Should I have my hip replaced if I have MS?

Here is My Question:
I was diagnosed with MS in 2006. I had a few minor flare ups that were treated with steroids and other than minor numbness in my fingers and toes I never experienced any lasting damage. I went in for a work up in the Fall of 2015 due to difficulty walking: No new lesions were found and nothing was active. As it turned out I needed a new hip with the good news I began the process of getting my hip replaced.

I got sick (bacterial chest infection) and as anyone with MS knows it can exacerbate your symptoms, only this time they were entirely new. I had another MRI and as it turns out there is an active lesion on my thoracic cord which wasn't there 6 months ago. My question is do I continue on the road to hip replacement or do I wait and what is the criteria for this decision? I would like to get the surgery because my mobility is affected by my hip more than MS ever affected me. 

Answer:
It sounds to me that you are a very good candidate for one of the disease modifying therapies (DMTs), however, I can't tell based on your question if you are currently on a DMT.  All of the DMTs are designed to work on the inflammatory phase of MS, and your new cord lesion is evidence that you remain in this inflammatory phase.  I agree with you that your hip is going to affect your walking; however, the cord lesion can contribute as well (a careful examination by your neurologist will likely help clarify this more). 

​While a hip can be replaced with a more functional prosthetic hip, there is no such option for the brain and spinal cord.  Based on what you have told me in your question, I'd strongly recommend you meet with your neurologist to either discuss 1) starting on a DMT or 2) transitioning from the one you are on to another with a different mechanism of action (assuming that you have been consistent in taking the one you are currently on).  The decision to transition to a different DMT needs to be considered in context of your prior MS disease history.

Some DMTs can theoretically slow down healing after surgery, however, my experience has been that a DMT usually can be continued before and after surgery.  However, this should be carefully considered with your treating neurologist.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente