Choosing your Surgeon PDF Print E-mail

It is very important to develop a good working relationship with your orthopedic doctor in managing osteoarthritis pain. A good patient-doctor relationship is a two way communication,  you should be comfortable in discussing with him any concerns regarding your treatment and be able to advise him the types of treatments that work for you.


Once physical therapy, conventional, and alternative forms of treatment are not adequate in taking away your pain, you may want to consider surgery. Your orthopedic doctor should be able to evaluate whether you will need the surgery, and discuss the benefits of having the procedure. In this article we would like to discuss some common questions on how to choose the right surgeon for you.


Common Questions:

1. Can any orthopedic surgeon perform a joint replacement?

Yes, any orthopedic surgeon should have the ability to perform the procedure. During the training of an orthopedic surgeon (called residency training), he/she is exposed to a myriad of cases, including joint replacement surgery. However, exposure is not equivalent to hands-on training. Oftentimes, a resident may be allowed to do certain aspects of the procedure. Sometimes, a resident may be allowed to perform the entire procedure under the supervision of a senior surgeon. But usually, the number of cases that a resident performs during his entire orthopedic training will be limited.

2. Is there any advantage in choosing a joint replacement specialist to perform the surgery on me?

Joint replacement surgery is a very successful procedure. However, it is also very technically demanding. Risks and complications occur, even among the very best. These can be minimized, however, if your surgeon is adept at what he does.

The instruments used to attach the artificial joint to the bone have been designed for the standard patient with a typical problem. Thus, there will be occasions when it will be necessary to “free hand” certain steps of the surgery. An experienced and properly trained joint replacement surgeon will recognize these situations and will know how to proceed when he finds himself in such situations.


3. How does an orthopedic surgeon train to become an arthoplasty surgeon?

After four or five years of training in orthopedic surgery, your doctor should take and pass the diplomate board examinations. In this way, the Philippine Board of Orthopedics can be assured that your doctor has had the necessary training to become a good orthopedic surgeon. It is only after finishing an accredited residency program that your doctor is eligible to train in joint replacement surgery, if he so wishes.

For it to be effective, the training should be a hands-on type of training. In several countries, but especially in the United States, certain qualifying examinations should be taken in order to be given the privilege to have hands-on training. Without this privilege, your doctor will only have the chance to observe what is happening. If he is lucky, he may even be allowed to assist or do some parts of the surgery.


4. What should I look for when choosing a joint replacement surgeon?

Surgeon_EvaluationWhen choosing a joint replacement surgeon, several things have to be considered. First, you should be comfortable with your surgeon. Although your attention may be focused on having the surgery done properly, remember that this is just a part of the entire treatment experience. Even after the surgery, you will be seeing your surgeon on a regular basis in order to make sure that the artificial joint continues to function properly. There will be instances when you will have to contact him at odd hours due to concerns that you may have.

Second, your surgeon should have the necessary training to perform the procedure correctly. This often requires at least a year of subspecialty training (fellowship training) under an experienced joint replacement surgeon after the basic 4 to 5 years of general orthopedic training. During this subspecialty training, the fellow does joint replacement procedures almost exclusively. Part of a good training program will also prepare the fellow to perform difficult replacement procedures and revision surgery procedures.

Third, in addition to having the required training, your surgeon should have the necessary experience to perform the procedure. Risks and complications are lower when your surgeon is properly trained and performs a lot of joint replacement surgeries. Correct practice makes perfect.

Fourth, your surgeon should be accessible. If you are comfortable with having a surgeon based elsewhere operate on you, and then have your follow-up with another surgeon or physician, then this would not be an important criteria. However, the ideal situation would be that you follow-up with the surgeon who operated on you. There will be certain details that may affect your recovery that only your surgeon knows. And if problems do develop during the course of your recovery, it would be a comforting idea to know that your surgeon would be there for you.

5. How do i go about looking for the right surgeon for me?

There are several ways to look for a surgeon. In general, you would probably be using more than one method in finding the right surgeon for you.

1. From a friend. A friend may know of a surgeon who operated on someone he/she knows. Or a friend may know an orthopedic surgeon. An advantage is that friends will not refer a surgeon who they think may cause harm to you. On the other hand, even if the intention to do good is there, a friend may not necessarily know if the surgeon he is recommending to you is truly a capable surgeon.

2. From previous patients. Patients who are happy with their physicians will not hesitate to recommend their doctors to other patients. However, a problem may arise if the happy patient underwent a procedure completely different from your planned procedure. Put another way, not all orthopedic trauma surgeons are joint replacement surgeons, just as not all joint replacement surgeons are spine surgeons. Thus, the surgeon may be good at what he did for the patient, but he may not necessarily be the best doctor for you.

3. From previous patients who underwent the same procedure. If you know of a patient who underwent the same procedure that you are planning to have and who is happy with the results, then the chances that you will also have a successful outcome with that surgeon is greater. Although this might be the best way to find your surgeon, there is, of course, the risk that you may be talking to a minority of his patients and that the majority may not have been happy with the results.

4. From other physicians. Physicians should refer you to surgeons whom they believe are the best in their fields. Unfortunately, this is not always so. Physicians will often refer you to their friends or to surgeons who immediately come to mind, irregardless of whether they are adept at joint replacement or not. For them, any orthopedic surgeon should be able to perform a good joint replacement procedure.

5. From other orthopedic surgeons. Orthopedic surgeons know who among them perform joint replacement surgery. However, although this should be a very good starting place when searching for an orthopedic surgeon, it is not fool-proof. Oftentimes, they will refer you to those surgeons whom they perceive to be good joint replacement surgeons (previous mentors, senior surgeons, those who are often invited for talks).

6. The surgeon closest to you. Some people do not want to go of their way to look for a competent surgeon and will settle for the surgeon in the most convenient location. You could get lucky and the surgeon nearby would be a joint replacement surgeon. But the chances that this would be the case could also be very slim.

7. From hospitals. Hospitals will do their best to bring in patients, since that is how they earn. They will often have joint replacement units supposedly staffed by the best joint replacement surgeons. Unfortunately, this is not always the case. As long as an orthopedic surgeon has an interest in performing joint replacement procedures, he can apply as a staff of the unit. In some hospitals, even a simple 6-month or 1-year observership could qualify as subspecialty training.

8. Referral from your insurance company. For a majority of those covered by health insurance, they often have no choice but to see the orthopedic surgeon referred to them by the insurance physician. Since not all orthopedic surgeons are accredited by the various insurance companies are properly trained to perform the surgery, there is a chance that you will be operated on by one who has not been properly trained. Even if insurance companies claim that their surgeons are properly screened, in reality, they can only screen those surgeons who have applied to them for accreditation. And since these companies often pay very little (from one-half to one-fourth of the going rate for a joint replacement), there is not much incentive for a joint replacement surgeon to apply to such companies.

6. Are there hospitals that are better at doing joint replacement surgery?

There are no hospitals that are better in the performance of joint replacement surgery. The main determinant of the success of the procedure resides mainly on the person who performs the surgery. A skilled surgeon will perform well wherever he operates. On the other hand, no amount of technology can improve the skills of a mediocre physician.What a good hospital can offer, however, are advanced operating rooms and technology that can aid the surgeon in the performance of the procedure.

7. My Surgeon says that he uses the latest techniques and implants. Is that a good thing?

There are two ways to look at this. On one hand, it is possible that the latest techniques and implants would give better results than the more conventional way of doing things. On the other hand, since these techniques and implants are still new, there are still no long-term studies (for example, 10 - 20 years) to show that they are actually better. In our opinion, when it comes to joint replacement surgery, the main goal is to have the successful outcome of your surgery last you as long as possible. No short-term advantage can ever replace the long-term advantage of this procedure. For example, the success rate for joint replacement surgery is anywhere from 95% - 99% and the implants are expected to last an average of 15 - 20 years. Nowadays, there are some techniques that are being introduced and early studies appear to show that they may be better than the traditional methods. However, as long as there are still no long-term studies on these techniques and implants, how sure are we that they can replicate the success of the previous methods?

8. My physician, who is not a surgeon, advises against surgery. What is your opinion of this?

If your physician is not a surgeon, it might be a good idea to get the opinion of an orthopedic surgeon. There is a very strong misconception that all a surgeon loves to do is to operate. Not only is this a prevalent notion among patients, but this thinking is also prevalent among physicians who are not surgeons. For one thing, non-surgeons are often not familiar with the indications when patients may be better served by surgery than with the present treatment. When it comes to treatment, there are indications when someone should be treated non-operatively, just as there are indications when someone should be treated surgically. Unfortunately, just as there are surgeons who are scalpel-happy to the detriment of their patients, so, too, are there non-surgeons who treat their patients with medications when a surgical option would have been the more appropriate thing to do. If your physician is a surgeon and he has not discussed the possibility of surgery, you could bring the matter up with him. Or you could ask him to refer you to a joint replacement surgeon, assuming that your doctor is not one.

9. Is it better to have my surgery done abroad?

The choice, of course, depends on you. However, if it is a question of skill, our joint replacement surgeons are just as properly trained as those abroad. An additional advantage of having the surgery done here is that your doctor will not be very far away. Should anything trouble you before, during, or after surgery, be it immediate or years later, your doctor will always be here. As we mentioned earlier, in a joint replacement procedure, you are building a long-term relationship with your doctor.

10. My Insurance will only pay for their accredited surgeons. Would that be alright?

That depends on whether their accredited surgeon is an experienced joint replacement surgeon or not. But if you have chosen a particular surgeon that you believe and trust, then we feel that you should stick with him. Don’t let the insurance company have their way. In the end, it’s your body against their business earnings. And guess who stands to lose if anything should go wrong? If your surgeon is not accredited with them, try to see if they will at least cover for the hospitalization and medications.

An Article by Dr. Jose Fernando C. Syquia

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Who else but our patients can testify to AOJR’s expertise in joint replacement surgery and how we helped improve their lives. Here are what some of our patients have to say:


Alcera" After the operation, I thought I wouldn't be ableto enjoy the same lifestyle as I had before. I was wrong, It's amazing how I can still enjoy activites likes dancing and aerobics."

Doris Alcera, 63y.o. Total Knee Replacement, February 2011

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