To determine your surgeon’s experience level, ask how many operations for your specific injury he or she performs each year.
By W. Thomas Gutowski, M.D. Princeton HealthCare System
With millions of Americans being treated for musculoskeletal injuries each year, chances are you or someone you know will need orthopedic care at some point in your life. One in 7 people in the United States has a musculoskeletal impairment ranging from a muscle strain to a broken hip, according to the American Academy of Orthopedic Surgeons.
So when you find yourself headed to the orthopedic surgeon’s office with a bad knee or a torn rotator cuff, here are 10 important questions you should consider:
1. How do I know I need an orthopedic surgeon?
Orthopedic surgeons treat a wide range of diseases and injuries of the musculoskeletal system, which includes your bones, joints, ligaments, tendons, muscles, and nerves. Generally, if your condition isn’t causing any disability, your primary care provider will likely be able to treat it. However, if you experience numbness or tingling or your condition is disabling — for example, your knee locks every time you get up from a chair — you likely need an orthopedic surgeon.
2. What type of orthopedic surgeon should I see?
Today, most orthopedic surgeons are part of a large practice that offers a range of services from joint replacement to sports therapy and has a variety of specialists on staff. Often, your primary care provider will refer you to the appropriate surgeon.
3. Is my surgeon board- certified?
Board certification means your surgeon has met the specified educational, evaluation, and examination requirements of the American Board of Orthopedic Surgery. Once board-certified, some surgeons pursue fellowships in a specific area of orthopedic surgery. A fellowship represents an additional year of focused training.
4. What is my surgeon’s breadth of experience in my particular procedure?
If you have a shoulder injury, you wouldn’t see a surgeon who specializes in foot problems, and vice versa. Your surgeon should be an expert in the specific surgery you need. To determine your surgeon’s experience level, ask how many operations for your specific injury he or she performs each year. Research indicates that surgeons should complete between 25 and 50 of the same operation annually to be maximally competent.
5. What are my treatment options?
In non-emergency situations, the last thing you want to do is rush into surgery. Depending on your injury, treatment options may include physical therapy, a Cortisone shot, acupuncture or just plain, old-fashioned rest. Surgery, in many respects, should be the last option.
6. What is the diagnostic process?
During your first visit with your orthopedic surgeon, be prepared to explain your symptoms and how they impact your life. In most cases, your surgeon will order X-rays to aid in making a diagnosis. In some cases, an MRI scan or other tests may also be necessary.
7. What if my doctor recommends an MRI?
If your doctor recommends an MRI, the machine should have a magnet strength of at least 1.5 Tesla and ideally 3 Tesla. The greater the magnet strength, the clearer the picture, and the more accurate the diagnosis.
It is critical that your image be interpreted by a board-certified radiologist. The radiologist will then issue a report to your surgeon. Your surgeon, however, should look at the scan him- or herself. You should also look at your report.
8. What are the risks of surgery?
There are always risks with any type of surgery. Despite doctors’ best efforts, infection or blood clots could occur. You may experience a stiff joint due to scar tissue. Anesthesia could cause complications. We tend to take success for granted, but we always want to temper our enthusiasm with an honest discussion about the pitfalls.
9. When can I resume normal activities such as working, driving, and exercising? What can I do to speed my recovery?
It’s important you have a clear understanding from your orthopedic surgeon of how long it will take to recover from surgery. If the surgery is minor, you may be able to return to work in a few days. If your surgery is significant, your recovery may take several weeks. Rehabilitation and conditioning are keys to a smooth recovery. Additionally, if you are overweight, your surgeon may recommend a weight loss program to relieve the burden on your muscles and joints.
If you have a hip or knee replacement, you should have little problem with most activity, including swimming, biking, walking, skiing, and tennis. Runners, however, are discouraged from competitive long-distance running. Jumping, which means basketball, is also discouraged.
10. What are the consequences of whatever device may be implanted during surgery?
Most metal devices used in orthopedic surgeries today are compatible with MRI machines, but it remains critical to advise the radiologist of any implants prior to any scans. Most devices — such as plates and screws — can remain in your body for life and won’t need to be removed. Joint replacement devices when well cared for can reasonably last for upward of 15 years.
Metal implants are certain to set off airport scanners, requiring travelers to undergo a separate wand scan. Patients are advised to carry a card — issued by their surgeon — advising security personnel of the implants.
Finally, when it comes to your orthopedic surgery, you should select a doctor who understands your needs and is attentive to your questions. Most importantly, you should feel confident, comfortable and conversant with the surgeon you choose.
W. Thomas Gutowski, M.D., FAAOS, is board-certified in orthopedic surgery and a member of the medical staff at University Medical Center at Princeton, which is ranked among the top hospitals in New Jersey for overall joint replacement surgery by HealthGrades.