5 things to consider before going under the knife
Before I start this post, I should lay out that I am not "anti-surgery," I am "anti unnecessary surgery" and "anti uninformed surgery"
I have heard the story a thousand times - I ask a patient what was going on prior to their surgery and they say, "well my pain wasn't to bad, I had some discomfort and the doctor saw some problems on the MRI and I decided to have the surgery now before things got worse" sometimes followed by the more disheartening "and I figured I would just get the right and left done to get it over with."
A lot of times I also hear at the first session, "doc said its an easy surgery, come see you guys here at PT a few times and I'll be good as new." While this may be true occasionally, this isn't the common experience post surgically.
Now I am not placing blame on all of the docs here, but "easy" is all about perspective. I would agree that a knee replacement or rotator cuff repair is probably easy for them, as they do it hundreds or thousand of times a year, but that doesn't mean it is easy for the patient. Just like doing someones taxes may be easy for an accountant, but that doesn't mean it is easy for the client to understand and accept the result. I, too as a PT am probably guilty of saying that ACL rehab is "easy" but as someone who has gone through it myself, it is very far from it.
I wanted to share with you 5 things to consider/ask prior to going under the knife for non-emergent orthopedic surgeries.
Is the likely long term outcome significantly better than what I have now?
Many orthopedic surgeries come with an accepted definition of a "successful" surgery that includes some long term limitations in range of motion or strength. For example, the ROM standard for knee flexion (bending your knee) is 135-140 degrees of motion. After a knee replacement, anything over 120 is considered a success. Similar limitations exist for shoulder replacements or rotator cuff repairs. While some patients due exceed these limitations, that is the exception not the rule. For some individuals, these limitations may not matter, but for others, they can be life changing. Having conversations where people find out -after their surgery- that they may never participate in certain activities again is tough and can lead to regret of ever having the surgery. I think it is important to know long term expectations, and ensure the surgeon's version of "good as new" is the same as your version.
2. Am I having surgery because of the results of my imaging, or my symptoms?
Although this surprises many people, imaging has nearly no correlation with pain. That means there are people walking around out there with torn tendons and "slipped" discs with absolutely no pain. So, if your pain is minimal but your doctor recommends surgery because of something on your imaging, I think a bit of clarification is in order. Some level of persistent pain after surgery is common, so if that is about equal to what you are experiencing prior AND your function is acceptable for you, is it worth the possible complications/side effects of surgery. That being said I have treated people with minor rotator cuff tears that needed surgery to function, and others with multiple full thickness tears and a compromised labrum that could still do 30 pull ups. Surgery is a serious event and should be reserved for serious problems.
3. What is the realistic timeline for recovery?
It can be tough to know how to ask this question to your doc. When you ask, "when will I be back to normal" it really depends on what your normal is. If your normal is moving from your bed to your desk job to your couch and back, that will likely be a sooner date than if you are a gym teacher or CrossFit coach who likes to lift weights and go for hikes. Rather than asking about getting back to "normal" asking about specific activities may be more effective in learning what the rehab process will be like. Although you may have told your doctor previously that you work as a plumber, they may not remember or realize the exact demands of your job.
4. Have I truly exhausted "conservative care" options
Let me ask you this, if you were having a problem with your car, you'd take it to the mechanic right? If you got it back and were still having the same problem, would you immediately sell/get rid of your car and get a new one? Or if you were having a leak in your house, which remained after the plumber came, would you move? I would hope not. Yet, I hear a lot of times, "well PT didn't work." I would urge you to do the same thing you would do in one of the scenarios above, probably either 1. call the professional you used and say, "I'm still having the same problem, do you have any other ideas you can try" or 2. find a new professional. You will have to do the PT anyway, so why not give it your full effort prior to surgery.
5. What is defined as a "successful" surgery and what is the likelihood of that outcome for me?
80% of people 18 and under who have a labrum repair in their shoulder will re-tear before age 25. Do those sound like good odds to you? They don't to me. Yet, I have seen doctors recommend many young athletes for this surgery. I have also seen rotator cuff repairs fail after what was described by the patient as "brushing up against someone at the mall" This can lead to multiple surgeries, scar tissue, long term limitations, etc. And while "secondary repairs" may be "easy" for the surgeons, the physical, mental and emotional factors can be quite difficult for the patient. Don't be afraid to ask your surgeon for the numbers on this and what factors may make a successful outcome more likely.
I know sometimes it can feel like your doctor is in and out of the room on roller skates, but remember to take an extra 5 minutes of their time, as your decision to have surgery or not can affect your entire life. Feel free to take a list of these questions in to your next appointment. If you have been told you need a surgery that you would like to avoid, email me at email@example.com for a free consult on your case.