Knee Replacement surgery and PMR

Posted by aliceoleary @aliceoleary, May 15 8:48am

Hello – does anyone have information on, or experience with, PMR and total knee replacement (TKR). I have had diagnosed PMR for a year and I am hoping to taper off medrol next month. I am currently on 1mg EOD. My CRP and SED levels have been normal for several months now.
I am having problems with my right knee which has osteoarthritis and is failing fast. I had a partial replacement in that knee eleven years ago which worked quite well but now the rest of the knee is failing. My physical therapist asked me if the PMR would complicate my surgery. Does anyone know?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) group.

Hi @aliceoleary, I have PMR but it is in remission. I had a TKR on my right knee a few years ago while my PMR was inactive and I was not on prednisone or other medication for the PMR. If I remember correctly, my surgeon went over my list of medications prior to surgery to make sure they wouldn't cause a problem. I would recommend discussing the question with your doctor or surgeon.

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Thanks John. That is helpful and I will certainly be talking things over with my doctors. I am hopeful that my PMR is inactive. I'll know in a few weeks when I stop the 1mg EOD that I have been taking. I see my rheum two weeks after that.

Things have changed since my diagnosis with PMR last summer and I am starting to realize there is a new normal being established. I thought once I got the inflammation down and off prednisone that everything would be back to where it was a year ago but I am starting to realize that physically I have some changes–the fatigue and heaviness of the lower extremities–that may be with me forever.

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I’m scheduled to have a TkR this March 2022. I told my orthopedic Dr that I was on 10 mg prednisone due to PMR. He said he didn’t want to operate TKR unless pred is down to 5 mg in case of infection. I don’t know when that’s going to happen. I was down to 5 mg 4 weeks ago but suffered severe pain in my groin. Had to go back to 10 mg.

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@ella0515

I’m scheduled to have a TkR this March 2022. I told my orthopedic Dr that I was on 10 mg prednisone due to PMR. He said he didn’t want to operate TKR unless pred is down to 5 mg in case of infection. I don’t know when that’s going to happen. I was down to 5 mg 4 weeks ago but suffered severe pain in my groin. Had to go back to 10 mg.

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Initially my surgeon said the same ( I have PMR for about 10 years, on 5 mg of prednisone for the last year prior to surgery). They wanted me totally off of prednisone prior to surgery. I told him that wasn’t possible. He did some further research and said that the research indicated that 15 mg was the limit, and since I was taking less than that, he did the surgery. He used additional antibiotics during surgery, but that was it. I suggest that you push back with your surgeon on that. Good luck.

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@ella0515

I’m scheduled to have a TkR this March 2022. I told my orthopedic Dr that I was on 10 mg prednisone due to PMR. He said he didn’t want to operate TKR unless pred is down to 5 mg in case of infection. I don’t know when that’s going to happen. I was down to 5 mg 4 weeks ago but suffered severe pain in my groin. Had to go back to 10 mg.

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Get another doctor. I had knee replaced over 10 years ago on 10 mgs. I’m fine. The knee is fine and I’m still on 7 ml. For GCA

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Thank you for that wonderful information. Can I ask how long it took you to recover from the TKR? Your feedback would be greatly appreciated.

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@ella0515

Thank you for that wonderful information. Can I ask how long it took you to recover from the TKR? Your feedback would be greatly appreciated.

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My TKR was March 3, so not quite 3 months ago. I tore up my knee last July (tore ACL, PCL, partially tore the LCL and meniscus and fractured the tibia). Insurance insisted that I try PT to see if it would heal. Long story short, my therapist concentrated on preparation for the surgery the last month or so, so my healing process is fabulous (plus my surgeon was very good) and well ahead of schedule. At 2 weeks out, my movement was 90+ degrees, and at 130+ degrees at 8 weeks. I’ve actually had to slow down the movement because the tissue is not healing as quickly. I use the ice wrap daily which also helps the healing process. The main issue is that the prednisone masks some problems because it reduces the swelling so much, and it can fool you into thinking it is better than it is (my issue). Hope this helps. Good luck.

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@violaange

My TKR was March 3, so not quite 3 months ago. I tore up my knee last July (tore ACL, PCL, partially tore the LCL and meniscus and fractured the tibia). Insurance insisted that I try PT to see if it would heal. Long story short, my therapist concentrated on preparation for the surgery the last month or so, so my healing process is fabulous (plus my surgeon was very good) and well ahead of schedule. At 2 weeks out, my movement was 90+ degrees, and at 130+ degrees at 8 weeks. I’ve actually had to slow down the movement because the tissue is not healing as quickly. I use the ice wrap daily which also helps the healing process. The main issue is that the prednisone masks some problems because it reduces the swelling so much, and it can fool you into thinking it is better than it is (my issue). Hope this helps. Good luck.

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Thanks for this helpful reply. I am a firm believer in “pre-hab”. I had a partial replacement in the right knee in 2012 and found recovery arduous. In 2017 my left knee was replaced but I spent about four weeks with extensive PT and the recovery was substantially easier. I am “pre-habbing” again in anticipation of this surgery but I think the steroid has added a complication with weakened leg muscles. It is always something. 😉 Thanks again.

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@violaange

Initially my surgeon said the same ( I have PMR for about 10 years, on 5 mg of prednisone for the last year prior to surgery). They wanted me totally off of prednisone prior to surgery. I told him that wasn’t possible. He did some further research and said that the research indicated that 15 mg was the limit, and since I was taking less than that, he did the surgery. He used additional antibiotics during surgery, but that was it. I suggest that you push back with your surgeon on that. Good luck.

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Thank you for sharing your experience. Very helpful in planning my TKR.

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