Basics of Surgery for Arthritis.
Last updated Thursday, December 30, 2004
Is surgery right for you?How can a person with arthritis learn about a possible surgery? The decision to have surgery is a major one. It is not a decision to be made quickly or without good reasons.
Before you decide to have surgery, be sure to learn what operation
is being suggested, what are the alternatives, what are the risks and
what is involved in the recovery process. Don't be shy about asking
lots of questions of your surgeon, including information on his or her
success record with the particular procedure.
As you consider whether or not to have surgery, keep in mind that
every person's needs are different. Your doctor may inform you that
surgery won't give you the results you want. If your doctor thinks that
surgery can help you, there are still many things you need to know. What questions should a person with arthritis ask about a possible surgery? Preparing mentally and physically for surgery is an important step
toward a successful result. People who understand and are knowledgeable
about the process have swifter recoveries and fewer problems.
Sometimes it may be hard to remember what you want to ask the doctor
unless you write down your questions. Here are some questions you may
want to ask.
About the surgery
- What other kinds of treatment may I have other than surgery?
- How successful will these treatments be?
- Can you explain the operation?
- Do you have written materials or videotapes on this surgery that I can review?
- How long will the surgery take?
- Can surgery be performed as an outpatient?
- What risks are involved in the surgery? How likely are they?
- Are blood transfusions necessary, and if so, can I donate my own blood?
- What type of anesthesia will I have? What are the risks?
- How much improvement can I expect from the surgery?
- Will more surgery be necessary?
- If surgery is chosen, will you contact my family doctor? Will he or she be involved in my hospital stay? In what way?
- Are you Board Certified, and do you have a special interest in arthritis surgery?
- What is your experience doing this type of surgery?
- Would you give me the name of another person who has undergone this surgery who would talk to me about it?
- Is an exercise program recommended before and after the operation?
- Must I stop any of my medications before surgery?
- What happens if I delay surgery?
- What are the risks if I don't have the surgery?
After the surgery
- How long will I stay in the hospital?
- How
much pain will there be? Will I receive medication for it? What kind of
pain is normal to expect? How long will this pain last?
- How long do I have to stay in bed?
- When do I start physical therapy? Will I need home or outpatient therapy?
- May I review written materials or videotapes concerning this phase
- of my care?
- Are
physical therapy, occupational therapy, and home health care covered by
insurance? (You may need to address this question to your insurance
company.)
- Will I need to arrange for special help at home? If so, for how long? Is it covered by my insurance?
- What medications will I need at home, and how long will I need to take them?
- What limits will there be on my activities-driving, using the toilet, climbing stairs, bending, eating, sex?
- How often will I have follow-up visits with you? Are they covered by insurance? Are they included in the cost of the surgery?
How should a person with arthritis prepare for surgery? If you have serious problems with your lungs or heart disease, the
strain of some types of surgery may be too much for you. Before any
kind of surgery, it's important to have other health problems under
control.
In addition, any type of bacterial infection must be cleared up
before surgery. One possible problem after joint surgery is infection,
which can spread from one part of the body to another through the
bloodstream.
If you smoke, you should stop prior to surgery if you can.
Diet
is an important factor in general health and becomes especially
important in times of stress, such as around the time of surgery. It is
best to eat foods that are rich in nutrients prior to surgery and
during the entire first year after surgery. Vitamin C is especially
important because it enhances the healing process.
Do not take aspirin or aspirin-like medications
for three days before surgery. These medications interfere with blood
clotting. If you take cortisone, prednisone, or any steroid medication,
you must tell your surgeon before the operation. These medications
should not be stopped before or after surgery.
Occasionally people develop blood clots in their legs or arms after
surgery. The risk of this may be decreased by using blood-thinning
drugs. Discuss this and other potential problems with your surgeon.
Being overweight may put extra stress on the heart and lungs. Also,
if the surgery is on a weight-bearing joint (like a hip or knee),
recovery of the joint may be slower. Excess weight puts added strain on
the joint and makes it harder to do the exercises needed to make the
joint stronger after surgery. How important is the recovery process for surgery for arthritis? Before you decide on surgery, you must be aware that you have to
follow a strict treatment plan after the operation. It's important to
realize that the operation is only the first step toward restoring
joint function.
The amount of work you put into the recovery process often makes the
difference between success and failure. Your doctor's orders regarding
medication, joint protection, rest, exercise, physical therapy, and the
possible use of splints must be followed very carefully. If you don't
believe you can follow through on all your prescribed care, then
surgery may not be the best treatment for you.
After the surgery
Depending on the type of surgery, your doctor will usually prescribe
a period of rest, physical therapy, and limited activity. Before you
decide on surgery, make sure your household can be arranged so that
your full recovery is possible. You may need days or weeks of rest. In
addition, you may need to use splints, a cane, a walker, a wheelchair,
or crutches before you are able to perform your usual tasks. Talk with
your doctor about any short-term limitations and what you can expect
during the recovery period. You may also be referred to an occupational
therapist for advice on how to do your daily activities in ways that
are safe for your joints.
If your surgery involved your hand(s) or arm(s), you will most
likely be able to get up the first day after the operation. If it
involved one or both legs, how soon you are allowed out of bed will
depend on the surgery. Often, you will be able to get up the first day
after surgery, but it may be longer. Once your doctor has given
permission for you to get up, you will begin to feel better the more
you move around.
Physical therapy
As soon as you're able and depending on the type of surgery you've
had, you will begin physical therapy consisting of various exercises.
You must dedicate yourself to this program and be prepared to work
hard. If you don't, your repaired joint may be less useful than it
could be.
Some pain is common during the early stages of physical therapy.
This pain usually comes from the muscles, not the joint. Some of your
muscles have not been used much or may have been working in abnormal
ways to protect a sore joint. Some muscles may have been cut and
stitched during surgery. It is important to realize that muscles
strengthen in response to exercise. An exercise that hurts today may
hurt a little less tomorrow. You will see improvements in range of
motion, along with decreased pain, as time goes on.
You will have to work hard for the first few weeks after surgery to
achieve range of motion, and a little less so for several months after
that to regain strength. As time goes on, keeping up with your physical
therapy requires dedication. You may find that you're bored with the
exercises, and you may be tempted to slack off. Don't! Remember that it
takes time, but the rewards can be great. You should start to see some
encouraging results, such as the ability to perform a task that was too
painful to do before surgery. The combined efforts of your doctors,
nurses, therapists--and most important--yourself are essential to
success. How can a person with arthritis learn about the costs of surgery? Costs will vary depending on the surgeon, anesthesiologist,
admitting physician, hospital, type of surgery performed, medication,
physical therapy requirements, types of implants used, and any other
special tests or treatments. Check with your doctor, insurance company,
and if you qualify, Medicaid or Medicare to find out what your coverage
includes. Do this before the surgery so you won't have any unpleasant
surprises. A hospital stay is expensive.
If you've already spent time in the hospital during the year, you
should check your insurance policy for benefits coverage during the
remainder of the year. You will probably want to check on the managed
care requirements of your policy, which may include second surgical
opinions and assigned length-of-stay designations. Who makes the final decision about surgery for arthritis? Joint surgery is not for everybody. Even if your doctor and surgeon
determine your condition would be improved by surgery, the decision to
have the operation is up to you. You need to weigh your options and
understand what the surgery will involve--before, during, and after
surgery, and over the months of physical therapy. It will require
patience and the willingness to follow through with physical therapy.
Your commitment is the key ingredient in the success of joint surgery.
If you're not sure about having surgery, ask for a second opinion
from another doctor. Ask your doctor to suggest a surgeon with
arthritis experience. Sign a release form and ask that your medical
records and X-rays be sen to the consulting physician. Consider the
advice of all your doctors carefully.
Doctors, nurses, physical and occupational therapists, and social
workers are part of the team that will work to make the surgery a
success. Your family and friends are also members of the team. Look to
them for emotional support and for assistance during your recovery. But
the most important team member is you.
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