Pain after a total knee replacement might be due to the hip

Dear Dr. Roach: I read your recent column about a person who had knee pain after a knee replacement. I am a retired orthopedic surgeon who performed on over 10,000 total joints of the hip, knee and shoulder in my 47 years of active surgical practice. A well-done total knee replacement does not give the patient much pain postoperatively. I saw many patients who had this story in my career, and the first thing that comes to mind is that the patient was having referred pain to the knee from an arthritic hip joint.Oftentimes, the surgeon who performed a painful knee replacement never X-rayed the hip or did a complete exam to look for a limited range of motion in the hip. The patient who has knee pain after a total knee replacement needs to have an examination and X-ray of the hip.I saw more than a few patients who had surgery on their knee when it was their arthritic hip causing referred knee pain that was the real diagnosis. In this case, performing a total hip replacement may eliminate the pain completely. Qualified orthopedic surgeons will agree with me in this case. My advice to inexperienced surgeons is: "Always check the hip before jumping into a total knee replacement!" — Gary Wolfgang, M.D., Retired Orthopedic SurgeonAnswer: I thank Dr. Wolfgang for writing and for the important reminder of the close connection between the knee and hip. It isn't that the knee doesn't have any problems; it's that there may be more than one cause for knee pain, and I have certainly seen, as Dr. Wolfgang has, many patients with knee pain whose pain was actually due to a hip problem. So, replacing the knee won't help the hip, which is the underlying cause of the pain.Dear Dr. Roach: I have just had my prostate gland surgically removed three weeks ago, and I am experiencing incontinence because of the surgery. I am worried that if I drink my usual amount of 8 glasses of water a day, like I did in the past, I will be inside the bathroom more than I am outside of it.What is your opinion on this issue of not drinking enough water because of my fear of bathroom trips? Do you think I should just keep drinking water and not care about the trips to the bathrooms? — M.G.Answer: Some degree of incontinence is extremely common after surgery for prostate cancer. But you will be glad to hear that over time, most men regain much better control over their bladder function. The rates of complete continence are much higher one month after surgery compared to one week, and the rates continue to improve months or even years after surgery. The use of pelvic floor muscle training also speeds up the recovery of bladder control.In the short-term, you absolutely need to stay well-hydrated, especially after surgery, but this doesn't mean you need to force down fluids. Most people don't need 8 glasses a day; 4 is enough. Thirst remains an excellent guide of whether you need fluids or not.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.