A week or two ago, a patient whom we had been treating at BPC had surgery to reconstruct her injured ankle. She had quite a lot of questions about how and when we make the call to send a person to a surgeon, so I thought some of you might like to know more.
That decision isn’t always simple, because there are many factors we take into account. Of course the vast majority of injuries we treat don’t need surgery, or have already had surgery and are coming to see us for rehabilitation. For those people there isn’t any confusion.
But if you have, for example, a ruptured ligament leaving your knee, shoulder or ankle unstable, how do we make the decision to refer you on? Here are a few things we consider:
Will you make a full functional recovery without surgery (being able to do everything you could do before in spite of the injury)?
If the answer is most likely “yes”, we probably won’t send you to a surgeon.
What will you need the injured part to do?
Sometimes the need for surgery is determined by activity levels, for example playing contact sport versus just being able to walk safely and comfortably. This can be a significant factor in making a decision about having surgery.
Is this the first time you have done it, or has this happened before?
With some injuries, surgery is only recommended for an injury if the problem has been recurrent.
Your age
Your joints change as you age and so does the number of years you would be expected to need the joint into the future. This has implications for surgical interventions. Some procedures, such as knee reconstructions are more likely to be recommended for younger people (generally adults), while others, such as joint replacement surgery are more often suggested only for older people.
Are you getting better?
We don’t have the ability to see into the future, so we make clinical decisions based on our previous experience and accepted clinical best practice. One of the most important factors we take into account is whether you are getting better. It makes sense not to change the treatment approach if recovery is going well. On the other hand, in many conditions, surgery may be recommended when, or if, improvement is not satisfactory.
Scans and x-rays
Contrary to common belief, x-rays, ultrasound, CT and MRI scans are normally not the most important part of the decision making process. I have purposely left this well down the list, where it belongs, because the previous factors are more important in most cases. Sometimes, with a fracture, for example, the decision is generally clear cut, but in most musculoskeletal conditions these investigations are only a part of the data.
Because of this, we sometimes discourage people from getting radiological investigations done. As often as not, there is information that can be misleading and can cloud the decision making process. Not to mention leaving you with unnecessary worry. Patients often come to us with misleading information that has arisen from radiological reports offering misleading information.
If in doubt, ask your physiotherapist.
Do you want surgery?
The final, and most important factor is whether you, the patient wants to have surgery. If there is a chance a surgical procedure might help you to recover, or recover more quickly, our clinical team will normally discuss this with you early in your treatment programme. If you are concerned, please ask your treating therapist. We love to share information and we want you to be informed so you can make the best decision for your own circumstances.
I hope this has been helpful. Please let us know if there are any topics that you would like covered in future newsletters.
Warm Regards,
Roy Daniell