Orthopedic surgery: 4 things you should know before going under the knife

HealthWayne

Nobody wants unnecessary surgery. On the other hand, who doesn't want to have more mobility and to be able to do the things they used to do? Elective orthopedic surgeries like knee arthroscopy and hip replacement tend to be very successful because they can greatly enhance quality of life for years or even decades.

But deciding on surgery can be complicated. People tend to bounce back quickly from knee arthroscopy, but bigger surgeries like spinal disc decompression and rotator cuff repair can be quite painful and require substantial healing and physical rehab periods.

Sixty-year-old Diane Wallace of Marengo recently faced this decision. After a complicated shoulder replacement, she was wary of pursuing knee surgery, even though pain had begun to prevent her from standing long enough to cook the delicious dinners she enjoyed. "I really love cooking and missed it, and the pain was keeping me awake at night and on the couch during the day," she says. "I knew it was time to do something, but I didn't know what."Here are some of the points Wallace discussed with her surgeon as she decided whether surgery was right for her.

One: Try other remedies first.

Most orthopedic surgeons don't want you to rush into surgery, either. Their first level of treatment for aching backs, hips, knees and shoulders often involves over-the-counter pain medications, supplements like glucosamine and chondroitin and possibly physical therapy to increase strength and function.

If none of these provide enough relief, the next step is to consider steroid injections into the affected joint. " Steroids are good for relieving pain and flare-ups, but they offer no lasting benefit," says Dr. Charles Bush-Joseph, an orthopedic surgeon at Midwest Orthopedics at Rush. "They might provide enough anti-inflammatory relief to get your body into its natural healing process."

Surgeons can also inject a gel-like substance into painful joints, particularly knees. These drugs are based on hyaluronic acid, a naturally occurring substance found in the joint fluid that soothes and lubricates healthy joints. "These viscosupplements help 50-70 percent of patients with osteoarthritis and the effects last up to 6-12 months," says Bush-Joseph. "But they're a bridge treatment and those patients will eventually need joint replacement."

Two: Complicated diagnostics may not be necessary.

Nowadays, it's common for patients to arrive at the surgeon's office for their initial consult with MRI results already in hand, ordered by their primary doctor. But many orthopedists suggest relying on lower-tech diagnostic methods instead. "In nearly all cases, we can get an accurate diagnosis by taking an extensive physical history, doing a careful hands-on physical examination and relying on a $42 X-ray versus a $2,400 MRI," says Dr. Wayne Goldstein, chairman of the Illinois Bone and Joint Institute. "It's too easy to skip straight to technology instead."

Bush-Joseph estimates that an X-ray provides enough information to cinch the diagnosis in more than 95 percent of his patients. "Patients often demand that the primary care physician order an MRI but virtually every patient who has arthritis that is visible on X-ray will also have a visible but symptom-free abnormality on MRI," he says. "Orthopedic surgeons generally prefer to use an MRI to show us exactly where to operate in specific circumstances, not as a routine diagnostic tool."

Three: Don't have surgery unless you're prepared to do rehab faithfully.

If you're just having your knee ‘scoped and are otherwise active, you may not need physical therapy after surgery. But if you're having joint replacement or rotator cuff repair, physical therapy will most likely be a crucial part of your healing process.

And it probably won't feel good, either, but that's part of normal healing. "Being in good physical condition with strong muscles is very important for the normal function of any joint and physical therapy is a way to make that happen," says Dr. Michael O'Rourke, an orthopedic surgeon at Illinois Bone and Joint Institute, which has 17 offices throughout the region. "After surgery, therapy can help with balance and normalize the walking pattern. When patients walk abnormally for a period of time before surgery, that starts to seem normal, so people often need help getting used to a proper gait again."

Four: Minimally invasive is not always better.

The term "minimally invasive" has become something of a buzzword in the media to describe surgeries done with smaller incisions and possibly different technologies and surgical techniques. Patients may experience less pain and blood loss and may heal more quickly with a lower infection rate. Or they may not.

The issue of whether minimally invasive surgery is better for you depends on your unique circumstances and the skill and preferences of your surgeon.

O'Rourke requests that patients consider carefully. "People tend to focus exclusively on how quickly they can recover from surgery, which is certainly very important. But surgeons also think about long-term successes," he says. "My goal is to perform surgery in the least intrusive way while reconstructing a joint to allow it to last for decades."

Goldstein is more blunt: "We're inserting an appliance of finite size into your body and we need adequate room to insert it. If either the appliance or the incision is smaller than it should be, that can be the difference between lifelong comfort and having to go through replacement again in just 7-10 years when it should last for 25-30 years."

As for Wallace, her surgery turned out even better than she expected. The first surgeon she consulted advised knee replacement, but the second convinced her that joint replacement could wait a few more years as long as she had arthroscopy now. "Now that I've had the surgery, I can cook again, go up and down stairs and sleep through the night--It's been wonderful," she says. "I know I'll need knee replacement eventually, but I'm not afraid of it anymore."

Copyright © 2014, Los Angeles Times
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