Is hip replacement the only option for my husband?

Q

My husband, who is now 81, began to experience pain in his right hip a couple of years ago. He visited the GP, who sent him for an X-ray, and was advised he had osteoarthritis in his hip.

He was referred to a consultant who said he needed a hip replacement. We were surprised as friends we know who have had this operation seemed a lot worse than he was. He asked about alternative treatments but was told that these could not help as his hip was “too far gone”.

A year later, he was invited for the operation, but during that time his hip has not got any worse, and in fact with some increase in exercise has improved a little. He decided to postpone the operation and to speak to the GP again about the possibility of other treatments.

His GP said that a steroid injection wouldn’t help and physiotherapy would only strengthen the muscles so he was not prepared to make a referral for this.

It seems that my husband has to accept an operation, as if he does not, he will receive no treatment at all. Your comments on this would be appreciated.

He does have difficulty walking, and pain, but no pain when resting or in bed at night. He does have some arthritis in the knees which could be made worse by a period of immobility.

A

In osteoarthritis (OA) the cartilage that protects and cushions the ends of bones inside a joint becomes damaged and worn. Eventually, in places, it may disappear entirely, so the ends of the bones rub on each other when the joint is moved. This can be incredibly painful.

Bony growths can also develop around the joint edges, making the joint appear deformed and knobbly. Unfortunately, once the cartilage is worn there is no way of replacing it, so there is no cure for OA.

Steroid injections can be helpful if the joint is very inflamed, but often have no effect, or the effect is very short-lived, lasting just a few weeks, so they are not often done.

Physiotherapy does not affect the worn cartilage, but it can help to strengthen the muscles that support joints. It can also be useful for those with knee osteoarthritis, though unfortunately it is often not so beneficial for those with OA of the hips.

Once the cartilage is very worn, the best option is usually to replace the joint. In 2019, more than 100,000 hip replacements were done in the UK. It is usually done in those who have severe pain, swelling or stiffness, who have problems performing everyday tasks and have a reduced quality of life because of pain and disability.

Like all operations, there can be risks, such as infection, injuries to blood vessels or nerves, or deep vein thrombosis, but these are small.

Most people come home three to five days after the operation, and it is important to be as active as possible afterwards, doing gentle exercises and starting walking as soon as possible as a prolonged period of inactivity would make knee arthritis worse.

In the end, it is up to each individual to decide if their pain and disability warrants surgery. If your husband feels the pain is not too bad, is not getting worse and can be controlled with painkillers, then it would be reasonable to postpone surgery for now. If he is having problems wwalking, then surgery would probably be a good option for him.

Q

I am a 77-year-old man and was diagnosed with prostatitis.

I had a year with no symptoms, but they have returned again and don’t seem to be going away.

On the advice of my previous doctor I’ve had a PSA test [blood test to screen for prostate cancer] every year (my reading last May was 0.6) but my new GP doesn’t seem very concerned and told me that if I had prostate cancer I would probably die with it, not of it, and that I didn’t need another PSA test. I have been prescribed tamsulosin which seems to be working but is this just masking the problem?

A

Prostatitis is the medical term for inflammation of the prostate gland. There are two main types – acute, where the symptoms come on and go away quickly, and chronic, where symptoms are more persistent, which is what you have.

The main symptom is pain, which may be around the base of the penis or anus, in the lower abdomen or in the lower back. Though this can sometimes be severe – and worse during sex – it tends to vary from day to day. Other symptoms can include a need to pass urine more frequently, with a poor stream, tiredness, and general aches and pains. Not surprisingly many men feel anxious or depressed.

The cause of chronic prostatitis is unclear and it is now often referred to as chronic pelvic pain syndrome, or CPPS, as some men with symptoms of prostatitis do not have an inflamed prostate. Treatment is aimed at relieving pain, either with standard painkillers such as paracetamol, or drugs that block pain messages to the brain, such as pregabalin.

Medications that relax the muscles of the bladder, making it easier to pass urine (such as the tamsulosin you are taking) are also prescribed.

There have been some studies that have suggested that men with inflammation of their prostate might be more likely to get prostate cancer, but more research is needed to be sure if the two are linked.

PSA is a protein produced by the prostate gland. Levels rise slowly with age and abnormally high levels can occur when the gland is enlarged or inflamed, and in some (but not all) cases of prostate cancer. Your level last May was very low, which suggests that your gland is not inflamed, which is good news and makes it very unlikely that you have prostate cancer. Even if you did, as your GP has suggested, it would be so slow growing that it wouldn’t be a serious threat to your health.

So in answer to your question, the tamsulosin is not masking a problem and if it is helping your symptoms you should continue to take it.