The prospect of a knee replacement

[Stargiver]

Hello All and happy new year

Just before Xmas I had results of an x ray on my knee and was told it showed arthritis and I could be eligible for a knee replacement and the wait time may only be about 6 months. I was a bit surprised although clearly it had been bad enough to prompt me to get an xray. I think the predisolone masks the pain and inflammation and I have not been able to reduce my dose easily below 7 and a half to 8 mg. Lots of excuses to keep dose up such as moving house and mother dying in the last 7 months. so..

1) I must try and reduce steroid dose as someone told me they may not operate otherwise

2) Have restarted the iCal-D3 chewable tablets to ensure calcium, although I take Vitamin D high dose on its own with no problem. However I feel the iCal-D3 things make me feel sick. Has anyone else experienced that?

So dear people advice really yet again. Has anyone out there had a joint replacement while on Pred, and has anyone found these chewable tablets make them feel sick?

[PMRpro Ambassador]

There has actually been a thread on the subject in the last few days

healthunlocked.com/pmrgcauk...

which includes replies from someone with knee replacements on 11mg and others having hip replacements on up to 15mg.

Now you have posted, you will see Related Posts which will almost certainly have similar tales.

"Somene told me" - who? It very much depends on the surgeon and if one refuses - ask for other opinions. In that link i have given you one reply says this

"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."

I can't find a paper that relates chronic pre-operative steroids to outcomes - but I can find papers that say that joint replacement surgery is accompanied by an increase in IL-6 which is the primary inflammatory agent in PMR/GCA and that pre- and peri operative steroids reduce that and result in shorter recovery and hospital stays. It is certainly pointless forcing a patient to reduce their pred dose to a level that isn't controlling their PMR as it will prevent them doing their post-op rehab which is critical for successful results.

I have noted that they seem to have improved PPI in the orthopaedic operating theatre - complex joint surgery is accompanied by suits that wouldn't be out of place in the space station! Which is almost certainly to reduce the risk of infection.

[piglette]

My surgeon wanted me on zero pred for my hip replacement, but after negotiations agreed on 5mg. I can understand surgeons wanting to minimise the risk in every way they can when operating on someone. It is very much up to the surgeon at what level they are happy to go. Some are happy to operate at one level while others will not consider it.

[Ballerina75]

Hello Stargazer

I had both knees replaced in 2019, 4yrs into my PMR journey & was on 5mg of pred which the medics were ok with. I was careful to balance exercise with resting & have no regrets. Good luck & hope all goes well for you.

[pegpowell]

I had knee replacement in 2017 on 6 mgs prednisone, 4 mgs in 2022 on hip replacement. There was no request by surgeon to reduce pred. Upped pred to 7 after knee replacement.

[Summerrental]

I had left knee replaced when I was on 10 mg of pred. No issues with the surgery & my knee feels wonderful since the surgery. Never took chewable calcium.

[Miserere]

I had a knee replacement a year ago when I was on 7.5mg - the surgeon had no problems with that. I take D3 and K2 - I don't take calcium but I do take AA weekly. All went well - I was at the stage where I could only take a few steps unsupported. They tell me the other knee needs doing and offered a date in December just gone but as it is not causing me the same level of pain I declined. I don't want surgery unless it is absolutely necessary even though I'm glad the first knee has been done. We are all different - only you know how bad/good your knee is.

[Indigo2417]

Can’t help regarding the operation, but I’ve had Calcichew D3 and have now been swapped over to Evacal. Both chewable and haven’t have a problem with either. Good luck with your operation.