Choosing Surgeon/Bilateral replacements 2 surgeons

[Simon]

I was wondering what to do about a surgeon.

I have spoke to one that I connect to but he operates in a very small hospital with a low volume. I have a complicated problem so this made me nervous.

The second is at an academic medical center with excellent technical skills but I just don't connect with him. He does answer my questions but I just don't feel totally comfortable with him but I can't quite explain it. Should one just consider the technical skills and forget the rest.

Also for those who have a bilateral replacements did your surgeon do both of them or did he do one while another did the second one? I am talking about having both done at the same time.

Or check out the third place which some people have recommended. This is a group practice but doing high volume of work. They work out of a community hospital about 180 beds (2nd largest in the state). One advantage of this place is they have one of the 3 approved acute rehabilitation units so I would not have to change locations after surgery.

Thanks

Simon

 

[Jamie]

Boy, you have a tough call. I think it might be a good idea to check that third option before you decide, though. The rehab is every bit as important as the surgeon. What is it that makes you not so comfortable with the second surgeon? If you can put your finger on it, you could make an appointment with him again and explain your concerns. His reaction would tell a lot about him, I think. I did that with a surgeon who did arthroscopic surgery on me that didn't turn out too well and I was quite surprised by his understanding and compassion. Although I didn't stay with him for my TKR (found one recommended by a nurse friend), I left him with a stronger respect for his strengths as a surgeon and he had some honest feedback that I think will probably help him in the future. Good luck and hope this helps a little. ...Jamie

 

[JenniferG]

Two knees, one surgery, one doctor. They have help and his PA closed me up. I would absolutely check out the rehab.

 

[1jt@atime]

Simon, I would check the third doctor out since you don't feel 100% with either of the first two. This is too important of a surgery to go in with any concerns like this.

My OS likes the patient to heal from one knee before doing the second. They all have different preferences and that's a question to ask when you visit.

 

[JenniferG]

As far as 2 at once vs 2 one at atime, aside from docs preference, I think you've got to look at whether or not you can physically do it and if your "good" knee is really good enough to be of any help. Some cases, the other knee can not do it while the operate d knee is healing, so they decided to just do it all. From what i hear also alot of folk have such a rough time with surgery # 1 they never do # 2. i don't know if my both knees were so bad I had to do them together. Doc never said, they just scheduled the bi-lat and i went with it. I saw the xray and they both needed to be done at some point, so let's do it. One surgery, one hospital stay, one bill. Harder to heal and rehab from? Maybe. I don't know because I've never done it before so I could compare. My other side of surgery has actually been miraculously good. I'm grateful. Maybe I was in so much pain before this isn't any worse. And now honestly after being on this forum for a while and hearing peoples experiences, I'm glad I'm done and don't have to do it again except for possible revisions years from now, and by then who knows what...... Now all I have to do is concentrate on healing and progressing, not the next knee.

 

[1jt@atime]

Simon, Jen has done great in her recovery and she's right on a lot of points. I'm getting ready to have the second done soon and I dread it, not surgery really, but the recovery. After having one done, I couldn't imagine recovery without even a second cruddy knee to stand on but then there's people like Jen that has done the bilat and is happy she's done it this way and it's working well for her.

I hope we are giving you something to think about and not just totally confusing you. It's a hard decision to make. My doc only offered an option of one knee at a time and I wanted my doc, 100% to be the one to do my surgeries so that decided it for me.

 

[Simon]

Re: Choosing Surgeon/Bilateral replacements 2 surgeons Clarification

Thank you all for your input it does help.

I would like to clarify one part regarding the 2 surgeons.

What I was referring to was 1 surgery where 1 one surgeon (the one I have been talking to) would do the right knee while his partner would be doing the left knee at the same time. I have never met the second surgeon.

I was trying to find out if this team approach is common.

I understand the pro/con about doing both at once versus one at a time. Both of my knees are in bad shape and the slightly better of the two will not really hold up and take the added stress. I have had several previous surgeries and each time within six months of the surgery, the one that was not operated on needed surgery because of the stress. Also, in September I fractured a bone in my foot and was in a walking boot for ten weeks (on the side of the worse knee )and during that time the "better" knee grew worse. The other complication is that I live alone and have only recently moved to the area so I don't know people well enough to ask for significant help . So if I did this 1 at a time, I would have to arrange for a second time for someone to come in and help as well as drive me to appointments which would include the doctor (which are 75 to 125 miles away) and that will get expensive. That is one of the disadvantages of rural living.

Thank you.

 

[JenniferG]

I understood that. That's why the PA helps. I don't think it is really the way it is done. Is that what your guy said they would do?

 

[Jamie]

I didn't understand from your first post that a "partner" would do the second knee at the same time. And the main surgeon hasn't done very many of these replacements because it's a low volume hospital. That would concern me a lot. In addition, your comments about living alone in a rural area would indicate you might want to consider your third option that would includ inpatient rehab. It is a tough decision. Keep talking with people and the doctors involved until you are confident you are making the right choice.

 

[1jt@atime]

Re: Choosing Surgeon/Bilateral replacements 2 surgeons Clarification

Thank you all for your input it does help.

I would like to clarify one part regarding the 2 surgeons.

What I was referring to was 1 surgery where 1 one surgeon (the one I have been talking to) would do the right knee while his partner would be doing the left knee at the same time. I have never met the second surgeon.

I was trying to find out if this team approach is common.

Simon, I have heard of this approach but don't know how common it is.

I can understand why you want to get two done at once. I'm going through quite a lot also. I've still got a second knee, a hip and and an ankle fusion or replacement ahead of me within the next year or two. (It's that last one that scares me.) Since I'm in my 40s, I'll probably need revision on all of the above one day.... My surgery count it up to 12 so far.

Good luck getting it all figured out.

 

[skichick63]

I based my decision on the OS that does the most cases -- at least 6-7 a week. I didn't want anyone who "dabbles" in the field to be doing MY knee. I "interviewed" every OS in the area.... really. I have access to all the OS at our two hospitals because I work with them on a daily basis.

 

[Josephine]

I was wondering what to do about a surgeon.

I have spoke to one that I connect to but he operates in a very small hospital with a low volume. I have a complicated problem so this made me nervous.

The second is at an academic medical center with excellent technical skills but I just don't connect with him. He does answer my questions but I just don't feel totally comfortable with him but I can't quite explain it. Should one just consider the technical skills and forget the rest.

Or check out the third place which some people have recommended. This is a group practice but doing high volume of work. They work out of a community hospital about 180 beds (2nd largest in the state). One advantage of this place is they have one of the 3 approved acute rehabilitation units so I would not have to change locations after surgery.

Thanks

Simon

Simon, have you read my post at the head of this forum? "How to choose a surgeon and a prosthesis"

I think it will answer most of your questions here. And skichic is dead right - I wouldn't go for a low volume surgeon, even if it meant travelling a distance. There's too much at stake. Anyone who does less than 500 a year is just dabbling, IMVHO.

I would like to clarify one part regarding the 2 surgeons.

What I was referring to was 1 surgery where 1 one surgeon (the one I have been talking to) would do the right knee while his partner would be doing the left knee at the same time. I have never met the second surgeon.

Did the surgeon actually tell you this is what they would do? Because to be truthful, I would say that is a practical impossibility for two surgeons to do two knees simultaneously. Manipulating the leg and the use of tools like retractors and needing assistants on both sides of the table would not be compatible with simultaneous procedures. But that's only my experience and it seems that US surgeons sometimes do things very differently from their UK colleagues.

Plus, it's one of the reasons why surgeons can be loath to do bilaterals because it actually takes about the same amount of time as doing two singles. In other words, they do one, close the wound and then do the other. Some hospitals will drape both knees and use the same set of instruments but in my last hospital we treated each knee as a separate operation with a completely new set of instruments, new drapes, gloves, gowns, the lot.

 

[Josephine]

I based my decision on the OS that does the most cases -- at least 6-7 a week. I didn't want anyone who "dabbles" in the field to be doing MY knee. I "interviewed" every OS in the area.... really. I have access to all the OS at our two hospitals because I work with them on a daily basis.

Hehe - me too, skichic! I was able to hand pick my surgeon both for me and for my sister. She's had both hers done. I, happily, have found the arthroscopy made enough improvement that a TKR is no longer on the immediate horizon.

Do your surgeons routinely do diagnostic arthroscopies? Some of our guys won't not do them and the rest won't do them at all!!

Also, have you read my post at the head of this forum? Is it suitable for US patients? I would be very happy to hear your suggestions if not.

 

[JenniferG]

Yes, when they did my bi-lats, they told me one knee usually takes 1.5-2 hours so 2 knees would be 3-4. I ended up being 3.5. Of course when I woke up it felt like 30 minutes.

 

[Josephine]

Yes, when they did my bi-lats, they told me one knee usually takes 1.5-2 hours so 2 knees would be 3-4. I ended up being 3.5. Of course when I woke up it felt like 30 minutes.

That would be correct - ergo - they did them one at a time.

 

[Simon]

I understood that. That's why the PA helps. I don't think it is really the way it is done. Is that what your guy said they would do?

JenniferG

No this is not the PA it is a second surgeon with both of them operating at the same time.

I did not think this is common and glad to hear that seems to be the case.

I am going to call the third surgeon on Monday. Hopeful now that ski season is almost over (I am in Vermont) they won't be too busy. This office is located close to major ski area.

 

[Simon]

Simon, have you read my post at the head of this forum? "How to choose a surgeon and a prosthesis"

I think it will answer most of your questions here. And skichic is dead right - I wouldn't go for a low volume surgeon, even if it meant travelling a distance. There's too much at stake. Anyone who does less than 500 a year is just dabbling, IMVHO.




Josephine

Thank you for your answer. Yes I read your post and he did answer the questions. His infection and complication rate are low. As for the volume of at least 500 a year. The doctor practices in New Hampshire at the only academic medical center in the state as well as being the main referral site for eastern Vermont. Given all this the volume is less than your 500 simply because there are not enough people in the area. He did do his fellowship at a New York hospital that only deals in joint/bone disease so I know he has done alot. Also, this places handles the majority of TKR revisions that have been messed up else where. The first surgeon who has a much lower volume for the same reason, the state of Vermont is small.

My problem is not with his technical skills but that he does not seem all that concerned or interested with the other parts like the rehab or some of the other medical problems which can have an impact. I do think that is because at the medical center rehab is in the hands of the PTs/OTs and those issues are covered in their joint class. I know that many surgeons focus that way as I had experienced that with my first surgeon. My second surgeon who did the majority of the other surgeons was much more interested in the overall picture and he knew that because of my job (I index medical journals including many orthopedic and physical therapy ones) I had more information about things.

After reading all the great posts I can see that there are 2 groups of people, 1 that focus entirely on the technical skills of the surgeon and not concerned with "bedside" manner and the second group who want a full package surgeon. The people on this forum clearly are in the second group.

I am going to call the third surgeon on Monday. The weather is finally clearing (though on Friday, it was snowing on my way to the doctor) and driving across the state should be safe. My town set a snowfall record this winter, 139.5 inches. There is still about 4 feet of snow on many parts of the lawn.

Thank all of you for the help.

Simon

 

[JenniferG]

JenniferG

No this is not the PA it is a second surgeon with both of them operating at the same time.

Right, she just helped like holding skin out of the way and closed my legs up. Guess I have the PA to balme for any scar imperfections.
Good that you are seeking information to assist you in making your decision. Best of luck.

 

[referee54]

you want the very best surgeon, period. You want the surgeon that does this over and over again and specializes in it---thta is, it is his (her) bread and butter. No dabbling, --you want the guy who does it a lot---and why doe he do many of them? Because he is the best.

You want the best technical guy---bedside manner---you are only going to see this guy a few times---it is th PT's and the OT's that you will see a great deal. I only have seen my Ortho three times (short exams) in the hospital and three times at his office.

Tim C.

 

[JenniferG]

That's true Tim. I've only seen my guy a few times. And I think the 3 week check-up is with a PA as well.