Hip operation and PMR

[caftan]

Hello All, I am on the waiting list for a new hip and have a pre-op assessment on 17th July. Hopefully I won't have to wait too long after this for the operation as I am in quite a lot of pain and only taking Cocodamol and paracetamol. I am 84 years old.

Any advice re steroids before my op would be greatly appreciated. I believe that the advice is to take 5mg extra before the op but for how long etc.

I am currently taking 6mg and 6 and a half mg per day on alternate days and have done for a few weeks now. I am being extremely cautious as I did get down to 4 and a half mg per day some time ago then had a flare and had to go back up to 15mg per day so I am now back down to 6 and 6 and a half and hoping against hope that I don't have another flare. I still feel very fatigued all the time but am hoping that I will start to feel a bit more energetic as time goes on but bearing in mind my age I have no idea when this might be, if at all. I was diagnosed with PMR in August 2019 and it's completely changed my life from being very active to hardly being able to do anything now. Thanks to PMR Pro, Dorset Lady and all those lovely people who give us such good advice.

[suzy1959]

Managing our steroids when we have an operation does need to be led by the anaesthetist and should be covered at the Pre-op.

I carried on taking the same dose of oral Pred. for all my joint replacements and had top up infusions post op. Sadly, I also flared after every op. too, but recovered well apart from that.

[piglette]

If you are having your pre-op you should have your op fairly soon after as they have to operate within a certain time limit between pre-op and op or you have to have another pre-op if they go over the time limit. I think I would ask the professionals about taking steroids, some orthopaedic surgeons are paranoid about them and refuse to operate if you are on too high a dose in their opinion. My surgeon wanted me on zero pred before he would operate and we negotiated 5mg in the end. I would check at the pre-op.

[PMRpro Ambassador]

You need to tell the anaesthetist about being a longterm corticosteroid patient - they deal with all the medications during the op and should administer hydrocortisone during the op to help your body deal with the stress. But tell anyone who will listen that you are on pred - then no-one can say they didn't know!

Your surgeon presumably knows you are on oral pred and is happy to operate. There is no need to raise the dose before the op - but it would be a good idea to ask whoever you are under - GP or rheumy? - what they would want you to do IF your symptoms flare after the op. Some do, some don't. Take pred with you and don;t give it up to a nurse - you may never see it again which is fine unless you actually NEED it.

[jaycee444]

I stayed on the same dose but made sure the anaesthetist knew . I also insisted on monitoring my own Prednisolone dose whilst in the hospital so I kept those on me. The hospital usually take away all your regular medication and give it to you with all the other meds needed after your op. I refused to let them have my steroids .

[PMRpro Ambassador in reply to jaycee444]

Especially since they arrive sometime, anytime ...

[marionofnorwich]

I have just had an unscheduled hip replacement after tripping over and fracturing my neck of femur. I was on 4.5mg took an extra 5mg while I was laying on the floor, as a precaution which pre-empted the hydrocortisone that they would have given me in A &E.After the op I continued with 9.5mg for 72 hours and then dropped down to 4.5mg although I did keep my own pred and secretly took an extra 2mg for a couple of days as a precaution.

Still early days but I don't seem to have flared and just kept talking about PMR while is hospital

[Sophiestree in reply to marionofnorwich]

ouch... hope your recovery goes well .. sounds like a nasty fall

[marionofnorwich in reply to Sophiestree]

Thank you. Yes it was a bit of a drama but thankfully it was swiftly dealt with. But annoying though as there was nothing wrong with my hip previously but hey ho. Now have a new one

[Polygolfer]

Hello there, I’ve just had my hip replaced and the responses above are spot on - your surgeon, the pre-op and the anaesthetist should know if any pre-conditions and drugs you take regularly. Last thing you want is to self medicate when your body will be subjected to such a trauma and you’ll be given so many drugs to handle the surgery and recovery. Best wishes and hopefully you’ll be up and about soon!!