AA and hip replacement

[StephM]

Hi!
I have read a few things on this forum about avascular necrosis and hip replacement due to high doses of corticosteroids but none actually answered my question.
To make it short, my brother is 12 months after horse ATG and his counts are close to normal. He still has a low dose of cyclosporin.
Severe hip pain. MRI showed osteonecrosis in both hips with edema and he needs protheses.
My question is about the potential danger of undergoing surgery and taking new medicine now. Is there a risk of AA relapse?
Thanks

[Neil Cuadra]

Steph,

I can't see how surgery could harm his bone marrow, so AA relapse shouldn't be a concern. Surgery can be risky if blood counts aren't high enough, but since your brother's counts are almost normal he'd likely be cleared for surgery.

Surgeons need to know about all of the medicines a patient is taking, and the status of all of their health conditions. A patient's hematologist should give an OK before surgery.

[StephM]

Thank you very much for your answer!
We had not seen that coming... That's how you realize the treatments for AA are incredibly aggressive too
Let's hope that after the hip replacement, we will be done with pain, doctors and hospitals for a very long time...

[Hopeful]

Unfortunately, I have heard the opposite...

I was told that surgery itself is a major stress for the immune system and can trigger a relapse. I met someone at one of the conferences with AA that relapsed after a knee replacement.

It doesn't happen to everyone, but be vigilant afterwards.

[StephM]

Thanks for the warning.
I will try to browse the net for information about that.
We are meeting the doctors on Friday. There will be an hematologist and an orthopedist. I will try to ask them but they probably don't know anything.

My brother seems to be the 2nd or 3rd patient with AA that has been treated in this hospital. So probably the 1st one who will need surgery after the treatment...

He was slowly tapering cyclosporin and is currently on a low dose; the last step before stopping it completly. This should have been next month.Probably the time when he will be operated on.
I wonder if it wouldn't be safer to keep the low dose a little longer.

[Susan]

I had a hip replacement, no problems. But my plts were 120, whites and ANC not very bad. Whites were in 2s, ANC around 1.2. Post surg no AA count decline, had it done on 2009.

I wasn't on Clyclo and had not had ATG. I had been on Prednisone many years. One ortho told me it was osteonecrosis. The other Ortho said no, definitely not but osteoarthritis. Either way it was easier and less painful than I expected. Just took a short course of antibiotics and morphine.

But just ask a couple of good hems, they should know the answers.

Now I need the other side done but can't since my ANC way too low. In my view get it done if counts reasonable in case they drop and it's too late then. I'm stuck limping and using a cane.