It’s common to be asked questions like, “What surgery can be done for this?” or “Would surgery be a better option?”
The answer can be complex and depends on several factors.
While surgery is often the best course of action in many cases, it is not always the ideal solution or a quick fix. This article explores why, including the trauma surgery can cause, the expected outcomes, and the potential benefits of conservative management options.
Factors to consider before opting for surgery
What pathology or injury are we dealing with? Have you tried conservative management? What are your expected outcomes?
Most musculoskeletal surgeries involve some existing trauma to the area. Conditions like a torn meniscus, osteoarthritis, joint surface damage, or a rotator cuff tear might require surgery. However, it is important to remember that surgery itself adds more trauma to the area, which will need time to heal.
For example, when a joint is replaced, there will be an incision site, muscles that are cut and restitched, and bone that is removed—each of these requires healing. Even when a torn meniscus or rotator cuff needs surgical repair (and many don’t), the repaired tissue still has to heal. This process adds further trauma to the affected area.
Surgery is just the beginning of the recovery process
The wait before many musculoskeletal surgeries can be lengthy, often leading to ongoing pain. During this time, muscles may weaken or stop functioning properly, and joint movement can become limited. These issues can lead to additional discomfort and stiffness.
After surgery, muscles do not automatically regain their strength, and joints do not instantly recover full mobility. It takes time and effort to restore muscle activation, rebuild strength, and regain joint flexibility. This process involves mobilising and stretching joints to restore their full range of motion, reactivating muscles through neuromuscular exercises, and gradually loading muscles to strengthen them. Post-surgery recovery demands patience and consistent effort.
What determines a successful outcome?
Is a successful outcome defined by increased movement or absence of pain? What a surgeon considers successful may differ from your own view. The surgeon might define success as a muscle being reattached or a joint being replaced effectively. However, we often judge the success of surgery by whether it results in reduced pain and improved function in the affected area. Achieving these goals usually requires more than just the surgery itself. It often involves enhancing muscle activation, rebuilding strength, and improving joint mobility. Therefore, it is important to have realistic expectations about what surgery can achieve.
Conservative management vs. surgery
In an article by Lee, Dong-Yeong et al., comparing arthroscopic meniscal surgery to conservative management in patients over 40, the study found no significant differences in clinical outcomes, such as knee pain relief and improved knee function, between the two approaches for degenerative meniscal tears.
The study also concluded that arthroscopic surgery is not superior to conservative management for this patient group and should not be the first treatment option. Instead, it should be considered only when conservative management has not produced satisfactory results.
As noted earlier, surgery is sometimes necessary and the best option for an individual, which is perfectly acceptable. However, it is crucial to understand all your options. If time permits, such as with joint replacements, engaging in prehabilitation and rehabilitation can greatly increase the likelihood of a successful outcome. Additional considerations include hospital stay, time off work, and risks such as anaesthesia and infections.
References:
Lee, Dong-Yeong, Park, Young-Jin, Kim, Hyun-Jung, Nam, Dae-Cheol, Park, Jin-Sung, Song, Sang-Youn & Kang, Dong-Geun. Arthroscopic meniscal surgery verses conservative management in patients aged 40 years and older: a meta-analysis. Archives of Orthopaedic & Trauma Surgery. Dec 2018, Vol. 138 Issue 12, p1731-1739.
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