DEAR DR. ROACH: I have been suffering from strong pain in my left knee for a long time. An MRI was performed, which showed an “extensive degenerative tear throughout the body and a posterior horn of the medial meniscus.” It also showed a “flap tear of the body and an anterior horn of the lateral meniscus, with meniscal tissue displaced adjacent to the anterior horn.”

Is there anything I can do to alleviate the pain and try to walk normally again?

— E.R.

ANSWER: Although meniscal tears in young people are usually a result of trauma to the knee, in older people (sadly “older” in this case generally means above 50), degenerative tears in the knee may happen without identifiable trauma. A flap tear may occur from an injury or due to degeneration of the meniscus.

I would refer you to an expert in knee surgery were you my patient. Your surgeon can give an educated opinion on the benefits and risks of surgery. The current surgical technique is to remove as little meniscus material as possible since removing more meniscus material means a higher risk of arthritis in the future.

DEAR DR. ROACH: I have been told that I can’t have my planned hip replacement surgery until I lose about 35 more pounds. I have swelling and lymphedema in my legs, and my legs are still large even with weight loss. Is this standard?

— A.U.

ANSWER: There is some justification for wanting people to lose weight before a hip replacement therapy when people are very overweight. The risk for needing to do a second surgery is higher in people with a BMI over 35.

I do not agree with inflexible rules about weight loss prior to surgery. Obviously, doing exercise, which is an essential component to healthy weight loss, is very difficult for people with such severe hip arthritis that they need surgery. Many people find that weight loss is easier after surgery. A medication treatment, such as a GLP-1 drug like tirzepatide (Zepbound), might be appropriate.

Finally, aggressive treatment of your lymphedema before surgery is critical since lymphedema treatment may be more difficult in the period of time around your surgery. Lymphedema is a risk factor for a poor outcome after hip surgery, so your lymphedema specialist and surgeon need to work together closely.

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.