Most of the shoulder and knee surgery I do is elective. Therefore it is not life saving or life extending type surgery. When I see patients with an ACL tear or Rotator Cuff Tear they will frequently ask me, “should I have surgery?” For some people this question is easy to answer and for others it’s more difficult. It’s certainly much easier to answer if the problem is a fractured femur or tibia. Because of the fact that most people can cope with some level of pain I find it challenging to answer the question, “should I have surgery?” The challenge is due to the fact that pain affects everyone differently. Some problems may not cause a lot of pain but it might be just enough to affect function, i.e. the ability to work or do a serious sport. I personally have had half a dozen surgeries on my knees therefore I have some personal insight on surgery decision making. This experience has helped my council my patients more effectively. When I see that my patients are having difficulty making the decision I tell them this:
The 4 Questions You Should Ask Before Choosing Surgery:
1- If I choose NOT to have surgery now will it change anything in the future in terms of of the procedure and the outcome?If the answer is no, then there is time to pursue non operative treatment without worrying about causing further harm. For example if a patient has a non displaced, small, meniscus tear that is not causing any mechanical symptoms, it is probably safe to wait. If the patient fails to improve with time then the surgery we do in the future will probably be the same and the results will be unchanged.
2. If I elect To HAVE surgery is it likely I will be a lot better? This question is very important. Although a surgeon will never guarantee anything, a good surgeon should be able to answer this question. After all one is making the decision to have surgery so that they can have less or no pain and consequently have better function. For example if one has severe arthrofibrosis wit patella baja and post traumatic arthritis, a surgery to improve the motion is very hard to predict. The rehab after said surgery may be over 3 months. The result unfortunately may be be minimal to no improvement in motion. Alternatively ACL surgery is provides a reliably good result. Albeit, if your surgeon says that they are not sure or that its a 50/50 chance of having a good result, I would pause and re think about having the surgery.
3. Does the surgery have a high incidence of complications? Some surgeries are riskier than others. For example having a PCL and ACL and Posterolateral corner reconstruction all at the same time is much riskier than a simple ACL reconstruction. A relatively simple surgery like a achilles tear repair has a relatively moderate level of risk. If the complication rate is relatively high one may not want to expose oneself to a serious complication. If the surgeon says that the likelihood of a serious complication is really really low or extremely rare, that is good news. It may be worthwhile looking into a medical negligence lawyer just in case anything goes wrong during the procedure.
4. How long do I need to be off work. This is important because some people cannot afford to be off work for too long. When patients say how long is recovery? They usually mean to say, how long will I be out of work? Some patients cannot afford to be on crutches for more than a week. If a patient requires a microfracture chondroplasty of their knee along with an ACL reconstructin they would need to be on crutches for 6 weeks. If you cannot afford to be on crutches for any time period, it may be better to hold off on surgery.
So if you think you are going to be asking your doctor ” Should I Have Surgery? ” I hope that ” The 4 Questions You Should Ask Before Choosing To Have Any Surgery ” above will help. I believe these questions have helped my patients make better decisions about their treatment. Write these 4 questions down and take them on your next appointment.
Steve A. Mora MD
Orange County Orthopedic Knee and Shoulder Doctor
I focus on injuries related to sports related trauma, combat sports and soccer injuries. I perform mesenchymal stem cell injections derived from bone marrow and platelet pure plasma.