Tapering before hip replacement

[arvine]

my rheumy says more prone to infection from surgery when on prednisone, 7 weeks of methotrexate injections now, no relief so havent tried to taper pred, still at 4 mgs, surgery date Feb 20th, orthopaedic surgeon says must stop methotrexate 2 weeks prior, had hoped to be able to taper from 4 mgs pred before surgery but that s not going to happen, anyone out there been told being on pred would be more apt to get infection from surgery, know both metho and pred lower immune system ?

[PMRpro Ambassador]

Most of the people on this forum who have had a hip replacement did so at higher than 4mg and with no problems. DorsetLady and piglette are amongst them

[arvine in reply to PMRpro]

Oh thank you

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Mine was afterward finishing Pred … but certainly many have had replacements at much higher dose.

[PMRpro Ambassador in reply to DorsetLady]

Oh, sorry, thought one was while on pred.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

😊 - that was part of whole new medical life!. Keeping fingers crossed for quiet times from now on..

[suzy1959]

I had 2 hips and 2 knees replaced, all on 11mgs of Pred. No infections. Just be careful as I’m sure you will be anyway!

[arvine in reply to suzy1959]

Oh thank you can I adk ifyou have sny other medical conditions ie osteoarthritis etc?

[suzy1959 in reply to arvine]

Yes, riddled with OA. Now dealing with a very painful foot, fingers, and much back pain mostly due to arthritis. The hip replacements were a doddle!

[MarksPoint in reply to suzy1959]

Wow, you certainly have had a lot of replacements......I need to have a knee replaced and am really concerned about infection etc even though I am now off Pred and don't take any other inflammation meds. How was your recovery with the knee replacements? I am scared more than anything of bringing GCA and PMR back to my body.

[suzy1959 in reply to MarksPoint]

My recovery was pretty straightforward. Hips are much easier as the knees are more painful in the beginning. Doing the exercises is vital so take your painkillers beforehand to ensure that you can do them. With my second knee, I went to a rehab centre that mainly works with knees and hips, using hydrotherapy and physio every day for 5 days. It was magic! It is called the Claverdel and is in Guildford. There may be others around the country. Highly recommended.

[MarksPoint in reply to suzy1959]

Thanks for your info Suzy.....can I ask how long you were in hospital for with each knee and then were you at home straight after the hospital? I have a small dog and have to consider him.....

[suzy1959 in reply to MarksPoint]

I was a private patient( the NHS wouldn’t consider operating due to my BMI) and was in for 4 nights I think, but it may not be the same with NHS.

[MarksPoint in reply to suzy1959]

Thanks for your info....Im in Australia so a different system I guess.

[PMRpro Ambassador in reply to MarksPoint]

I think it is less how long you are in hospital than how long until you are really mobile again - I assume you are thinking about walking your dog?

healthline.com/health/total...

brettgilbert.emergeortho.co....

[MarksPoint in reply to PMRpro]

Thanks for all the info...the hospital one outlined recovery very well. It is more a case of leaving my dog with someone whilst I'm in hospital....when I am home it won't be so bad.

[PMRpro Ambassador in reply to MarksPoint]

Hope your dog doesn't pull, though most are very good at identifying their hooman is not 100%! In most places these days you are only IN hospital a short time unless something goes wrong - so whoever you have as dog-sitter should be someone able to be flexible.

[KASHMIRI1]

I am waiting for spinal surgery and was told to stop methotrexate for two weeks prior and two weeks afterwards. was also told I need ted to be under 5mg before they would operate which is ok as I am just on the way down to 4mgs.

[proactive]

I was on 9.5 mg of prednisone when I required an emergency hip replacement. I expressed my concern about an increased risk of infection due to the possibility that my immune system was compromised and the surgeon assured me that they would flag my chart and take "extra" anti-infection precautions. Antibiotics are given prophylactically following hip surgeries anyhow and I am happy to report that I did not develop any infections and my surgery was one year ago.

[oscarandchloe]

My surgeon had no problems with 5 mg and this was two two replacements 7 months apart. I had no infection and minimal pain.

[MillMoor]

I had my hip done when on 10mg with no problems. When I went back to see the physio she asked me if I had had my hip done. When I said yes, her reply was but you are not using any aids! Make sure you do your exercises before and after.

[S4ndy]

I had spinal surgery at 5mg Prednisolone. I discussed everything with an Anaesthetist prior to my surgery. He did not require a taper. He told me I would be given prednisolone as part of his duty in the day. All went well and I healed nicely. Hopefully, you will see an Anaesthetist prior to your hip replacement. Hope it all goes well for you. Make sure you do your exercises afterwards as vital to recovery.

[Joseph14612]

I'm getting right hip done in two weeks and am still on 14.5 mg Pred.

[Shandylowe]

when I had a knee replacement the surgeon increased my steroids he said it was a major trauma for the body.

[marionofnorwich]

I had emergency hip surgery in June. I was on 4mg prior and them upped it by 5mg as it was an accident. Had 9mg for a few days in hospital then came back down to 4mg in a couple of stages. No problem at all with infection and I would try and ignore him if your possibly can, especially as you are reducing methoxotrate (which I don't know about). Incidentally, I gave several masterclasses in PMR while I was in hospital, including to one nurse who had been diagnosed but seemed to know little about it

[Nightingales]

I had a total hip replacement on 15 mg and am scheduled for spinal fusion on 11 mg. Both drs made me aware of increased risk of infection but made no demands and weren’t fazed by the amounts. I had a steroid booster during surgery and I healed very well. Best wishes for a successful outcome.

[arvine in reply to Nightingales]

Thank you

[Linny3]

I have had 1 major surgery. Not only was I on 15mg of prednisone, they upped my dose the entire time I was in the hospital to 60 mg of prednisone. The surgeon was very worried I would not heal properly otherwise. As it was, it took 2 years to totally heal when it should have taken about a year. I did not experience any infections.

Good luck with your surgery.

[1951grumpa]

In 2016 I had a knee replacement at that time on 5-7mg prednisone , and since 3 mor surgeries while on 5 mg prednisone . Before my TKR I asked my rheumatologist about reducing the prednisone and she said not to that newer studies said there’s a good possibility of worse outcomes, flares etc.

[PMRpro Ambassador in reply to 1951grumpa]

Oooh - like the sound of that rheumy - I'd love to get a reference for that. I've said that for years - you have to be able to do the rehab post-op and you can't if you flare.

[1951grumpa in reply to PMRpro]

I remember her showing me a paper. I may have had it but it’s been so long ago (2016)I didn’t keep it. I have recently switched rheumatologists so I’m unable to ask for it.

[PMRpro Ambassador in reply to 1951grumpa]

That's a shame - having something in the literature is always a positive. Anecdotal evidence from patients is often regarded as only to be ignored. Though there are increasing numbers who realised some of aren't half as green as we may be cabbage looking ...

[Rubha]

my ortho surgeon did say there was a slightly higher possibility of infection . I’m currently on 13.5 pred for GCA and PMR. I had hoped to be a bit lower but COVID …..then my flu jab made me slow the taper even more. My surgeon did not seem unduly concerned.

[Temeraire]

I had a basal cell skin cancer removed from near my ankle where there was no spare skin to pull wound together. This meant surgeon had to leave the wound open as quite a deep ‘hole’ to heal slowly from base up over several weeks. I was on 7.5mg pred at the time. It healed very well, no infection. I dressed it myself all that time till it healed. Sterile dressings, hand washing etc. I had no problems at all. Hopefully it all goes well for you.