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Total knee replacement help please! Options
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Kassy
#1 Posted : Wednesday, April 27, 2011 10:15:05 AM Quote
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Last year I was canvassing you all on additional DMARD's to Methotrexate. Well a couple.were ruled out and then I reacted badly to the selected one! So now it has been decided that I should have TKR on both knees ( One at a time,thank God) .

The first is to be operated on 5th May.My dilemma is this . My rheumatologist has gone AWOL or to be fair on holiday. I see her under my husband's work health car scheme. The surgeon said I should get her advice on what to do about my medicines ie 25 mg Methotrexate weekly and NSAID's daily.Unfortunately, no guidance and so I have stopped both from info on net. I am not asking anyone for their advice but just what they were asked to do in prior to their op.

Looking forward to hearing from you guys!
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jeanb
#2 Posted : Wednesday, April 27, 2011 11:35:51 AM Quote
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Hi Katharine,

First of all good luck with the TKR's. I know we are all different but I have never looked back since mine. It's hard work at first as you must do the exercises, and it's not comfortable BUT so worth the effort.

My rheummy and my surgeon stopped the mtx 2 weeks prior to the ops (and aso when I had my right hip replaced) so I would say you are doing the right thing. This is really a precaution. As you know, the body doesn't repair itself too well when it is full of mtx so, of you were to contract an infection, it would take much, much longer to get rid of.

Take care and please let us know how it goes.

Love Jeanxxx

PS I thought I'd let you know that I sailed through all the ops, despite being much overweight and suffering from high BP, so try not to worry.
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smith-j
#3 Posted : Thursday, April 28, 2011 4:46:45 PM Quote
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Katharine

I have my first total knee replacement on 14th January this year. I did not stop my Methotrexate or NSAID's. My Orthopaedic Surgeon and RA team said that the last thing they wanted was for me to go through a RA flare immediately after my operation so to continue with all medication apart from on the day of the operation and this was only because of the amount of water I would need to consume to get them down. The Surgeon said he would pump me full of antibiotics during the operation to keep infection at bay. Everything went fine and infact for 11 weeks after the operation my RA went into total remission. Apparently this is not unusual as your immune system is so busy repairing your knee that it forgets about your other joints. Hopefully you will be the same. My recovery has been quite slow and I did not realise how much physio I would have to do myself to get myself mobile again but I have no pain in my knee and it is wonderful.

I am sorry that you are obviously going to wonder what to do now. Could your GP help or even phone the hospital where you are having your operation done and they may be able to help?

Good luck and take care

Jackie
xx
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LynW
#4 Posted : Thursday, April 28, 2011 7:03:40 PM Quote
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Location: Thornton Cleveleys
Hi Katharine

Unfortunately this is another of those rather grey areas where different surgeons and rheumatologists do different things. My orthopaedic surgeon will not operate unless anti-tnfs and methotrexate are stopped two weeks prior to surgery and for a minimum of two weeks after. They can be restarted once the wound is healed. I have been having this argument for the last 11 years as my previous rheumatologist thought it unnecessary to stop but the surgeon was adamant he would not operate. The ball was in his court and I have stopped every time. However, I did increase the anti-inflammatory (naproxen) to try to add a counter balance and it was okay to do this.

One of the arguments against the prescribing of anti-biotics for surgery is that they are over used and infections can quickly mutate making them resistant and difficult to treat (ie MRSA). But clearly in Jackie's case they were happy to take this chance and everything was okay!

Good luck with your op. hope it goes well ThumpUp

Lyn x
My son, Ian, completed the BUPA Great North Run on 15th September running for the National Rheumatoid Arthritis Society (NRAS). You can read his story at http://www.justgiving.com/ianlukewilson

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Kassy
#5 Posted : Friday, April 29, 2011 11:42:10 PM Quote
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Thank you for you replies.I decided to ring my surgeon's office to explain my predicament and within a few hours my rheumatologist's secretary rang with advice to cease Methotrexate for 2 weeks and keep taking my NSAID. I was in such pain from the inflammation by the time the advice came through I was delighted to restart the NSAID . My joints have now settled down to the usual more bearable pain.

I do appreciate your kind words and support.
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