10 Things To Know BEFORE Having Orthopedic Surgery

1. Make sure your surgeon is BOARD CERTIFIED by the AMERICAN BOARD OF ORTHOPEDIC SURGEONS (www.ABOS.org).
While this is voluntary, it demonstrates the minimal commitment to staying current in a field of medicine. If the surgeon claims to be a “sports medicine” surgeon, make sure they hold a CAQ in Sports Medicine from the ABOS.

Prior to 1977, the AMA disallowed any advertising by doctors. Since that has changed, many medical practices have online presence via a website or social media and/or PAY for advertising (i.e. Newspaper, Phoenix Magazine, radio/television.)

Because there is no method to verify content, it is important to seek out further information on both the surgeon and any recommended procedure. Consult an expert in the field for a second opinion. Question physical therapists or other medical providers who have knowledge in the area. Ask friends or family about their personal experiences. It is important to get factual information regarding the skill and expertise of the surgeon.

Don’t overestimate the power of the media! A British study demonstrated that on popular shows like Dr. Oz and The Doctors, more than 50% of the information presented were not only unsupported by science, but in fact, 1/3 of these recommendations made by these TV Docs were blatantly disproven by science.

3. If it sounds too good to be true, be skeptical
There are over 600 billboards in the US marketing &quot;stem cell&quot; treatments as the new “cure” for everything. Current claims made by providers injecting “stem cells” are an example of this dangerous and false advertising. Do your homework before paying out-of- pocket for these injections, as they are NOT FDA APPROVED, nor covered by any insurance. They also have not been proven effective nor safe for many conditions for which they are being used. In fact, the use of REAL stem cells is prohibited in the US unless under an FDA study protocol. What many medical clinics claim to be stem cells are actually a mix of cells and other components of blood or bone marrow. For example, the use of bone marrow injections as a source of stem cells has been shown to contain <0.01% stem cells. What are you paying to have injected then and why? Don’t go on blind faith, seek evidence instead.

4. Ask the surgeon about their training, practice focus, expertise and outcomes
To be an excellent surgeon, one has to not only be knowledgeable with human anatomy/physiology/biomechanics, but must also be SKILLED with their hands. This is “the art of surgery” and has been proven to be difficult to teach. A level of innate talent must first be present and then fine-tuned via training and experience. Studies have shown that it takes 10 years or 10,000 hours to master a craft that requires fine motor skills such as those needed to perform surgery. When choosing a surgeon, remember that the more specialized the surgeon, the more proficient in that area of expertise. Therefore, it is more advantageous to seek out a specialist.

You may always ask for their CV (curriculum vitae or resume) which should list academic training, skills training, professional affiliations, publications (peer reviewed papers and book chapters), lectures/presentations even consultant positions.

5. ALWAYS understand your options.
There are many ways to solve problems – all have risks and benefits. Sometimes, surgery is the best answer, while other times it may be the 2nd or 3rd choice. As the human body is dynamic, waiting too long to do surgery can have negative implications. On the other hand, performing unnecessary surgery can be harmful as well.

6. MRI is not always needed
In the hands of an experienced specialist, a history and focused physical exam by the PHYSICIAN (not a physician assistant or other mid-level provider) and specialized x-rays are all that is needed to reach a specific diagnosis. Advanced imaging such as MRI or CT (Cat Scan) is done to CONFIRM the diagnosis and provide information for surgical planning. If a physician cannot be specific about the suspected diagnosis after speaking with you and examining you PERSONALLY, then he/she is not an expert. Simply treating “test results” is inappropriate and dangerous!

7. If a physician gets upset or offended by you stating your desire for a second opinion, leave and do not return!
Physicians should be concerned about seeking the best care and treatment of their patients. One of the most important factors contributing to successful outcomes is a patient’s comfort with the understanding of their condition and optional remedies.

8. Arthroscopy is a TOOL not a procedure
Arthroscopic surgery is typically better than any open surgery of the knee and shoulder, outside of joint replacement. Although Arthroscopic techniques (for example: ACL surgery or massive tears of the rotator cuff), result in a faster and less painful recovery, and can be used for nearly every procedure,  they are more complicated and technically demanding. It is important to understand that surgeons use the tools that work best for them. Therefore, a surgeon who is not comfortable or skilled at arthroscopy may be better off recommending/performing older open versions of the same surgery.

9. Have appropriate expectations!
This requires education on the part of patients via their surgeon and reputable online resources. The AAOS is the premier site for patient education in Orthopedic Surgery. For the scientifically inclined,  dearches on PUBMED can provide useful information on the peer reviewed literature and outcomes of a
variety of treatment methods.

THIS IS YOUR BODY! Do not be shy or intimidated. The surgeon should see you at the initial consultation and at every major appointment, thereafter. For quality of care, a physician assistant should not see patients unsupervised or on a frequent basis. How much your surgeon cares can often (but not always) be determined by how much time and effort they put in to communicate with you personally via office visits, email or phone.

David S Bailie MD
Arizona Institute for Sports Knees and Shoulders, LLC
Chief Medical Officer, Integrated Endoscopy