Help-need knee replacement while on Cellcept
 

Hi everybody, need other MG peoples experience with knee or hip replacement while on Cellcept, lowering the bodies immunity to infection.
I,ve had MG for 8 years,I take 2000 mg of Cellcept a day, plus 60mg of Mestinion three times a day, I'm 72 years old. My doctors are not sure how to get me thru a knee replacement with lowered immunity, and have a safe recovery.
Any help with your experiences would be appreciated.
Steve

Hi, Steve. Welcome!

Are you having one or two knees done? Most places have you mark the knee in ink before surgery. If they don't, do it yourself!!!

Do you get infections easily? When patients do, they will often premedicate with an antibiotic before surgery and then after surgery for 7 - 14 days. It really depends upon your history. No surgeon wants a patient to get an infection in their replaced knee! Neither do patients.

The main risks for MG patients while being given anesthetics are 1) a myasthenic crisis and 2) breathing issues due to the anesthetics and/or pain meds such as morphine.

Morphine, usually used after surgery, is great for pain but can really tank breathing in an MGer. If you can transfer to NSAIDs or Tylenol as quickly as possible, your MG will do better.

Muscle relaxants are not a great idea for MG. They can use inhaled anesthetics like Sevofluorane. I've attached some articles that you can read and print out for the docs ahead of time. Really, they will be grateful for things to read about it! They should be doing the research for themselves, but they don't always do that.

It's very important to be well-rested before surgery and have your MG be stable. Same diff after surgery!

If you're at all anemic, that can affect surgery recovery, O2, etc. There's not normally a lot of blood loss during a knee surgery though.

Will you be going to a care facility afterwards for PT? It's really important to do all of the exercises (and the machine that helps to bend the knee) after surgery. It makes a huge difference in recovery. And then someone else can do the cooking, etc. for you! You will need help for a while.

Has your B12 ever been checked? Since there will be some peripheral nerve damage in the knee area, taking extra methylcobalamin for weeks after surgery will help to heal those nerves. Several studies have shown that it heals nerves more quickly. It has for me! You can't get too much B12.

If you haven't had an ECG, they should do that because of your age. They usually do pre-op stuff like that and a complete blood count, chemistry, etc.

I really hope that you will do great! My mom went through knee replacement at about your age, although she didn't have MG. She was fine. If you don't have a walker, get one. And putting tennis balls on the front helps. Try to find one with an attached pocket, so that you can use it to carry things around in.

I hope this helps.

Annie


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258733/

http://www.ncbi.nlm.nih.gov/pubmed/3019175

http://www.aana.com/newsandjournal/D...2_p301-310.pdf

http://ispub.com/IJA/11/2/12944