Many people experience hip, knee and shoulder pain, and reach out to their doctors for help. Every year, millions of people complain of pain in their hips, knees and shoulders. However, not all of those complaints result in surgery. For example, even though there were 18.6 million doctor visits for knee pain in 2010, just 645,062 total knee replacements were performed in 2011.
Do I Need Surgery?
Before deciding on surgery, your doctor will opt for non-surgical treatments such as medication, physical therapy and lifestyle changes. While those options do work for many people, musculoskeletal pain that occurs in the hip, knee and shoulder may require surgery, but how do you know if you need an operation?
Here are some ways to determine if surgery might be the best treatment for you.
1. Non-Surgical Options Are Not Working
Before deciding surgery is the best course of action, doctors will first take a more conservative approach to treatment. The most common first-line treatments for hip, shoulder and knee pain include:
Medication - Your doctor might prescribe medication to help manage your symptoms and improve your condition. Common medications prescribed for hip, shoulder and knee pain are opioids. If you are suffering from a minor, short-term condition, medication might be the only treatment you need. Short-term conditions will typically resolve within days to weeks with the help of medication. For more persistent orthopedic conditions, such as tendonitis or arthritis, your doctor may opt to administer cortisone shots. Cortisone, a type of steroid, has anti-inflammatory effects, which can reduce symptoms. Cortisone shots are a limited option because repeated injections could cause joint deterioration. Typically, patients will not receive cortisone shots more than three to four times annually. Like cortisone shots, other common medications are meant to be prescribed temporarily.
Physical Therapy - Musculoskeletal pain can be caused by all sorts of underlying issues related to your bones, muscles, tendons, ligaments and joints. Physical therapy is a common treatment option to help people reduce pain and recover full function in the affected part of the body. Physical therapy involves a variety of exercises designed to improve strength, flexibility, range of motion, balance and endurance. Physical therapy can also include other treatments like massage and electrical stimulation. What type of exercises you do and how often you do them will be determined by your physical therapist and your kind of injury. Your physical therapist may also recommend ice or heat for your injury. Typically, physical therapy is prescribed for a set period with specific goals in mind. You, your doctor and your physical therapist will track your progress and reassess what needs to be done after that specific period.
Lifestyle Changes - Some joint pain issues can be addressed with changes to your lifestyle. Your doctor may talk to you about potential changes to your diet and exercise routine. Certain supplements, such as fish oil, can help improve joint pain with natural anti-inflammatory properties. A healthier diet can also contribute to weight loss. Excess weight on the body can stress the joints and cause pain. Likewise, exercise can help people lose weight and improve range of motion in their joints. Lifestyle changes like this take time and dedication before beginning to make a difference. Talk with your doctor about goals and expectations. If none of these options are reducing your pain and helping your condition improve, it is time to talk about surgery with your sports doctor.
2. Your Pain Is Unmanageable
Some orthopedic issues, such as a fracture or a worn out joint, require surgery. If your pain level is unmanageable, you need to have a discussion with a surgeon right away. If you find yourself struggling to move because of pain in your hip, knee or shoulder, things like medication, physical therapy and lifestyle changes are likely not going to be the answer. Do not try to ignore the pain. Be honest with your doctor about your pain level and how it is affecting your ability to manage your life.
3. Your Condition Is Affecting Your Work and Social Life
Monitor how much your pain is affecting your life. Do you struggle to concentrate at work? Do you skip social engagements to go home and grab the nearest ice pack? Most people want to avoid major surgery, but when your pain starts to affect how well you can function on a day-to-day basis, surgery can be an effective solution. You may feel like you can manage the level of pain, but pain should not dictate your life. When your quality of life begins to decline because of hip, shoulder or knee pain, it is time to explore other options for treatment.
4. Your Doctor Recommends Surgery
Orthopedic doctors have spent years training to evaluate and treat pain in specific areas of the body. When they hear your symptoms and review your imaging, they form an expert opinion about the best course of treatment. Listen to your doctor. If they think a more conservative approach first is the best option, try the medication, physical therapy or lifestyle changes. If your doctor recommends surgery, carefully consider that when deciding on how to pursue treatment.
Questions to Ask Before Surgery
Do you need surgery on your shoulder? Do you need surgery on your hip? Do you need surgery on your knee? If you have answered "yes" to one of those questions, you will want to be adequately prepared. Here are eight important questions to ask before undergoing surgery.
1. Should I Get a Second Opinion?
This is a question you can ask yourself. Whenever you decide to undergo surgery, it is always helpful to have input from more than one doctor. One doctor may think surgery is the right option, while another may not. Similarly, doctors may have differing opinions on what kind of surgery will best treat your condition. On the other hand, a second opinion may simply confirm what the first doctor has said. A second opinion can help you make the right decision for your body.
Additionally, speaking to more than one doctor can help you find someone you are comfortable with and trust to perform the surgery. You can request copies of your images from your doctor's office or request those images be sent directly to the physician rendering the second opinion. Surgery is a serious decision to make, and doing your due diligence can help you feel as prepared as possible and comfortable with your choice. As a patient, you have the right to seek as many opinions you want before deciding to undergo surgery.
2. What Are the Risks and Benefits of the Surgery?
Any medical treatment, whether medication or surgery, has both benefits and risks. Before undergoing any procedure, ask your doctor what those benefits and risks are. Do the benefits outweigh the risks? How likely are you to experience postoperative complications? How long will the benefits of the surgery last? Is there a chance the procedure will need to be performed again? Generally, potential benefits of orthopedic surgery include reduced pain, improved quality of life and improved range of motion. Potential risks include things like infection, poor outcomes and a reaction to anesthesia. Whether you are undergoing elderly surgery or athletic surgery in your prime, make sure you fully understand each benefit and risk. If the benefits outweigh the risks, surgery is likely the right course of action.
3. Are There Any Alternatives to This Surgery?
If you find yourself uncomfortable with the risk-to-benefit ratio of a potential surgery, ask your doctor about alternatives. For example, is there a minimally invasive approach as opposed to an open surgery? Is there a procedure that can be done with a different type of anesthetic? Carefully explore all avenues open to you before making your decision.
4. How Long Is the Postoperative Recovery Period?
Most people are probably very eager to have the answer to this question. It all depends on the type of surgery and the individual patient. In the case of knee surgery, the procedure is completed in a relatively short span of one to two hours. After that, the patient is moved to recovery and then a hospital room. Some joint procedures can be performed on an outpatient basis, which means you can go home the same day. Others are performed on an inpatient basis, meaning you may need to stay one or more nights in the hospital.
In most cases, postoperative physical therapy will begin the day after the procedure. Physical therapists will work with you to get you on your feet and begin rebuilding your strength in the affected area. You will likely need to take pain medication and possibly antibiotics to prevent postoperative infection. In the days and weeks following surgery, you will likely remain in physical therapy. You will have scheduled appointments and exercises you can do at home.
With knee surgery, it can be possible to return to many of your regular physical activities within three to six weeks, but the recovery timeline will vary from person to person. Hip replacement patients can have a similar recovery timeline of three to six weeks. In the case of a shoulder replacement, it may take up to six weeks to be ready to drive again.
Physical therapy will likely continue beyond the six-week mark for any major orthopedic surgery. You can also expect to have regular follow-up visits with your surgeon to assess the success of the surgery and progress on your recovery timeline. If you are not sure whether you can do a particular activity after the surgery, always ask.
5. What Is the Surgeon's Experience Performing This Surgery?
When you undergo surgery, you are trusting your surgeon with your life. Ask them about their credentials. How many knee or hip replacements has your knee or hip doctor done? Have they ever experienced cases with complications? What does their successful track record with this surgery look like? Where did they do their fellowship training? Is the doctor board certified? Asking these questions will help you be as comfortable as possible when you decide to undergo surgery.
6. What Kind of Anesthesia Will the Surgery Require?
Surgery on the joints will require anesthesia to ensure you do not feel any pain. Some procedures require general anesthesia, which will put you to sleep for the duration of the procedure. Others will require an epidural, which will ensure you do not feel anything below the waist. Orthopedic surgery may also use peripheral nerve blocks, which involves blocking sensation to specific nerves like the femoral nerve or the sciatic nerve.
Talk to your doctor about the benefits and risks of each option. Regional anesthesia, which includes epidurals and nerve blocks, have relatively minor side effects like nausea and headaches. General anesthesia does carry the rare risk of major complications. Your doctor can explain in detail the benefits and risks of each option you have. Fully understand your options and the risks before deciding how to proceed.
7. Where Will the Procedure Be Performed?
Ask your doctor where the surgery will be performed. Will it be performed in an outpatient surgery center or a hospital? Check ahead of time how far away the surgery location is from your home. When you are scheduling your surgery, you will need to plan on a route to and from the hospital with someone who can drive you. You will also need to check with your insurance company to ensure the surgery center or hospital is within your policy's network.
8. How Much Will the Surgery Cost?
While your health is a top priority, you also need to think about the financial aspect of undergoing surgery. Review your insurance policy to understand your coverage. How high is your deductible? What portion of the surgery will your insurance provider cover? Is the doctor who will perform your surgery in-network? You can talk to both your doctor's billing office and your insurance company to answer these questions. After you undergo surgery, you want to concentrate on getting better and regaining quality of life. You do not want to be worrying about unexpected bills. Considering this issue ahead of time will help ensure you are financially prepared for the surgery.
When you ask these questions, it can be helpful to take notes or have someone you trust accompany you and listen to the answers as well. When you have the answers to these questions and any others you may want to ask, you are ready to make an informed decision.
Schedule a Consultation With Dr. Gombara
If you are experiencing acute or chronic joint pain, you don't have to wait for answers. Dr. Mufaddal Gombera's orthopedic surgery and sports medicine practice, a part of Fondren Orthopedic Group, serves Beaumont, Cypress and Houston. Dr. Gombera is a Houston native and an expert sports surgeon with a focus on shoulder, hip and knee injuries. Pain can hold you back from enjoying the things you value most in life. Let us help you get the specialized treatment you need. Schedule an appointment to have your injury assessed and to get on the path to recovery, whether or not you need surgery.