Squeaky hip joint likely aggravating, but not dangerous
DEAR DR. ROACH: I'm 69 years old. I take no medications, and I'm in very good health. Fifteen years ago, I had a hip replacement and now it is starting to squeak when I walk.
It is a ceramic socket and a titanium ball. Is there any kind of cream I can rub on my hip or an injection I could get to lubricate the joint? When will I know that I absolutely have to get my hip replaced? -- P.F.
ANSWER: I can understand why the squeaking noise could be very annoying or troubling, but most often the squeak does not indicate a problem with the joint.
Unfortunately, there is no cream you can rub on that can get into the prosthetic joint, and no lubricant that can be injected will stay in long enough to effectively treat the squeak.
The main goal in evaluation of the joint is to determine whether there is damage to the prosthesis, the replacement hip. This requires a history and exam, imaging studies, and possibly blood tests or testing of joint fluid. If the joint is still in good shape (90% still are, even after 15 years), and you are moving well and not in pain, then nothing needs to be done. I would strongly advise against surgical revision of the joint unless there is a clear reason to do so. The presence of symptoms, especially pain, is the primary reason to do a surgical revision of the hip, which is generally a more difficult surgery than the initial replacement.
DEAR DR. ROACH: I've been taking the statin Zocor for the past 30 years. I understand that one of the side effects is diabetes. I will be 84 in August, and I have a family history of diabetes. Last year, my A1C reading put me in the prediabetes range. I have remained active by walking, using small weights, etc., and I watch my calorie intake. I weigh 199 pounds at 5 feet, 11 inches tall. I was disappointed with a follow-up A1C reading because I thought my actions would take me out of the prediabetic range.
I'm aware that after 65, the pancreas produces less insulin. What are your recommendations? -- R.C.
ANSWER: For most older people with diabetes, resistance to insulin is the primary reason. This is opposed to decreased insulin output, although the pancreas does lose some ability to make insulin with age. The mechanisms by which statins predispose a person to diabetes are not clear, but they probably include both resistance to insulin and decreased production.
Regular exercise and a moderate diet are the mainstays of diabetes prevention. Since you are walking and weightlifting, diet is the most likely place where you might be able to make changes. Even so, it may not be possible to prevent diabetes entirely. Visit a registered dietitian nutritionist for some personalized dietary advice.
Your body mass index, or BMI, is 27.8. A few pounds of weight lost -- I really do mean just a few pounds -- could reduce your risk of developing diabetes in the future, but you would want to lose weight the right way, through a healthy diet and regular exercise.
Even though statins increase the risk of developing diabetes in those people who are predisposed to developing diabetes, the benefit in preventing heart attack outweighs the risk. That is, as long as statins are appropriately prescribed to people with existing heart disease or those at very high risk. The benefits of statins in people with no known heart disease lessen with advancing age, and I seldom prescribe statins to people over 85 unless they are known to have blockages in the arteries.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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