as if ALL doctors never get beyond that basic level of knowledge! Wonder WHICH bit of training it crops up at ...

[Predderman2020]

When I had my cataracts done, the surgeon wouldn't operated till I had been on 7.5 mgs (max) for a week. All went well. Good luck.

[Bella59]

I had first hip replacement but was told by surgeon he wanted me off pred.My second hip six months later he let me stay on 5mgs.After ops i upped dosage to help my recovery.I am now down to 3 mgs this is my second time trying to get to zero.Wishing you well for your op.

[Viv54]

Hi, i was on 9mgs my surgeon was fine with it , He said he would top me up when i had the painkiller etc in an infusion .

[ncfaaeos]

I had a hip replacement while on Pred. ( I think I was on 5 mg at the time) - there was no problem.

[Miserere]

I am 12 weeks post-op for left total knee replacement and I was on 7 mg. Surgeon and anaesthetist didn't see any problems with that.

[proactive]

I had a fall and broke my hip while on 10 mg of Prednisone and had an emergency surgery to do a hip replacement. They just flagged my chart that I was on Prednisone and took extra anti-infection precautions. Six weeks post surgery now, no infections, (but I was administered IV antibiotics while in the hospital). I have managed a 5 week taper to 9 mg now and holding at that for a couple for a couple of weeks or more before attempting another taper. You may be on steroids for some time with PMR, so it doesn't seem right that you should be left waiting so much longer for a knee replacement because of that....