Find out what's at stake with your surgery.
Orthopedic surgery could be anything from a minimally invasive procedure to a complex reconstruction involving hours on the operating table. Your post-op recovery could range from a short period of discomfort with your limb propped on a pillow to weeks of pain management and physical therapy to get you back on your feet.
Before committing to surgery, learn all you can about what to expect. Read on as experts walk you through which questions to ask to make the best decisions and optimize your surgical outcomes.
What do I need for my first appointment?
Information gathering is key to your first appointment with an orthopedic specialist -- both for you and your new doctor. "When patients schedule their appointment when they first come to see me, they should find out if there's any imaging that will be done the day of the appointment," says Dr. Charla Fischer, an orthopedic surgeon at NYU Langone Spine Center in New York City.
If you have prior imaging tests, it can help to bring them along, says Fischer, who is also an American Academy of Orthopaedic Surgeons spokesperson. Although she asks new patients questions like these from a spinal perspective, they can apply to almost any bone or joint condition: Where is your pain? Can you rate it on a scale from 1 to 10? What kinds of positions and activities make you feel better or worse? How long has the problem been going on?
When do I truly need surgery?
Orthopedic surgeons routinely explain benefits, risks and complications when you're discussing the possibility of surgery. Timing is also important. Do you need the surgery right away or can it be delayed? What are your other alternatives, at least for now? A common conversation between Fischer and her patients centers on how much a condition like a herniated disc is interfering with their lives and whether that's becoming intolerable.
"Usually, it's when all the conservative treatments aren't helping and (patients) are at a functional point where they feel they're just not getting much out of their daily lives because they're in so much pain," Fischer says. For an adolescent patient with scoliosis, she says, the tipping point might be: "Your curve has reached 50 degrees and we need to do surgery to prevent it from getting worse."
Is it possible that I'll 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 you should also ask about how surgery will affect you in the next one, five or 10 years, says Dr. Daniel Green, a pediatric orthopedic surgeon at the Hospital for Special Surgery in New York City. "Sometimes we almost have to take a time out with patients and say: Let's talk about what's the best way for this to heal long term, so you can have your best long-term recovery."
Follow-up or secondary surgeries might be needed for some complex orthopedic conditions. That's something you want to know while you're still weighing the need for the initial surgery.
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 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.
Patients should also know about immediate postoperative expectations, Green says. Will you be walking the first day? Will therapy start that evening or the next morning? For more severe cases, you might need to be in bed a day or two, or start off with a wheelchair. "Setting those expectations about how your mobility will progress is very important," he says.
Can I stay with my child who will be hospitalized overnight?
A common question from parents is: Can I stay with my child that night in the hospital? Green says. (And if so, is a bed available?) "In most children's hospitals, there are set-ups so one parent can spend the night," he says. "Most hospitals are flexible with visits by siblings." However, he notes, "Most hospitals do not promote bringing in the class and having a birthday party."
To increase your child's comfort level, and your own, he suggests also asking: "Could my child visit the hospital unit in advance?" Some hospital child life specialists arrange for kids to visit an operating room and see equipment before they undergo surgery. From a child's perspective, Green says, you're less afraid of what you know.
Will I feel anything during surgery?
Being awake or aware while under the knife is a common apprehension among patients. Fortunately, fears of feeling pain during surgery are largely unfounded. When patients ask, Green says, "I reassure them I haven't seen that happen with the modern era of anesthesia and the great anesthesia teams we have." Anesthesia prevents you from feeling pain during a procedure.
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. It's also important to clarify whether opioid medication might be needed. "We're really big on multimodal anesthesia, meaning not just narcotics but also medications to minimize the amount of narcotics," Fischer says.
Gone are the days when patients routinely went home with a week's worth or more of prescription opioid pain medicine, for instance after a major knee surgery, Green says. "Nowadays, it's probably: Go home with a two- or three-day supply and don't take it unless you need it," he says, with instructions to safely dispose of any extra pills. "We're talking more about the alternatives to narcotic medications -- which could be ice, elevation, Advil or Tylenol -- than we used to."
What kind of physical therapy will I need?
Physical therapy is important for full recovery and the best function possible after orthopedic surgery. Your orthopedic surgeon can give you a sense of what PT will encompass for you in terms of specific exercises and the frequency and length of your PT course.
"What can I do before surgery to improve my outcomes?" is another key question, says Dr. William Hefley Jr., an orthopedic surgeon who specializes in hip, knee and shoulder surgery at Arkansas Surgical Hospital in North Little Rock, Arkansas. Proactive measures patients might take to improve outcomes include quitting smoking, losing weight and building lower extremity strength. Going through a physical therapy prehabilitation exercise program is one way PT might help you even before surgery.
How should I plan to care for myself 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. "You don't want to leave the hospital and not have someone with you when you go home," he says. "You want to prepare your house." You can address mobility barriers by temporarily moving downstairs, possibly adding ramps for a split-level home or arranging for assistance in climbing stairs, he suggests. It's about thinking through your home environment to ensure you have a safe place for rehab and recovery.
Will I need help at home during my recovery?
After a major orthopedic surgery, performing everyday functions can be challenging, and traveling for follow-up appointments might be almost impossible. Ask about your doctor about your health care needs at home, Fischer advises.
The support of a friend or family member may suffice, 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. In addition, Fischer says, it's important for orthopedic practices to arrange visits with a home health nurse for recent surgical patients as needed, to check that their vital signs are stable and make sure their incisions are doing well.
How many of these procedures do you perform per year?
Experience counts. "Having a surgical procedure is a big day in your life," Hefley says. "It's potentially life-changing in either direction." To improve your odds of getting a great outcome, he says, ask your surgeon how many cases of your specific procedure he or she does in a year.
Evidence supports the importance of finding a surgeon who frequently performs a given procedure. With total hip replacements, when surgeons performed a higher number of procedures patients had lower joint dislocation rates and shorter hospital stays, and costs were lower as well, according to a systematic review of 28 studies in the October 2018 Journal of Arthroplasty. Similarly, when surgeons performed more total knee replacements, patients also fared better. Knee replacements done by surgeons who performed a low volume of the procedure, with "low volume" defined differently from study to study, was associated with a higher infection rate, longer procedure time, longer hospital stay, more transfusions (which are necessitated by blood loss during surgery) and worse patient-reported outcomes in an earlier systematic review of 11 studies published in BMC Musculoskeletal Disorders.
Where will you perform the surgery?
Hospital volume also matters. A hospital that does a large volume of joint procedures is likely to be better equipped, Hefley says. "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, he adds: "The surgeon is not the only pair of hands performing that procedure." Surgical technicians, physician assistants, circulating nurses and others all contribute their well-honed skills.
Greater familiarity and experience with orthopedic procedures makes another notable difference: A U.S. News analysis found that the more cases of hip or knee replacement a hospital performs, the fewer deaths result from either procedure.
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 CMS ratings, Hefley suggests. Hospital Compare, from the Centers for Medicare & Medicaid Services, 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 gives an overall hospital rating from one to five stars. Mortality, safety of care, readmission rates, patient experience, effectiveness and timeliness of care are the measures combined to arrive at overall ratings.
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 safety, 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.
Should I get a second opinion?
"If there's any confusion or doubt on the patient's side about the diagnosis or treatment plan, it's OK to get a second opinion," Green says. "It's also OK to ask the physician if they think it's a good idea to get a second opinion." Doctors may be able to recommend a colleague or peer who has specialized knowledge regarding a specific orthopedic condition or procedure.
Physicians are accustomed to this question and rarely insulted, Green notes. Another way to phrase this, he says, is to ask: "Is there anybody else in our area that has expertise about this particular diagnosis that you think I should see for a second opinion?"
When can I resume my normal activities?
Not surprisingly, this is one of the most common questions that orthopedic surgeons hear from patients and parents. 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. You should receive guidelines on when it's safe to resume various activities.
Questions to Ask an Orthopedic Surgeon
Having surgery? Ask your orthopedic surgeons about issues like these in advance:
-- What do I need for my first appointment?
-- When do I truly need surgery?
-- Is it possible that I'll need to undergo a second surgery?
-- How long will I be in immediate recovery?
-- Can I stay with my child who will be hospitalized overnight?
-- Will I feel anything during surgery?
-- How will my post-op pain be managed?
-- What kind of physical therapy will I need?
-- How should I plan to care for myself at home?
-- Will I need help at home during my recovery?
-- How many of these procedures do you perform per year?
-- Where will you perform the surgery?
-- How does the hospital rate?
-- Should I get a second opinion?
-- When can I resume my normal activities?