What to ask your orthopedic surgeon before surgery
It’s common to have questions if a doctor has recommended you have orthopedic surgery — a procedure performed on the bones, ligaments, joints, tendons and muscles. More than 40 million visits take place each year in orthopedic offices around the United States. During these visits, medical providers take time to address any concerns.
Each orthopedic surgery differs, ranging from minimally invasive hand procedures with same-day discharge to total joint replacements requiring hospital stays and extended rehabilitation, so each surgical consult may take a slightly different approach.
According to experts, here are the best questions to ask an orthopedic surgeon to inform your decision-making and optimize your surgical outcome and recovery.
What do I need for my first appointment?
For both you and your doctor, information-gathering is a key first step at your initial appointment.
Some information to collect and give to your surgeon may include:
— Prior imaging, such as MRIs, CT scans or X-rays, related to your pain or injury
— Medical documentation from previous providers who have evaluated your injury or problem area
— A rating of your pain on a scale of 1 to 10, with 10 being the worst pain
— What your pain prevents you from doing in your everyday life
— What positions, medications or other interventions make your pain better or worse
Having this information is not only helpful for your surgeon but also matters for submitting an insurance claim for the procedure, associated hospital stay or post-hospital therapy.
When do I truly need surgery?
Orthopedic surgeons routinely explain benefits, risks and complications when discussing the possibility of surgery.
With your provider, you may want to discuss the following:
— Is the surgery necessary right now, or can it be delayed?
— Are there any other short-term interventions we can do for now?
— Are there any less invasive forms of this procedure you would recommend? For example, a partial knee replacement instead of a total knee replacement.
In some cases, it might be optimal to delay the surgery for additional conservative treatment or to have a less invasive form of surgery. Joint replacements don’t last forever. While your provider won’t want you to delay surgery if you have severe pain and inability to perform your daily activities, also discuss the possibility of the procedure failing or needing to be redone in the future.
How will you fix it?
Every provider will answer this question a little differently, says Dr. Jim Hsu, an orthopedic surgeon specializing in sports medicine at Yale Medicine in New Haven, Connecticut.
“We all have our preferences on how to best approach an orthopedic issue,” he says, adding that having “the discussion puts us on the same page and also helps patients better prepare for rehabilitation after surgery.”
Orthopedic surgery constantly has technological advancements, so this discussion, even with the same surgeon, may differ from year to year.
“There is a constant influx of new knowledge and techniques,” Hsu explains. “Every procedure I perform today, I do different than how I performed it when I started my practice in the 2000s.”
Some technological advancements in orthopedic surgery include:
— Less invasive incisions
— Smaller implants and machinery
— More natural restoration of bones and joints
— Robotic assistance
Where will you perform the surgery?
Hospital volume matters. A hospital that performs a large number of joint procedures is likely to be better equipped, explains Dr. William Hefley Jr., an orthopedic surgeon who specializes in hip, knee and shoulder surgery at Arkansas Surgical Hospital in North Little Rock, Arkansas.
Consider asking, how many of these surgeries does this hospital perform annually? How does that compare to other local hospitals?
“Chances are that hospital has rooms that are specifically designed to optimize the outcome in joint replacement,” he says.
Patients also benefit from operating room staff members with more experience.
“The surgeon is not the only pair of hands performing that procedure,” Hefley adds.
Surgical technicians, physician assistants, nurses and others all contribute their well-honed skills.
How does the hospital rate?
You can compare objective rankings of hospitals when choosing where to have an orthopedic procedure.
Ask about a hospital’s Centers for Medicare & Medicaid Services ratings, Hefley suggests. CMS’s Care Compare tool provides information about the quality of care at more than 4,000 Medicare-certified hospitals in the U.S. For each hospital, the government-hosted site combines several measures to give an overall hospital rating from one to five stars:
— Mortality
— Safety of care
— Readmission rates
— Patient experience
— Effectiveness
— Timeliness of care
You can also turn to the latest U.S. News Best Hospitals rankings and ratings. Scores are available for a variety of clinical specialties, procedures and conditions based on factors including survival, patient experience, nurse staffing and more. Top-performing hospitals for hip and knee replacement, as well as orthopedic doctors or orthopedic surgeons, are ranked so you can compare those in your location.
How many of these procedures do you perform per year?
Hsu explains that many orthopedic surgeons also work in clinics, labs, conferences and research. How many surgeries they perform each year doesn’t necessarily correlate to their clinical knowledge and expertise, but it can be a place to start.
In addition, evidence supports the importance of finding a surgeon who frequently performs a given procedure. With total hip replacements, for example, when surgeons performed a higher number of procedures, patients had lower joint dislocation rates, shorter hospital stays and costs were lower, according to a 2018 systematic review of 28 studies in The Journal of Arthroplasty.
What type of anesthesia will be used, and what are the risks?
Most orthopedic procedures will involve regional or general anesthesia. Regional anesthesia numbs the affected body part, while general anesthesia will also induce a loss of consciousness.
If you have had anesthesia before, discuss your experience with your surgeon. Anesthesia providers take many personalized factors into account, such as your weight, age and the type and duration of surgery, when deciding on anesthesia medications and dosages.
You shouldn’t feel any pain during the procedure with anesthesia, and surgeons check to make sure you are numb before they begin operating.
As with any medical procedure, anesthesia does carry some risks, which your anesthesia provider will explain to you, such as:
— Headache
— Nausea or vomiting
— Decreased breathing, or decreased urge to breathe
— Allergic reaction
Anesthesia complications are low; less than 1% of operations have any issues. Still, talk to your provider if you have a risk factor for anesthesia complications, such as:
— Diabetes
— Heart disease
— High blood pressure
— Obesity
— Seizure disorder
— Medication allergies
How long will I be in immediate recovery?
If you’re having outpatient surgery, it helps to know how many hours you’ll spend in postoperative recovery before you’re ready to go home. With more extensive surgery involving an inpatient stay, also ask how long you’re likely to be hospitalized. If you are a senior or have other health complications in addition to your orthopedic condition, you may end up needing inpatient rehabilitation at an outside facility specializing in more long-term surgical recoveries.
Have an honest conversation with your provider about your hobbies and lifestyle. If your provider knows you are an avid hiker, for example, they may be able to set expectations with you about how soon you can get back to your regular activities after a knee replacement.
How will my post-op pain be managed?
You should go into orthopedic surgery with an idea of how much pain to expect and how it will be kept under control.
Dr. Kevin Stone, an orthopedic surgeon at The Stone Clinic in San Francisco, says, “The key is to never let the patient feel pain if possible.”
He advocates for using a variety of post-op pain control methods, including:
— Local injections, like bupivacaine
— Regional blocks, like nerve blocks
— Implantation of long-acting gels, like ropivacaine or meloxicam
— Non-narcotic drugs, like Tylenol or Toradol
In addition to these, some more invasive surgeries may warrant narcotic medications, like Percocet or Norco. If you have concerns about taking narcotics or have a personal history of opioid abuse, be upfront with your provider. They can help create a pain management plan that avoids these opioids or that has a specific tapering plan for when you need to come off the medications.
How should I plan my care at home?
Your bedroom is upstairs, and you just had surgery to repair a hip fracture — now what? Ask your orthopedist about planning your homecoming in advance, Hefley advises.
Dr. Rojeh Melikian, an orthopedic surgeon at DISC Sports & Spine Center in Southern California, says that he would recommend preparing for recovery in three key ways:
— Follow a healthy diet leading up to surgery, and try to stay physically active.
— Prepare your house for your recovery. Hefley advises temporarily moving downstairs, possibly adding ramps for a split-level home or arranging for assistance in climbing stairs.
— Review your after-surgery instructions ahead of time. Then, clarify any possible issues before you leave the hospital.
While you’re recovering at home, the support of a friend or family member may be helpful, or you might consider home health care as an option. Orthopedic practices can make arrangements for a visiting physical therapist to work with you on basics like getting in and out of bed.
What kind of physical therapy will I need?
Physical therapy is important for a full recovery and the best function possible after orthopedic surgery. Your orthopedic surgeon will order physical therapy for you and can give you a sense of what it will encompass in terms of the type of exercise, frequency and length of your recovery.
“What can I do before surgery to improve my outcomes?” is another key question, Hefley says. Proactive steps can help improve outcomes, including:
— Quitting smoking
— Losing weight
— Building strength
— Going through a physical therapy rehabilitation exercise program
— Managing blood sugar if you’re diabetic
Additionally, if you take immunosuppressive medications, like methotrexate for rheumatoid arthritis, consult with a physician about pausing that medication prior to surgery and resuming after your surgical wound is healed, Hefley suggests.
When can I resume my normal activities?
Not surprisingly, this is one of the most common questions to ask an orthopedic surgeon after surgery. Getting back to driving is often the top priority, and adults and kids alike are eager to return to sports and other activities they enjoy.
However, you want to maximize your recovery and protect your still-healing incision. Hsu says that because orthopedic surgery affects the musculoskeletal system, it will impact how you move around your home and do daily activities.
“Each patient’s needs are different,” he points out.
He suggests communicating your expected activity levels, temporary activity restrictions and home environment to your provider to determine how you can ramp up to normalcy after surgery.
Is it possible that I will need to undergo a second surgery?
It’s natural to focus on surgical outcomes in the now, like how soon you’ll get better and be able to go running again. But, some surgical procedures, such as spine surgeries, have a bigger failure rate than others.
Talking to your provider about their experience in the field is paramount. Questions like, “Have you performed this procedure on a patient with similar symptoms to mine? Did they experience long-term pain relief?” can help you understand if you have a high risk of needing additional procedures.
For some complex orthopedic conditions, follow-up or secondary surgeries might be necessary. That’s something you want to know while considering the initial surgery. A reliable source to consult for orthopedic surgical statistics is the American Academy of Orthopaedic Surgeons. Your orthopedic surgeon may be a member.
Should I get a second opinion?
Seeking a second opinion regarding orthopedic surgery provides a few benefits.
— It may instill confidence. The second opinion could reaffirm that the planned surgery is the right choice for you. If you are struggling with chronic pain after attempting conservative measures but are nervous about undergoing the procedure, having another provider tell you that it sounds like the right choice can be reassuring.
— It may determine the surgery isn’t necessary. Perhaps the risk of surgery is too great with your age or an underlying condition you have. Maybe the surgery will not improve your quality of life and would end up being a more painful and expensive recovery than what it’s worth.
— It may indicate that you have other options before proceeding with surgery. Maybe the second provider has a great success rate for a specific type of pain injection that you haven’t tried. Or maybe they encourage you to finish a few more months of physical therapy before pursuing surgery.
Be upfront with your surgeon if you’re interested in a second opinion, and ask them about colleagues in their specialty they recommend you visit. A confident surgeon will not fear you seeking a second opinion.
What happened during my surgery?
Once you’ve had the surgery, don’t forget to ask your surgeon how it went and what they did during the operation.
“I have a video that I send to patients right after surgery telling them everything we did with pictures attached,” says Dr. Sean Rockett, an orthopedic surgeon and a senior partner of Orthopedics New England in Natick, Massachusetts.
He offers to take videos and pictures of the surgery as part of his surgical consent process with his patients under a secured system compliant with the federal law restricting release of medical information.
“They also want to know that their condition was bad enough to have surgery to begin with, which the photos usually confirm.”
The pictures showing the damage compared to the final product and reconstruction can be dramatic, Rockett shares.
Top questions to ask an orthopedic surgeon
— What do I need for my first appointment?
— When do I truly need surgery?
— How will you fix it?
— Where will you perform the surgery?
— How does the hospital rate?
— How many of these procedures do you perform per year?
— What type of anesthesia will be used, and what are the risks?
— How long will I be in immediate recovery?
— How will my post-op pain be managed?
— How should I plan my care at home?
— What kind of physical therapy will I need?
— When can I resume my normal activities?
— Is it possible that I’ll need to undergo a second surgery?
— Should I get a second opinion?
— What happened during my surgery?
More from U.S. News
What Are the Types of Orthopedic Doctors?
Reasons You Should Call Off a Surgery
11 Questions You Should Ask Your Cardiologist During Your First Visit
Questions to Ask an Orthopedic Surgeon originally appeared on usnews.com
Update 05/29/24: This story was previously published at an earlier date and has been updated with new information.
