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Private Orthopaedic Surgery

Dear Visitor

Based on two decades of working with patients who’ve undergone private surgery in Canada and the United States, I believe it’s absolutely critical for patients to educate themselves in order to make the most informed decision and to be fully educated on what to expect before and after surgery.

To help visitiors like yourself I’ve highlighted;

  1. Five things you need to know about orthopaedic surgery
  2. Why these five things are important to know.
  3. Twelve recommendations to make the most informed decision and reduce the risk of post-operative complications or problems.

As a matter of full disclosure,  I have no business relationship with any private surgical clinic or surgical brokerage service in Canada or the United States. I also have no business relationship with any provincial public health authority or orthopaedic governing body / organization.

I appreciate that his article may be long, but making a decision on elective private orthopaedic surgery should not be a snap decision and I believe you need to do your research.

If you know of someone considering private surgery, I invite you to share this website / article with them.

Terry Kane, Registered Physiotherapist (Calgary, Alberta).

Founder / Owner, OrthopaedicsCanada.com Network.

terrykane@orthopaedicscanada.com

Five things you need to know about Orthopaedic Surgery

 

  1. Orthopaedic surgeons don’t operate on “pain”, instead they operate to correct anatomical structures that they believe are the single and distinct source of pain and / or current disability. By correcting or restoring anatomy, the goal is that it will reduce the patient’s symptoms and improve their functional capacity.  Unfortunately as we get older, our cartilage and soft tissues degenerate and change in appearance, which can make it very difficult for surgeons to isolate the single cause of a patient’s pain (i.e. is the patient’s pain caused by a meniscal tear or arthritis? what do I operate on?).  In other situations, the cause of pain may be clearer, but there may not be a proven and accepted surgical solution to correct or fix it (i.e. multi-level arthritis of the spine).  Lastly, there are anatomical problems that can improve with proper non-surgical treatment or rehabilitation and don’t need surgery (i.e some stages of arthritis, some rotator cuff tears, some disc injuries). For these reasons, just because an x-ray or MRI shows tissue damage, does not mean a person needs surgery or that there is a proven surgical solution.
  2. As an orthopaedic surgeon once said, ‘There isn’t a joint that I can’t make worse through surgery and that’s why it’s always a last resort‘.  To ensure that patients understand the risks of elective surgery, surgeons are required to educate patients on them as well as other treatment options and important details associated with the procedure. For a list of questions that surgeons typically educate patients on, click here.  Before undergoing surgery, patients must provide informed consent by signing a legal document acknowledging that they have been informed of the risks and benefits of the surgical procedure and agree to proceed with the treatment.  Because complications can occur during and after surgery, surgeons are very very careful not to imply or use the term “guarantee” that surgery will eliminate a patient’s pain.   While you may think you hear a “guarantee” of instant pain relief it’s highly recommended to have a friend or family member present during your meeting as a second set of ears.
  3. Because surgery is highly individualized to each patient, if a patient  has a complication, question or problem after surgery, any other physician or surgeon that the patient sees will typically refer the patient back to the surgeon who performed the surgery. This isn’t personal or political,  it’s because it’s in the patient’s best interest to see the surgeon who performed their surgery and who is aware of every detail of the procedure they performed.
  4. Unlike a car that comes off an assembly line “ready-to-drive”, when a patient leaves the hospital their surgical repair, reconstruction or replacement isn’t often 100% healed and “ready-to-drive”.  Given that orthopaedic surgery often requires a period of protection or immobilization after surgery, a consequence is that surrounding joints can get stiff and muscles can get weaker.   For this reason, surgeons provide a detailed protocol that describes what patients can and cannot do after surgery.  They also provide a protocol of rehab exercises that must be done to restore range of motion and muscle strength.  Because of the importance of restoring motion and strength, surgeons are totally dependent on patients to finish the job that they started by performing surgery. Since surgeons rely on patients to follow orders and their rehabilitation protocol,  they can’t offer a “guarantee” or “warranty” because they have no control over whether the patient will do the necessary rehabilitation or won’t return to activity prematurely and damage the surgical procedure.
  5. To help identify and prevent complications and problems after surgery, orthopaedic surgeons typically (1) book face-to-face follow up visits in the first three months to ensure that the patient is on-schedule with their rehabilitation goals and (2) refer patients to a local experienced orthopaedic physiotherapist that they trust, to oversee post-operative care.   The job of a physiotherapist is to ensure that patients avoid doing “too much, too soon” and to make sure they do the necessary rehab exercise until they are finished.

Why is this article is important to you?

 

  1. Unfortunately surgery is not without risk of complications and problems.
  2. Not all complications or problems occur during surgery – in fact they often occur after surgery when patients get home. Unfortunately, I’ve seen complications in patients who’ve undergone surgery in Canada and the United States;
    1. where patients have done “too much, too soon” and damaged their surgical procedure (i.e. returned to daily activities, work or sports too soon)
    2. where patients have failed to do their prescribed rehabilitation (protocol)  and ended up with stiff joints and pain (some of whom have required additional surgery that doesn’t always work)
    3. where patients have struggled with coming off opioid and other pain medications prescribed by surgeons (i.e. dependency)
  3. If you undergo public funded surgery in your province,  and you encounter a problem or complication, you can follow up with your Canadian surgeon in Canada easily and at no charge.
  4. If you undergo private surgery, and you encounter a problem or complication, you can expect that you will have to return to your (private) surgeon at your own expense (time, travel costs +/- additional professional and clinic fees).

 

If you undergo private surgery, and you encounter a problem or complication, you can expect that you will have to return to your (private) surgeon to follow up, at your own expense (time, travel costs +/- additional professional and clinic fees).”

 

Recommendations to help make an informed decision before private surgery

 

  1. A surgeon is the ONLY person who can determine if you would benefit from surgery and ONLY after they’ve physically examined you (not by an MRI alone). The single most important question you need answered by a surgeon: Is surgery the only realistic option left to reduce your pain and / or improve the quality of your life?  You can either wait in the public queue to see a surgeon to answer this question,  or you may want to seek out a private assessment with a surgeon who specializes in your injury or condition.  If the answer is “yes”, then you can move forward to explore your private or public-funded surgical options anywhere you want.  If the answer is “no”, then you’ve just saved yourself surgery and you can explore other options.
  2. Don’t act like a Canadian and apologize for asking questions.   Deciding to undergo elective surgery is one of the most important decisions you will ever make in your life. Prepare a list of questions to ask the surgeon and ask them in order of thei importance to you.    Example: “How many times have you performed this surgery on patients my age and what kind of outcomes (results) did these patients have at one year and five years?”  (Most surgeons track outcome data and will be happy to share this information with you).
  3. Take a family member or friend to all  appointments with a surgeon and ask them to take notes during the discussion.  Review what you think you heard with the notes taken by your friend to make sure they match.
  4. Don’t sign any documents until you have all your questions answered to your satisfaction and you’ve talked with your family.
  5. Get a written list of activities you cannot do after surgery and a schedule of when you will be able to resume each activity (i.e walking, driving a car, overhead activities, lifting, work, sports)  Ask, are there some activities that you’ll never be able to do again after surgery?
  6. Before you leave the surgeon’s office, get a written copy of the surgeon’s post-operative rehabilitation protocol so you understand your responsibilities and your “job” after surgery.  How many hours a week of rehab will you have to do and for how many months? (hence why I use term “job”).
  7. Ask your surgeon if they want to see you face-to-face for follow up appointments or if there is a surgeon in your local community, that they recommend you follow up with.
  8. When you return home, your family physician will be responsible for your medical management.  Make sure to inform your family physician of your intentions to ensure they’re prepared to assume responsibility for wound care, answering questions and prescribing medications as needed.
  9. Ask for the name and telephone number of the person in the surgeon’s office that you can contact with follow up questions or in the event of a complication
  10. Ask the surgeon or staff for the name of the most experienced physiotherapist in your community.  In my experience, there is nothing more important in your post-operative care than working with the most experienced orthopaedic physiotherapist in post-operative rehabilitation. If the surgeon or facility really wants to ensure you receive the highest standard of post-operative care, they’ll do the research for you, to find you the name of a physiotherapist in your community that they trust and recommend you work with. To find an experienced orthopaedic physiotherapist in your community, visit www.orthopaedicphysiotherapy.com or www.homecarephysio.com
  11. Before surgery, see the most experienced orthopaedic physiotherapist in your community to find out (a) how much “free” physiotherapy coverage your are allowed under your public health insurance plan (b) how many physiotherapy appointments you can expect to complete your rehab (c) review your post-operative rehabilitation protocol so you understand exactly what you’ll be expected to do after surgery and how often, and lastly (d) to get a pre-operative rehab program so you’re prepared physically and mentally for surgery.
  12. Discuss with your immediate family what kind of support you will require after surgery when you return home and until you’re ready to dress and bath yourself, walk outside your home,  prepare meals and drive a vehicle to physiotherapy. You will need help and need to know you have a support system in place.

I hope this article is helpful to you and I invite you to contact me with any questions or suggestions.

[Based on feedback this article has been updated since it was originally posted September 23rd, 2017]