Things to Consider Before Orthopaedic Surgery
By Robert Feinberg, Physician Assistant
In last week’s Health Matters column, my colleague Dr. William Vranos referenced some studies that indicated a significant rise in total joint replacement surgeries being carried out. Indeed, one study by the Agency for Healthcare Research and Quality projects a 670 percent increase in knee replacement surgeries alone by 2030.
But the good news is that a lot of people seeking orthopedic care aren’t in need of immediate surgery. In fact, some patients may not need surgery at all to treat their conditions. One of the main roles of physician assistants who practice in orthopaedic surgery, like myself, is to help make that determination.
Physicians have been utilizing physician assistants for about 40 years now. A PA’s training is a condensed medical school training. We do similar coursework but over a shorter time; most of our experience comes on the job. Instead of four years of medical school, we do one and a half years of didactic, followed by a year of clinicals and then it’s all on-the-job training. PAs can specialize in any specialty with orthopaedic surgery one of the most common.
PAs who specialize in orthopaedic surgery see a lot of non-surgical, musculoskeletal injuries and complaints which are orthopedic in nature but may not require surgery to fix: anyone who strains or sprains their knee, people who twist or trip, people who have meniscal injuries and those with cartilage or other soft tissue injuries. Often, these injuries are not severe enough to require surgery. Many knee problems, for example, can respond well to rest and physical therapy as well as injections of cortisone. In addition, synvisc (lubricating injections) are beneficial in many cases of degenerative arthritis. So, working with Drs. McLarney, Thatcher and Vranos, I may try some of those methods first and see what kind of results we get. If the results are less than optimal then I can work with the team of physicians to coordinate further evaluation and surgical interventions as needed.
I ask every patient this one question: How much does this injury affect you every day?
The ones who say it limits their everyday activities are the ones I refer on to surgery. In addition, some patients need to be put on a pre-surgery treatment plan to reduce inflammation and strengthen the affected area prior to an operation. A patient who follows a pre-surgery plan can recover more strength more quickly when doing rehab afterwards.
If it comes to surgery, a PA can assist the surgeon in all phases of the planned surgery. We assist in the pre-operative, inter-operative and post-op phases. Every state has different laws and different doctors have their own preferences. I’ve worked very closely with the surgeons on learning incisions and closures, fracture reduction, and assisting with total hip and knee replacements. With their guidance I can be a useful addition to the surgical team, which will enhance your surgical experience.
At most orthopedic practices in the United States there’s generally a 2-3 month waiting period to see somebody. Having a PA opens a practice to a lot of patients who couldn’t get in here before, especially for non-surgery complaints. Since I joined Southern Vermont Orthopaedics and Sports Medicine last fall, we’ve been able to schedule appointments within a couple of days and sometimes even the same day. There are people who are exclusively my patients. If there’s no surgery involved I treat them until they’re better. New patients will see me first and if they’re a candidate for surgery they will be assigned to whichever surgeon is here with me that particular day. However, if a patient already has an established relationship with a particular surgeon we try to keep it. So I learn the routines and preferences of Drs. McLarney, Thatcher and Vranos for approaching a patient. Each has their own area of expertise and their own preferences when determining when the time is right for surgery.
Part of my job is to facilitate pre-surgical planning. I will work closely with each patient and the surgical team as we map out a treatment plan. So when we are considering whether a patient is a candidate for surgery, I have to take into account not only the surgery but the recovery period, lifestyle, age and other medical issues. I will order x-rays, MRIs and lab work to make sure there are no other health-related risks, such as cardiac problems. We look at every individual patient’s case and determine the cost benefit of doing the surgery versus not doing the surgery and what it’s going to be like for her or him. I then work closely with the patient and surgeon to determine the best timing and course of treatment for each individual patient. This way BMH can provide optimal care for your orthopaedic needs.