Is 93 too old for a hip replacement? DR MARTIN SCURR answers your health questions

My 93-year-old mother has constant hip osteoarthritis pain, but her age precludes joint replacement surgery. Her family doctor recommended co-codamol, but it affects her digestion, so she takes acetaminophen. Are there other medications that can help?

Wendy Thurley, by email.

One in four of us will develop osteoarthritis by the age of 80. Her mother is now at a point of limited mobility, which affects her general health and threatens her independence.

Paracetamol may work in some, but not all, patients. Adding codeine can help (co-codamol is a mixture of codeine and acetaminophen), but the side effects often make it unbearable, as your mother found: drowsiness, constipation, nausea and headaches are common. Addiction is also a problem when codeine is taken regularly for long periods of time.

Paracetamol may work in some, but not all, patients. Adding codeine can help (co-codamol is a mixture of codeine and acetaminophen), but the side effects often make it unbearable, as your mother experienced: drowsiness, constipation, nausea and headaches are common

Other pain relievers include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac.

But instead of taking it daily, it is better to take it when needed, for example before your mother leaves the house for shopping or similar activities. Routine use is not recommended because these drugs can cause ulcers in the lining of the stomach and increase the risk of cardiovascular disease and kidney damage.

If your mother is taking an NSAID, try to make sure it is at the lowest effective dose and for the shortest possible time.

Surprisingly, non-drug treatments include mobility aids and walking aids. Ideally, she would see a physical therapist for an exercise program, an approach that has been shown to improve function and reduce pain.

The goal is to improve range of motion and strengthen the muscles around the hips.

In the event of surgery, a hip replacement should not be ruled out just based on their age.

It is a safe and effective operation for elderly patients – the main consideration is whether the patient is healthy enough to undergo the operation.

Hip replacement is one of the most successful orthopedic surgeries – would it be worth reconsidering whether it would be right for your mother?

I have had a fungal nail infection for years, even though I have been in severe pain from it for the past month. At my last appointment the podiatrist said my nail was loose and wanted to pull it off! But is this the answer?

Mary Blackwood, by email.

Experts—especially microbiologists—find nail fungus interesting because it has so many different causes, including yeast and mold.

But for general practitioners and patients, the focus is on one thing: how to overcome this often very difficult to treat problem.

In my experience, unless it causes pain or damages the nail to the point where it becomes very unsightly, it is often best to leave it alone.

Pain is rare, but when it does occur, it is usually because bacteria have invaded and caused an inflammatory reaction.

Experts—especially microbiologists—find nail fungus interesting because it has so many different causes, including yeast and mold. But for GPs and patients the focus is on one thing: how to overcome this often very difficult to treat problem

In some patients with other conditions, especially type 2 diabetes, this can cause the infection to spread to the soft tissues of the toe and foot, even the leg. Topical antifungals aren’t very helpful—and while oral antifungals are potentially more effective, they can cause uncomfortable side effects like nausea.

I wouldn’t mind having your podiatrist remove the nail. It is a simple procedure performed under local anesthesia.

The pain you experienced will be resolved and there will be an immediate healing.

There is a high chance that the problem will return when the new nail grows out – usually because microscopic fungal spores remain in the area.

You can try to prevent this by applying an antifungal to the nail bed – the standard treatment is with amorolfine (brand name Loceryl). It is only available by prescription, so your GP will need to prescribe it, or you can try an online pharmacy.

Write to Dr. scramble

Write to Dr. Scurr to Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk — add contact details. DR Scurr cannot respond to personal correspondence. Answers should be taken in a general context. If you have health problems, contact your GP.

In my opinion… Hidden risks of our tattoo epidemic

There’s sort of a tattoo epidemic in the country, among people of all ages: I think I’m the only one at my gym who doesn’t have one.

My concern is the risk of infection as the technique involves piercing the skin with needles, especially concerns about hepatitis B and hepatitis C.

I agree that it’s not a big deal. But this type of transmission does occur.

While in the UK every tattoo artist must be licensed by their board, regular inspection of the equipment and premises is not required. Sterilization of equipment between customers is recommended and the use of disposable needles is essential. This is all for customer protection. So if you are planning to get a tattoo, make sure these standards are met

It was recently reported that 21 people contracted smallpox at a tattoo parlor in Spain – nine of those infected were under the age of 18. When investigators tested the premises, traces of the virus were found on chairs, work surfaces and appliances .

While in the UK every tattoo artist must be licensed by their board, regular inspection of the equipment and premises is not required.

Sterilization of equipment between customers is recommended and the use of disposable needles is essential. This is all for customer protection.

So if you are planning to get a tattoo, make sure these standards are met.