Q: I have terrible trouble climbing stairs. I get totally out of breath and my hips and knees kill me. My doctor sent me for breathing studies, a stress test and X-rays. My lungs and heart are fine but I have arthritis in my "good" left hip and knee. The orthopedist says I may need a hip replacement. But both hips hurt the same when I climb stairs. What's wrong with me?

A: You probably just have PPS. Many Post-Polio Institute patients report shortness of breath when climbing stairs or walking any distance. Your doctor was right to test your lungs and heart first. You should always rule out other diagnoses before saying symptoms are due to PPS. But it's usual that those tests would be negative. The overwhelming majority of polio survivors aren't short of breath because of lung or heart disease. The problem is that they're doing too much with too little.

Since polio survivors have weaker muscles and about half the usual number of motor neurons , it makes sense that activities that aren't breathtaking for others will be for polio survivors. If one of our 25-year-old therapists gets winded running up a flight of stairs, you wouldn't worry that she had heart disease. She is short of breath because she just did something strenuous. Polio survivors may be using the same amount of energy walking up stairs as the therapist does running. What is the treatment for your shortness of breath? Stay off the stairs.

And the treatment's the same for joint pain. The overwhelming majority of polio survivors don't have hip, knee or back and neck pain due to arthritis. The pain-causing culprit is usually overexertion, doing too much with too few motor neurons and weakened muscles. When you climb stairs repeatedly, your muscles burn, your ligaments complain and you develop "polio hip"--inflammation and bursitis in your overstressed joint. The same thing can happen in your knee or shoulder. The big question is if your pain is in the joint, due to arthritis, or in the muscles and tissues around the joint.

Even if severe arthritis is causing hip pain, polio survivors aren't the world's greatest candidates for joint replacement. You need strong muscles around an artificial hip to hold it in its socket. Unfortunately there isn't even one follow-up study of hip replacements in polio survivors. But our experience is that polio survivors with severe arthritis can have successful hip replacements if their hip muscles are strong enough.

Adequate muscle strength is also the limiting factor when polio survivors have total knee replacements, as the only follow-up study shows. Pain decreased and function increased after knee replacements in 60 percent of knees where the thigh muscle had at least antigravity strength. But all knees with less than antigravity strength and 45 percent of the knees even with antigravity strength weren't better or got worse after the replacement. So knee replacements aren't a cure-all for post-polio knee pain.

Unfortunately, some polio survivors have actually been told that knee replacement is a "cure" for new leg muscle weakness, especially knee buckling due to a weak quadriceps. A patient came to the Post-Polio Institute from Puerto Rico and had both knees replaced with the promise of walking without braces; he was unable to stand at all after surgery. Replacing a joint to "cure" post-polio muscle weakness is like replacing a tire to "cure" a car that's run out of gas.

If you have a joint replaced, you need to be concerned about muscle weakness after surgery. In this age of managed care your insurance company will want you out of the hospital long before your muscles are ready. Non-fatiguing muscle strengthening exercise--which is monitored by a physiatrist and physical therapist knowledgeable about PPS and whose pace is determined by you--is required if muscle strength is to be regained and retained after surgery (see "Preventing Surgical Complications" at http://members.aol.com/harvestctr/library/surgery.html).