Post Op Problems: Navigating pain and expectations after surgery
Back in March, a man went to a local hospital with a gun. Within minutes shots were fired by deputies and the man was dead. Before the shooting, the man was holding signs that read, “Messed up knee, sorry no!”
The man’s son wrote to News Channel 3, “My father didn’t go there to hurt anyone but was willing to pay the ultimate price to be heard.”
It was a scary incident that put local physicians on edge and reminded many that patients may need more education about their options when surgery doesn’t go as expected.
Dr. Raj Sinha, an orthopedic surgeon, said the incident was extremely shocking to the local medical community
“Extremely shocking because again, what could possibly have happened that he felt like he wasn’t being heard that would lead him to bring himself to that extreme of a situation? It’s just unfathomable to me,” Sinha said.
Sinha says stats show between 10 and 15 percent of patients are dissatisfied with the results of their surgeries, mainly due to blood clots, stiffness, infection, or residual pain.
Database of Patient Reported Outcomes for Joint Replacement Surgery
“That’s a fair number of people with knee replacements who are not exactly where they thought they were going to be, and a lot of it is counseling, making sure they know what the limitations are going into the surgery, and coming out of the surgery,” said Sinha. Managing expectations is crucial. To assess, Sinha says he often asks a patient “Are you better or worse than you were before surgery?”
The American Association of Hip and Knee Surgeons devotes considerable resources to providing patients with information to develop realistic expectations about life after surgery. The AAHKS website states: “Setting high expectations that are unrealistic can lead to dissatisfaction with the final result. Setting expectations too low may not allow you to achieve the best possible function and result after surgery.”
The website also provides information on how to ensure satisfaction after hip or knee replacement surgery. Some suggestions involve taking a more active role in your overall health before surgery, and discontinuing the use of narcotics before and after surgery.
However, complications arise, and “Any surgeon that says that he or she doesn’t have complications is either lying or has their favorite ostrich suit on. They’ve got their head stuck in the sand, right?” Sinha said.
Knee and hip replacements are the most common joint replacement surgeries at Eisenhower Medical Center, with 1,808 of those surgeries reported in 2018. Desert Regional and JFK would not release how many joint replacement surgeries were performed there.
Jim Camplin had one knee replaced three times. The first time because of bad glue.
“It was in there and it literally came apart,” Camplin said.
Camplin said the the second time, whenever he would walk, his knee would swell, getting as large as his thigh.
By the third time, “It was just something I felt like I had to move on from that particular doctor.”
Sinha says some patients feel uncomfortable reaching out to another surgeon.
“Getting an opinion is so easy. It doesn’t commit you to anything, it doesn’t insult anyone,” Sinha said.
And if a patient is blocked by their insurance?
“There are ways to go around it. For example you can either go a layer above the local level and go to the national level, you can go to the commissioner of insurance here in California,” Sinha said.
Some hospitals, like the Cleveland and Mayo Clinics, John Hopkins and Stanford, even do online consults but Sinha says patients must also be honest with their doctors.
“We can’t guess what’s going on in your life. We can ask certain questions, but if you don’t tell us, we can’t help you navigate some of those problems that you may have post operatively,” Sinha said.
Sinha says talk to your primary care doctor about prescribing more physical therapy if your insurance provides less than you need.
Mental health also plays a big role in recovery after surgery.
“Patients who are depressed going into surgery are going to have a worsening of their depression coming out of surgery,” said Sinha. The other aspect is anxiety. Because if you have an anxious personality going into the surgery it exacerbates the pain that you feel afterwards, and worse, it makes you feel more fatalistic about the pain that you’re experiencing.”
Pain recovery is also a crucial component to recovery, adds Sinha.
“The bulk of it is on us,” says Camplin. “The surgeon goes in and does his job, but if we don’t do the therapy portion of it, then there’s no point to it because you’re never going to get better.”
Camplin adds strength and flexibility work to his exercise routine now.
“I have a lot of grandchildren, they’re quite busy,” Camplin laughs. “So it’s nice to be at a point where you can grab them, play with them.”
Read: Complete Guide to Surgery Recovery
