An orthopaedic surgeon cannot guarantee a perfect outcome after any surgery, even an arthroscopic surgery like we typically perform in sports medicine.
Often it seems that some of the frustrations patients have after surgery arise from a discrepancy between their hopes and realistic expectations.
This article offers tips for patients preparing for surgery. It is crucial to ask the appropriate questions and become as informed as possible. While the list below is in no way comprehensive or meant to serve as a checklist of questions to ask, it does cover some points that patients occasionally fail to consider.
Research your doctor. Ask friends who performed their surgeries. Would they recommend him or her again? Go online for information. While not every doctor, especially one who has been in practice longer, has a blog or participates in social media, there are almost always informational pages and reviews of any doctor practicing in your area. No information is perfect, and certainly all reviews can be biased. The more opinions and information you obtain, the more likely you will be satisfied with your choice.
Research the diagnosis and both surgical and non-surgical options. With a very few exceptions, at least in sports medicine, surgery is usually not the only option. Giving the problem more time to heal, modifying activities, medications, or braces are often options. Surgery might be more desirable for a number of reasons, but it is always a good idea to know what other treatments are possible.
Discuss the risks of nonoperative treatment. Some injuries do not become progressively worse with time, while some injuries do. Many patients who have undergone surgery for a meniscus tear tell me they weren’t symptomatic at the time. They claim that they were told that their knee would develop worse pain and arthritis if they did not undergo surgery. Whether or not that scenario is guaranteed is a different discussion, but that and others like it are worth asking the surgeon.
Discuss the risks of delaying surgery. You can’t always plan injuries around your busy schedule. But not every surgery has to be performed immediately. It’s important to ask the surgeon about the timing of the procedure. Fractures and tendon ruptures often need to be fixed within about two weeks, while many other injuries can be treated later. Often I will suggest that a patient consider waiting until after a personal vacation, busy period at work, or final exams at school to undergo knee or shoulder surgery. Frequently patients can have equally successful outcomes with less disruption to their personal lives.
Discuss the surgical procedure. What exactly does the surgery entail? Many patients who undergo meniscus surgery claim to have had a meniscus repair (meaning, sewing the meniscus back together). Instead, many of them likely had a partial meniscectomy (trimming part of the meniscus out). It might not seem like a big distinction, but it does have a large impact on postoperative weightbearing restrictions as well potential long-term degenerative changes of the knee.
Discuss postoperative restrictions. Can you put weight on your leg after surgery? Can you drive? And ask any others that apply to your specific situation. If you will be required to wear a sling at all times for 3-4 weeks after surgery, how can you drive a car? If you aren’t sure, and if the answer will affect your ability to perform daily activities or work or school activities, ask before you undergo surgery.
Ask about return to school or work. While most of the time patients can return to their jobs in either full duties or with short-term job restrictions, occasionally that isn’t possible. Manual laborers, for instance, have a difficult time working if they have to use crutches. On the other hand, many patients can return and perform desk duties such as computer work. Students often can arrange to leave class a few minutes early to avoid crowded hallways. Talk to your boss or teachers ahead of time and work together to minimize time missed.
Inquire about the various anesthesia options. While most surgeries are done under some form of general anesthesia, that option isn’t always required (and occasionally it is not medically advisable). Ask if regional anesthesia to make the arm or leg numb is reasonable. There might be other options, like spinal or local anesthesia.
Ask about return to sports or exercise programs. Many athletic people are determined to return to sports or a certain form of exercise. It is important to know roughly how long to expect it will take you to return to that activity. In addition, knowing if there are ways to get exercise before that time can be helpful. For example, runners are often frustrated if they are kept from running for 2 weeks, let alone 2 months. Discussing options for exercise after surgery, such as a stationary bike or elliptical machine, might ease your anxiety, whether you’re a competitive athlete or weekend warrior.
Discuss an estimated time for full or complete recovery. No surgery is “no big deal,” even ones like I do arthroscopically, through 2 or 3 tiny incisions. Patients are often surprised to hear that it might be a full year before an athlete feels normal after ACL reconstruction or shoulder stabilization. Or it can take patients 4-5 months to reach maximum improvement after a knee arthroscopy to trim out part of the meniscus. While you might be back doing all of your desired activities much earlier, it is helpful to know roughly when to expect to be as good as you are going to be.
Ask if there are ways that you could injure the surgical procedure or harm your recovery. Recovery from surgery involves a balance between increasing activity as fast as you can without damaging the procedure done. As surgeons, we would love to allow mechanics to go back to work as soon as possible after shoulder surgery, but we know that lifting cars or heavy tools in the first six weeks could disrupt the repair. Knowing what normal activities you do that could be harmful to your surgery is critical to a good outcome.