Do I Need Surgery, Doc?

November 6, 2012

This is a common question in an orthopedic practice.  The answer lies at the end of an algorithm of treatment options based on science and physician experience.

Orthopaedic problems can be divided into those that are “surgical” and those that are not. The surgical group can be further subdivided into those with absolute (definite) indications and those with relative (reasonable) indications for surgery.

In the absolute group, there is no role for conservative treatment, and surgery is urgent or semi-urgent. These cases typically come through the Emergency Room (“ER”). Examples include open fractures and dislocations, infected joints, and deep lacerations involving nerves and tendons.

In the relative group, conservative treatment is usually tried first, prior to consideration of a surgical solution. Conservative modalities include activity modification, weight loss, Physical Therapy, bracing, anti-inflammatory medications, steroid injections, and observation.  I include the latter because, given enough time, the body will often “heal” itself.

An adequate trial of conservative treatment varies with the specific diagnosis, but generally runs 3 – 6 months. When conservative treatment fails to bring lasting relief from symptoms, surgery is considered.

For a patient at this juncture, asking the right questions of oneself and of one’s surgeon can be of great assistance in coming to a decision. Questions such as those that follow enable a patient to weigh the risks and benefits of the surgery in an informed and meaningful way.

Sample questions to ask oneself are:

Can I work and function reasonably well with my symptoms?

  •  Do I need to be on chronic pain medication to get through the day?
  •  Does the pain interrupt my sleep?
  •   If I develop a post-operative complication, will I still feel  I made the correct decision to underg0 surgery?

Sample questions to ask one’s surgeon are:

  •  What has been your experience with this procedure, and are you comfortable performing it?
  •  What is your complication rate following this procedure?
  •  When will I reach an end result, and what outcome can I reasonably expect?
  •  What will happen if I choose not to undergo the surgery?

By embracing a trial of conservative therapy and asking appropriate questions (particularly if surgery is an option) the patient becomes an active participant in his or her orthopedic treatment.

“Do I need surgery, Doc?”  Since most orthopaedic problems are not surgical, the answer is usually ‘Probably not”.  If a  patient does end up in the surgical group , however,  full participation in his or her own healthcare decision makes for a result better understood and therefore more satisfactory for both patient and physician.