my knee surgery!

[klinger]

Good morning Josephine,
Its really more of the same relating to the MIS(minimally invasive surgery) that i,m hoping to get on my right knee.I did manage to find out that my consultant does regulary carryout MIS.My problem is I dont know how to take the matter up with him or find out whether this is the technique he will be carrying out on me.
I was thinking that if I only see him a few days before the operation and find out that he not doing MIS will it not be too late by then to do anything about it? Should I ring his secretary? will she know?And also can me wanting MIS ever be a contributary factor on whether I get it or not? Can I leave it with you to have a think and see what you come up with. kind regards Klinger.

 

[Josephine]

No problem, klinger. Just ring his secretary (have your hospital number ready) and ask he. She will know. She will also know, or be able to find out, which you are scheduled for. If there is any doubt, she will ask the surgeon for you and then ring you back. If the answer is no, she will have an explanation from the surgeon as to why not. If there are still any unanswered questions you can just ask for an appointment to see him again to talk it over. That's allowed!

Wouldn't it be great if you found you were already down for one!?!

 

[klinger]

Hi jose,update is ,finally got through to Mr Roulolamins secretary and posed the question about MIS.Mmn she says,whats that stand for?thats a new one on me! So I explain what its about and she says you must be getting its mixed up with computer aided surgery.But her general attitude was a cross between vague and guarded.She couldnt find my notes and was going to get back to me.ps.... I did remain polite and didnt try to make her think I knew it all.Any thoughts?kind regards klinger.

 

[Josephine]

Oh dear! What an encouraging response!

Two thoughts - she must either have been new or standing in for the regular secretary. I have never yet met an orthopaedic secretary who did not know all about her boss's stuff - after all, she has to type up his operation and clinic notes and do his letters to GPs etc.

I would wait until she finds your notes and rings you back - don't give her more than a week to do that. Then, if there's no concrete answer, ask for an out patient appointment to see him or his registrar.

 

[klinger]

Thanks for the quick response Josephine.Just had a letter come through the door(medical assessment form)I think I,ll do what you suggest and go see the main man,sooner we find out the better eh?cheers klinger

 

[klinger]

Hi josephine,
have contacted my surgeons secretary again this morning to find out if she,s had a talk to him about the possibility of MIS on my knee.
She once again told me that she thought I may be getting it confused with the computer aided surgery(or something of that ilk)perhaps I am.
I dont suppose you could clear it up for me could you?I,m getting a bit confused.She said she,s talking to him this afternoon and will be ringing back later.p.s she is his regular secretary,bit puzzling isnt it? regards klinger.

 

[Josephine]

Oh dear, she really has got a bee in her bonnet about this, hasn't she? Thing is, it's not her place to tell you what she 'thinks' you are talking about. She should just be a messenger between you and the surgeon.

But there is a procedure whereby the surgeon can use a computer aided device to help align the prosthesis but it is horrendously expensive and few hospital can afford to purchase them. It is also very difficult to use and the surgeon needs a lot of training. As a result, most tend to do without it. So the Minimally Invasive Surgery is one thing. The computer aided alignment, usually known as robotics, is an additional option which is even less frequently used that MIS. It's she that seem to be confused, not you! However, since she is so totally ignorant of the terminology, I would think it a fairly safe bet that he doesn't do this particular procedure. Either that or he uses some totally different term to describe it.

 

[klinger]

Hi Josephine,
secretary got back to me yesterday,said that she,d had a chat with Mr Roulholamin and I,m not to worry because he does all his TKR surgery using MIS and has done for a very long time.
She went on to say that she was mistaken when she confused it with computer navigation surgery although he uses that sometimes as well.So there you go,looks like I,m getting the only surgeon in the world thats been doing it for a VERY LONG TIME.
Me thinks I,d best go and get an appointment (horses mouth springs to mind).Anyway we,ll keep smiling this end and I,ll let you know how I get on,
kind regards kilnger:D

 

[Josephine]

Well, I am delighted for you! Truly! That sounds like a cool situation to me!

 

[klinger]

Happy new year Josephine,I have another consultation appointment with Mr Roulholamin on the 28th Jan just to ask him a few questions about my surgery,just wondered if you could advise me what important questions you think I might ask him with relevance to possible (MIS) regards klinger.

 

[Josephine]

Sure thing, klinger.

I would ask him these questions:
1. How many of these procedures has he carried out and over what period of time (longer the better!)
2. what is his percentage of acceptable outcomes (no complications!)
3. what is his infection rate like
4. is MRSA a significant problem in the hospital and is the management taking action on it
5. which prosthesis does he use and why
6. does he use a Navigational System to position the prostheses
7. how long will I be in hospital
8. how long would you estimate it will be before I am fully mobile and independent, able to drive and (insert any other favourite hobby/occupation)


Not only his answers but his reaction to some of these question will tell you some things. If his answers to 1,2 and 3 are readily given then he pays attention to such things. If he waffles, well, hmmmm!! However, given that your choices vis a vis surgeons are somewhat limited, perhaps you might be prepared to hold back on those.

 

[klinger]

Hi all,
Had the consultation with Mr Rouholamin today and found out what I think I needed to know.He said he dosnt do the MIS(minimally invasive surgery) as we know it,but feels that he has refined the normal procedure by making the front incision smaller taking the length of the incision down to 12-13cm.
Now I dont know what the normal length is but he said he is sending a lot more patients home after just three days in hospital than ever before.He went on to say that he has on quite a few occasions had to perform corrective surgery on patients who have had TKR using MIS.
I also did as you suggested and asked him about failure and infection rates and both came out at 1-2%.He also showed me the prosthesis which was a LCS by Biomet utilising the rotating platform and no cement.Asked around a bit and this fellows reputation goes before him,so I signed the forms
for the operation today.Anyway thankyou for the suggested questions Josephine and will speak to you after surgery cheers Klinger

 

[Josephine]

Yep, haven't commented on that before but many surgeons are adapting their incision to a MIDI incision. Historically, the standard incision was around 20cms and the current feeling is that 10-12 is quite sufficient.

I am very pleased my suggestions helped you and look forward to hearing good news shortly. And the rotating platform is a good unit. Much more user friendly in my opinion!!