A dislocated shoulder from falling off your bike. A knee ligament torn during a pick-up basketball game. A hip worn down by years of osteoarthritis, or chronic back pain resulting from a work injury. These are just a few of the injuries and conditions that an orthopedic surgeon can help you with. And from time to time, people of all ages need this type of physician to treat acute injuries or chronic, degenerative conditions.
Dr. George J. Haidukewych, academic chairman of orthopedic surgery at Orlando Health Orthopedic Institute in Orlando, Florida, says orthopedic surgeons are “basically, the surgeons of the musculoskeletal system. There are a lot of subspecialties in orthopedic surgery, but to summarize the profession, we take care of disorders of the musculoskeletal system — bones and joints — including injuries and reconstructive surgery, broken bones, ligaments, sport injuries and arthritis.
Dr. W. Kelton Vasileff, orthopedic surgeon and sports medicine specialist at the Ohio State University Wexner Medical Center, says that as the name suggests, naturally “the focus is surgical, but also non-surgical care for musculoskeletal acute injuries and chronic problems” are part of the orthopedic surgeon’s arsenal.
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First exhausting those nonsurgical means of treating an injury or chronic condition is important, says Dr. Victor Romano, an orthopedist in Oak Park, Illinois, and author of “Finding the Source: Maximizing Your Results — With and Without Orthopaedic Surgery.” “You don’t have to go in with the intention just to operate right away. See what the injury is and see if you can help the patient to get back and functioning without surgery first,” he says.
Vasileff agrees. “The majority of orthopedic surgeons are not trying to operate on you as the first-line treatment. Most are going to try to exhaust conservative management, whether that’s anti-inflammatories, physical therapy, cortisone injections or other biologic injections. Surgery is the last resort.” Depending on the specific issue, nonsurgical approaches may also include physical braces, orthotics or other adaptive equipment.
No matter which approach is best for the condition you might be dealing with, finding the right orthopedic surgeon for your situation can be challenging, as there is a lot of subspecialization in this field, such as focusing on helping patients with bone cancer, replacing joints or treating problems in the upper or lower extremities or the back and spine. Some doctors focus on treating children, athletes or trauma patients.
To become an orthopedic surgeon, a doctor first completes medical school then goes on to complete a five-year residency program, Vasileff says. During that residency, the doctor learns surgical techniques and other ways to appropriately treat the wide range of conditions that might send a patient to an orthopedic surgeon. “There’s been a push over the past five or 10 years to try to increase that training to give people more hands-on training, whether that’s online simulation-based systems, or iPad touch-based training systems, video and mechanical-based simulators,” he says. In particular, training in arthroscopic surgery, in which small cameras are used to guide surgeries through smaller incisions, requires intensive training to build the surgeon’s skills.
After residency, most orthopedic surgeons do a year or two fellowship to further specialize. Most also pursue board-certification from the American Board of Orthopedic Surgery, which offers subspecialty certificates in hand surgery and sports medicine. This board-certification is a key signifier that the physician is good, Vasileff says, because to achieve it, the doctor must pass a rigorous two-part exam and must maintain that certification through continuing education.
In evaluating which doctor is the best for you, Haidukewych says a surgeon’s technical ability should be your top consideration. You can learn that by “looking at the surgeon’s volume. I think it’s important to ask the doctor how many of these procedures are done in a year and don’t be afraid to ask, ‘what are your outcomes and what are your complications?'” He recommends asking your primary care doctor or another doctor you trust who they would have handle their surgery if they needed it.
In addition to the surgeon’s track record of success, Haidukewych says the doctor’s training is also important. “Have they trained in a reputable orthopedic training program? Have they done additional fellowship training, which is yet another year of training beyond a routine orthopedic residency, and do they subspecialize in a specific area? All of that together will help you judge the surgeon’s technical skill, which is what you’re looking for.”
Vasileff says the search for a good orthopedic surgeon often boils down to the “three As: availability, affability and ability.” He says while you probably don’t need to be “best friends with your orthopedic surgeon,” it’s important that you trust the doctor and that your communication styles mesh well. “I think that relationship you have, that trust, has a lot to do with the success of the treatment.”
Haidukewych agrees, saying that the relationship may end up being a long-term one, especially after a joint replacement. “Once you have a joint replacement, you’re probably going to be seeing that surgeon for the rest of your life for follow-up visits, and you want to make sure you’re happy and have a good rapport and a good working relationship.” That relationship extends beyond the doctor to the rest of the office staff. He also notes that you should feel comfortable about the facility where the doctor works, especially if you’re having surgery, in case there’s a complication.
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To find this good fit, Vasileff says “getting recommendations from friends and family can always help, especially if you know anybody who works in the hospital or the office. They might be able to give you hints,” about which doctor is highly rated and works with patients with your same condition. You may also be able to find out whose communication style you’ll prefer. “Historically, orthopedic surgeons have a stereotype as being ‘high-tech, low-touch,’ and not super personable. I think that’s shifting as I think our practice across the country probably gets a little bit younger and are a little more aware of that.” Personality and technical ability are separate elements, but if you can find a doctor who has a good reputation for both, you’ll probably have a good outcome.
Both Vasileff and Haidukewych suggest checking online reviews, but keep in mind they may not tell the whole story about a doctor. “Online reviews can be somewhat helpful, but not a lot of those surveys get returned so I think it’s a small slice of the actual patients” who comment, Vasileff says.
And Haidukewych offers a word of warning about what else you might find online. “Beware of information on the internet. I’ve seen many patients tricked into spending thousands of dollars on unproven therapies that simply don’t work but are marketed heavily on the internet.” He also encourages patients to “beware of billboards. Some of the best doctors in town do not advertise.”
Before you visit with your new orthopedic surgeon, think about what you hope to get out of the interaction and what your expectations are, but understand that the doctor might have a different plan in mind. “The vast majority of orthopedic surgeons are looking out for our patients’ best interests,” Vasileff says. “It can seem a bit paternalistic, but sometimes what the patient wants is not best.”
Still, if you don’t trust what the doctor told you, Vasileff says it’s OK to get a second opinion. But don’t be surprised if the second doctor offers a similar solution. “Just because you don’t like the first answer you got doesn’t mean it’s not the right answer for you,” he says.
For any condition, especially chronic ones, you can prepare for your first visit with the doctor by gathering any records from previous doctors’ visits about the issue. This could include X-rays or other imaging results and records of any medications or surgical procedures you’ve previously had. Vasileff says it’s helpful if you come in with a “rough timeline and understanding of what the complaint is. One of the first things I ask patients is, ‘tell me the story — how long has it been hurting? Has it been the same or has it changed?'” Being able to chart how an injury or chronic condition has changed over time can help your doctor better target the problem and determine the appropriate solution.
Coming prepared with details of how the condition has changed over time goes for X-rays and records of past treatments and surgeries, too. “What treatments they’ve had, whether they’ve been to a chiropractor or had physical therapy or injections or other medications, that can be helpful info for us,” Vasileff says, to check off things that have already been tried and hopefully get to a good solution sooner.
Haidukewych says it’s also important to make sure any other medical issues you have are well managed. “It would be nice to have the medical problems optimized because we know from our research that if you are as healthy as you can be, you decrease your chances of a complication.” He says often patients need to delay a knee or hip surgery to lose weight or get their diabetes under control first.
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In some cases, surgery will be the right solution, but that’s rarely the sole treatment. For some patients, the real work begins after the last stitch is sewn. “If I do a knee replacement, that’s the easy part for them and then my job is done,” Romano says. “Then they have the hard part of rehabbing and getting back with strengthening and exercising to get the range of motion back.” This means a lot of the responsibility for getting better after orthopedic surgery lies with the patient. No pun intended, he says, “it’s a joint effort between me and the patient. I can do my part, but if they don’t do their part, they’re not going to get better,” he says.
But herein likes the appeal of this type of work. Romano says he was drawn to orthopedic surgery because unlike with general or cardiac surgery where even the most valiant of surgical efforts sometimes ends in death, with orthopedic surgery, he gets to work with “strong patients who are motivated to get better” who often have excellent outcomes. He says it’s rewarding to be able to take care of the people in his community and get them back to doing what they love quickly.
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