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Dr. Roach: Pain not only signal hip needs replacement

Keith Roach
To Your Health

Dear Dr. Roach: It would be helpful if you described some of the warning signs/symptoms of a bad hip that requires replacement. I now know that such a condition does not necessarily announce itself with chronic severe pain in the hip. Indeed, what sent me to the doctor was a recurrent pain in my groin. My hip was relatively pain-free and, even then, I had only a mild discomfort that I thought was simply some arthritis. What I failed to appreciate over the past few years was the very gradual loss of my range of motion, leading to difficulty with simple activities, such as tying my right shoe or cutting my toenails. In retrospect, I feel rather foolish that I did not realize sooner that I was having hip problems. Perhaps you can alert others to the signs of gradual hip degeneration that fall short of acute hip pain.


Dear B.A.: You have done a lot of the work for me. The groin is the most common location for pain from hip osteoarthritis, but other locations — especially pelvis and knee — all can be coming from the hip. We suspect arthritis when pain is worse after activity and improves with rest. But it is the range of motion and pain with movement that we, as internists, look for on exam to help us decide whether the complaints are likely from the hip joint or from another location. Pain is common with internal rotation (such as placing the outside of your ankle on the opposite knee and letting the elevated knee fall to the side). I think the main message is that pain in the hip or groin, especially if worse with exercise, suggests arthritis, and an X-ray can confirm the diagnosis.

Dear Dr. Roach: I'm 86 and had pneumonia in 2012 and was very sick for seven days in the hospital. Since I got home, I have had no sense of smell or taste. It's scary and disappointing. Can you tell me what caused it, and whether I will ever get it back?


Dear L.M.: Since it happened in the hospital, it's likely that something happened there to caused it. Sudden loss of smell and taste most likely are associated with infection, injury and medications. The organisms that cause pneumonia could possibly affect your sense of smell as well (disorders of both smell and taste usually are primarily related to loss of ability to smell). Injury can happen in the hospital, especially if you had to have a breathing tube placed through your nose. That leaves drugs as the other category, and MANY meds can cause loss of sense of smell.

Since this has been going on for more than a year and a half, the only common reversible cause is medication. It would be worthwhile to ask your doctor to review all of your medicines, especially any that might have been started around the time of the pneumonia.

Email questions to ToYourGoodHealth@med.cornell.edu.