As an orthopedic surgeon I spend half of my practice in the operating room and the other half evaluating patients in the clinic. Most surgeons will happily admit they most enjoy the surgical side of their practice as the variety of cases, intraoperative decision-making, and ability to directly improve patients’ quality of life make the job truly rewarding. That being said, the importance of the office visit cannot be understated.
Many patients come into my office hoping for an “easy” or “quick” fix and assume surgery will serve that role. Some surgeons are happy to accommodate, and I have found most patients can identify the doctors who fit the stereotype of the “knife-happy” surgeon. After all, “to cut is to cure,” right? Not always.
My hope in writing this post is to help you identify the main difference in performing an orthopedic surgery because we can versus doing a surgery because we should.
There is a long list of surgeries with good long-term data in the literature. Well-known examples include total hip replacement for improving quality-of-life and ACL reconstruction allowing return to jumping sports. Other commonly performed surgeries may not have quite the data to support them as first-line options. As most people age, their knees will wear out, the cartilage will begin to break down, and their menisci will tear. Traditionally, orthopedic surgeons would recommend a knee arthroscopy to “clean-out” the knee, and though a low-risk surgery, there is little data to support its effective long-term benefits. In fact, a 2013 Finnish study in the New England Journal of Medicine showed that in patients with a degenerative medial meniscus tear, surgery did not improve any outcome over the first year versus a sham operation.
While this is not the platform to debate individual cases or other surgeon’s recommendations, the literature does show that for most people with a degenerative cartilage tear in the knee, surgery is not overly effective. Options such as physical therapy, exercise, or biologic therapies, such as Platelet Rich Plasma (PRP) can be just as effective, with lower cost and risk. I find it important to stay up to date on the current literature for that reason; so that I can help my patients make the best decision for their specific problem. We can discuss the current non-operative treatments, surgical options, and outcome results for both. Given the rising costs of healthcare leading to surgeries that often cost as much as a new German sports car, it is important for me to help you in the most cost and time-effective manner.
If you find yourself in a consultation with an orthopedic surgeon, I encourage you to make sure to discuss the non-surgical and surgical options for your condition, as well as the outcomes data. No one knows your body and lifestyle better than you, and patients who fully understand their options and share in the decision making tend to be happy and satisfied long term.