Hello all, seeking advice on when to stop and when to start back up. Surgery set for 2.11.26. Thanks
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I stopped rapamycin 2 weeks before ACDF surgery. I am going to go back to rapa three months and a week after the surgery. Going back to rapa in my case is guided by the need for my cervical spine at C5-C6 to fuse. That generally takes about three months. It is confirmed by imaging. If the x-rays come back showing the fusion was successful, I will go back on rapa. If not, I’ll hold off until it’s confirmed.
I don’t know what exactly is involved in TKR, but if there is any bone fusion that needs to happen, I’d wait until that has been accomplished before going back on rapa.
The two week rapa break before the surgery was guided by Joanne Mannick’s protocol in the everolimus study. I figure since it dealt with immunity, it’s probably appropriate for surgery too.
When doing research on the impact of rapamycin on bone health, I came to the conclusion that it’s better to wait for bone fusion to be completed before going back on rapa.
When I was having titanium dental implants put in, I stopped rapa two weeks before the procedure and I resumed rapa six weeks after the procedure. The impact of rapa on the bone in the jaw might be somewhat better than elsewhere.
That’s my take, perhaps others have different opinions.
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My recent neck surgery gave some insight into this (although it differs from CronosTempi’s.)
From my surgeon’s perspective on Rapamycin, he didn’t want anything that might interfere with fighting potential infection.
As such, he had me stop Rapamycin 3 weeks prior to surgery and gave me leave to restart it 2 weeks following my surgery. Of some note, he did have me take an antibiotic post surgery for I think 4 days.
A surgeon doing TKR (considerably more invasive than what I had) might view the risk of infection extending beyond a 2 week period.
Talk to your surgeon about this. Never hold anything back from someone about to cut into you.
Hospital for Special Surgery (HSS) advised me that full fusion can take 9 to 12 months.
That said, the HSS team saw no reason for me to put off my pulse dosing of Rapamycin.
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Yes, full fusion might take 9-12 months, but it’s partially down to the individual and factors (smoking etc.). For some, it needs up 18-24 months or fails altogether. However, in general in 55.6 % people three months after ACDF surgery there is enough fusion that the danger of hardware loss is strongly attenuated. That is also when you are cleared for general activities including noncontact sports. Again there may be individual differences in the rate of fusion, these are just stats. At 12 months the rate of fusion is above 90%. There are many studies into spinal fusion after ACDF. And yes, TKR is a much more involved surgery.
Just a quick update
My 2 cents. It isn’t just infection risk, it is wound healing.
There is never a specific day that things are healed. Usually you talk about tensile strength extrapolated from various studies. Each tissue is a bit different of course. Usually a year to 95% of final strength but you might get 85% in 6 months.
With Ortho stuff, you lose muscle and you want to not get in the way of it coming back. There is no way that 2-3 weeks would allow time for muscle to rebuild even for an 18 year old.
I like 3 months if you have to give a one answer fits most.
AI says 18 months for full muscle recovery after TKR. That would be way too long to hold Rapa but something to keep in mind when you might be debating 1 month or 6.
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A postoperative wound infection after implantation of a prosthetic knee can be a real disaster requiring explantation of the prosthesis in some cases. I would be extremely cautious here. Additionally, as others have suggested, you don’t want to compromise wound healing and muscle recovery.
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