Dear Dr. Gott: I'm a 32-year-old tall, slender woman with no major health problems. During high-school sports, I suffered from a lot of bilateral knee pain because of multiple patellar dislocations.

My kneecaps would slip to the outside of my knees, and I would put them back in place, causing the backs of them to chip. During my late teens, I had four different arthroscopic surgeries to remove loose bodies.

Now I suffer from osteoarthritis in both knees. I have a difficult time sitting and standing. Stairs are not even an option because they cause too much pain.

My hips are starting to hurt because of the stress I try to keep from my knees. I try to walk for exercise, but end up stiff and sore with fluid on my knees.

At the orthopedist's office, I had several Hyalgan cartilage injections with some relief, but they don't last.

If the condition is already this painful, I can't imagine what it will be like when I am only 40. I am also sure that my overall health will deteriorate if I can't even walk for exercise. Do you have any advice?

Dear reader: I wish I could offer a more positive approach, but from my point of view, considering your age, you don't have many options. If you fail to remain active, your knees will continue to be painful and your ability to exercise will deteriorate dramatically.

Then you will be looking at bilateral knee replacement. From my perspective, this appears to be a certainty; however, it may not be a bad thing.

I know several people who have had successful bilateral knee replacements and continue to lead normal, active lives. The surgical procedure is common.

The cartilage injections you received were given to relieve pain and prolong what for you is probably inevitable knee replacement. As you have discovered, the injections do not provide lasting relief. Another consideration might be over-the-counter glucosamine and chondroitin.

Before beginning the regimen, run the idea past your primary-care physician or specialist for a second opinion. Osteoarthritis is commonly diagnosed in older people. When it occurs in young people, it is often the result of sports or other injuries.

When the condition begins, the surface of the cartilage softens and becomes frayed, pitted and cracked. Some areas of cartilage may wear away completely over time. This exposes underlying bone, damages it, and makes joint movement painful. Treatment is aimed at controlling pain, maintaining movement, and preventing joint deformity.

Medication, rest, exercise, joint protection and, in some cases, surgery are appropriate. Make an appointment with your orthopaedic surgeon, and bring him or her up to date so you can get the best care available in your area and your doctor can project what might be in store for you.

Perhaps a second opinion is in order. With ongoing research, it is possible that new treatments will work well for you.

To provide related information, I am sending you a copy of my Health Report "Osteoarthritis". Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dr. Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook". Write directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.