Are you planning to undergo orthopedic surgery? Here are the top questions you should ask your orthopedic surgeon before the procedure.
By Lisa Esposito and Payton Sy, RN
This article is based on reporting that features expert sources.
Find out what’s at stake with your surgery.
Orthopedic surgeries — procedures performed on the bones, ligaments, joints, tendons and muscles — range from minimally invasive hand procedures to total hip replacements and everything in between.
For some procedures, it’s common practice to have a same-day discharge. For others, you may need to stay in the hospital for multiple days and have long-term rehabilitation and physical therapy. Each orthopedic procedure is unique, so it’s important to learn what to expect before committing to surgery.
Read on as experts walk us through the best questions to ask an orthopedic surgeon to inform your decision-making and optimize your surgical outcomes.
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. For instance, Dr. Charla Fischer, an orthopedic surgeon at NYU Langone Spine Center in New York City, suggests that when patients schedule their visit, they ask about any potential imaging that will be done. If you have prior imaging tests, Fischer adds, it helps to bring them along.
Patients should also be ready to discuss their condition. Fischer asks a series of questions that she says 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? What treatments have you already tried?
When do I truly need surgery?
Orthopedic surgeons routinely explain benefits, risks and complications when 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, (that time) is 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 explains. 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.”
In some cases, it might be optimal to delay the surgery for additional conservative treatment or to have a less invasive form of surgery. This is one of the common questions to ask before knee or hip replacement surgery, for example. The surgeon could replace part of a knee joint rather than the entire knee or replace the hip causing you the most pain first, rather than replacing both hips at the same time.
Where will you perform the surgery?
Hospital volume also 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.
“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, or CMS, ratings, Hefley suggests. Their Care Compare 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 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?
“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 adds, ask your surgeon how many cases of your specific procedure they do in a year.
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.
Will I feel anything during surgery?
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.
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.
Having engaged parents during a child’s hospital stay may actually improve physical and emotional health outcomes for the child, according to some research, so it’s natural to wonder if you’ll be allowed to stay with your child.
Every hospital will have a different visitor policy, and children’s hospitals usually welcome parents and guardians with open arms. The hospital may restrict visitors to certain hours of the day, such as at nighttime or during the hours of nurse reports, or they might restrict the number of visitors per patient.
Many hospitals still have some type of COVID policy in place pertaining to visitors or mask-wearing while in the building as well. Call the hospital to confirm their visitor policies, and ask them if they have any tours available for you and your child to see the unit.
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.
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.
“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.
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.
In addition, Fischer says, it’s important for orthopedic practices to arrange visits with a home health nurse for recent surgical patients as needed. Nurses can check that patients’ vital signs are stable, monitor their pain and make sure their incisions are doing well.
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 measures patients might take to improve outcomes include quitting smoking, losing weight and building lower extremity strength. Going through a physical therapy rehabilitation exercise program might help you even before surgery.
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. Your surgeon should give you guidelines on when it’s safe to resume various activities.
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. In fact, some surgical procedures have a bigger failure rate than others, like spine surgeries.
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.
Follow-up or secondary surgeries might also 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. 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 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.
On the other hand, a second opinion 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.
Top questions to ask an orthopedic surgeon
- What do I need for my first appointment?
- When do I truly need surgery?
- Where will you perform the surgery?
- How does the hospital rate?
- How many of these procedures do you perform per year?
- Will I feel anything during surgery?
- How long will I be in immediate recovery?
- Can I stay with my child who will be hospitalized overnight?
- 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?
Source
Charla Fischer, MD
Fischer is an orthopedic surgeon at NYU Langone Spine Center in New York City.
William F. Hefley Jr., MD
Hefley is an orthopedic surgeon who specializes in hip, knee and shoulder surgery at Arkansas Surgical Hospital in North Little Rock, Arkansas.
