Now my new knee

QI AM 93 and had a knee replacement last September. It all seemed to go well and everyone was very pleased with my progress.

I’m still doing the exercises that were recommended but the knee has stiffened up and become painful again, especially in bed at night. I asked the practice nurse if I could get a scan but she didn’t seem to think it was feasible.

Should I go privately? How would I go about this?

AMOST knee replacements are problem-free. However around one in 20 people will have complications and this is unfortunately more likely to happen in older patients.

In most, the pain of the operation eases during the first few months after surgery but some have long-term pain. The exact cause of this isn’t known but it may be due to damage to nerves at the time of surgery.

Stiffness is common after knee replacement due to damage to muscles but doing exercises at least twice a day usually helps.

Scarring in the muscles can mean stiffness sometimes gets worse and if this is the case then seeing a physiotherapist may be beneficial. So rather than a scan I suggest you ask your GP to be referred for physiotherapy and for pain relief for night-time.

CAN you please suggest treatment for the numbness I’m experiencing in my toes? I run and go to the gym three times a week. I was thinking of buying a gadget to improve my circulation – do they work?

ATHE most common cause of numbness in toes is pressure on nerves from tight shoes. Pointed toes, especially when combined with high heels that propel the foot forwards, are the worst culprits. However, wearing shoes that are too narrow or too short can also cause numbness.

To check whether your footwear might be to blame, draw an outline of your bare foot on a piece of paper then place your shoe over it. If the shoe doesn’t cover the outline, this will be a pressure point.

In older people numbness in toes can be due to nerve damage (neuropathy) which may be linked to diabetes and it can sometimes be due to pressure on a nerve as it leaves the spine.

Narrowing of the arteries that supply blood to the foot can also be to blame. I advise you to see your GP who can arrange tests and sort out the underlying cause. If poor circulation is to blame then controlling your blood pressure, cholesterol levels and stopping smoking should be top of your priority list, along with taking regular exercise.

Sadly, I very much doubt that any sort of gadget will help.

I’M a 72-year-old man who takes co-codamol and tramadol for pain control. However I suffer from bad constipation.

Would ibuprofen or another painkiller be as effective without this side effect? If not, can you recommend a safe laxative that I can take on a regular basis?

ABOTH tramadol and the codeine found in co-codamol are opiates which are well known for causing constipation. The fact that you are on these suggests to me that you have severe pain, so just paracetamol – the other ingredient in co-codamol – is unlikely to be effective enough.

Anti-inflammatory painkillers such as ibuprofen can cause stomach irritation, fluid retention and kidney damage, especially in older people, so they are generally now not recommended for anyone over 70. Stool-softening agents such