Preparing for Joint Surgery
If your appendix ruptures or your coronary artery is blocked, getting to surgery – quickly – could save your life. But if you need joint surgery, you can take your time. And that’s a good thing
Although the pain of arthritis is a major factor in having joint replacement, the majority of joint surgeries are elective, says Art Schoenstadt, MD, founder of the health information Web site eMedTV.com, which features more than 30 articles on joint-replacement surgeries. That means you – and only you – make the ultimate decision as to whether you will have joint surgery, he says. It also means you have the luxury of time to make the decision and to plan, once you do.
People reach the decision at different times and for different reasons. For some, joint pain becomes unbearable and is no longer relieved by exercise, medication or other conservative methods. For others, stiffness or immobility affects their ability to do their jobs, care for their homes and families or enjoy their favorite activities.
Waiting a month – or even a year or two – to pursue surgery probably won’t have lifelong effects (although many people who have waited much longer say they wish they had had it sooner). And waiting for even a short time can enable you to learn all you can about the procedure and then prepare for it – mentally, physically and financially.
In this three-part series, Arthritis Today will guide you through all the steps – from decision making to recovery.
Although joint surgery is rarely life-saving, many people can attest it can be life-changing. Preparing for surgery properly can help ensure the change is a positive one.
Know thyself
Just as there are many forms of arthritis, there are many types of arthritis surgeries.
Understanding your precise problem – torn cartilage, worn cartilage, a limb-length discrepancy or osteonecrosis (death) of the bone adjacent to the joint, for example – as well as the treatment options, is important as you consider surgery.
In many cases, it’s best to first explore nonsurgical options. By doing so, you may be able to postpone – or even eliminate – the need for surgery altogether. At the very least, it can give you the reassurance that once you do sign on for surgery, you will have checked out the options thoroughly and made an informed choice.
Knowing the basics about the surgeries for your particular joint problem can help you discuss your options with your surgeon, understand the pros and cons of each surgery, and then decide what is right for you.
Throughout this series, knowing exactly what surgery you’re having is key – for ensuring that you prepare properly and for guaranteeing proper payment by your insurance company.
Find a surgeon and then find another one
Aside from your decision to have surgery, your most important decision will be the surgeon who will perform it. There are many ways to locate an orthopaedic surgeon: through your insurance plan or a referral from your doctor; through recommendations from friends or other health professionals; or through orthopaedic hospitals, medical centers or private practices.
If your surgeon tells you that you’re not a candidate for surgery but you feel ready for it, or if he says you need surgery and you want to make sure the procedure he’s recommending is the right one for you, you’ll want to get a second opinion.
“Second opinions are one of the options we have for dealing with uncertainty,” says Nortin M. Hadler, MD, professor of medicine at the University of North Carolina (UNC) at Chapel Hill and a rheumatologist at UNC Hospitals. A second opinion can help you get comfortable with a diagnosis or make a decision when considering surgery or an experimental drug, treatment or procedure.
“You need to do whatever it takes to achieve that level of comfort,” adds Joseph D. Zuckerman, MD, professor and chairman of New York University’s Hospital for Joint Diseases, Department of Orthopaedic Surgery.
Getting a second opinion – although it took years to do so – paid off for Len Vraniak, a 41-year-old media strategist in Arlington, Va. Eight years ago, an orthopaedic surgeon told Vraniak he was too young for joint-replacement surgery. So, for the next five years he coped with the pain in his hip as best he could. But a new job and a new insurance plan meant seeing a new primary care physician, who prompted him to see a new surgeon. Learning that the life expectancies of new joints have increased made Vraniak willing to take the risk.
So, three years ago, at age 38, he underwent total hip replacement and hasn’t regretted it for a minute. “My pain is gone completely,” he says.
Ron Harnish, on the other hand, wishes he had gotten a second opinion when his orthopaedic surgeon told him two years ago, at age 56, he was too young to consider joint-replacement surgery and that a less-invasive procedure was “just a few years away.” Harnish, who, at the time, was a police detective in Florida, decided to wait for the less-invasive surgery.
His bad knees, however, forced him into early retirement, costing him his insurance. Retiring to North Carolina, he found a new orthopaedic surgeon who told him the surgery he had been waiting on already was being performed throughout the country. Angry, Harnish now wonders how he’ll afford the double knee surgery he needs, now that he’ll be paying out of pocket.
If you feel you want or need a second opinion, it’s not necessary to inform your doctor, but, contrary to what you may think, most doctors aren’t put off by it. If you do let your doctor know, she can forward your medical records to the next physician, along with a referral for insurance.
Most insurance companies cover second opinions. In fact, a second opinion often is required when surgery is involved. If your insurance requires it, letting your doctor know that can make it easier to broach the subject.
And what if the second surgeon’s recommendations are different from those of the first? It may be necessary to receive a third opinion. “Certainty should come with the interaction between the patient and the doctor. It requires a level of trust, as well as sufficient time for conversation and education,” says Dr. Hadler.
Although getting different doctors’ opinions is good, the decision to have surgery, in the end, is a personal one.
Learn all you can
To get the best results from your surgery and minimize risks, it’s important to know as much as you can about it. Your surgeon should be able to address most of your concerns. (See a list of questions below.) But you also can learn more – and prepare for the important note-taking session with your doctor – by seeking out information. Good places to start: organizations, government agencies and Web sites, including the Arthritis Foundation, the American Academy of Orthopaedic Surgeons and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Your doctor also should be able to refer you to classes offered by local hospitals for people considering or signed up for surgery. Such programs not only provide classroom-type instruction on what to expect and how to prepare, but they also offer the camaraderie and support of others who are planning the same surgery.
If you can’t attend a pre-surgery class, you can educate yourself. Meet and talk with others who are going through what you are, or who have done so in the past.
When Vraniak began planning for his hip replacement, he didn’t know anyone who had had the surgery. “But as soon as I started talking about it at work, people would say, ‘My friend just had that done – why don’t you call him?’ So I had sort of an informal network of friends of friends. I probably talked to half a dozen of them,” he says.
This network, along with information from his surgeon and his research, gave Vraniak a mental edge. He knew he was as prepared as he could be for what was ahead, as well as confident that the treatment choice he had made was the right one.
When you’ve had arthritis pain for years, as Vraniak had, it can be difficult to believe that anything will make it better. “You start thinking that’s just the way it is,” he says. “A lot of people say, ‘I’m old, and that’s what happens.’”
Now the one to share his experience and advice, Vraniak says, “Yeah, that’s what happens, but it can be fixed.”
Questions to ask your surgeon
• Have I exhausted all of the options: Other drugs? Different doses? Alternative therapies?
• Can you describe the specific surgery you’re recommending?
• What is the success rate of the surgery, and how do you define success?
• How many of these surgeries have you performed in the past year?
• What are the potential risks, and how common are they?
• Will the surgery need to be repeated in a few years? What are the risks of repeat surgeries if I should need one?
• Will there be any short-term activity restrictions following the surgery?
• How long, potentially, will I need to take off from work?
• Will there be long-term limitations?
• Do you have information I can read or a video I can watch?
• Can you connect me with other patients who have had the surgery?
Laura