Optimizing recovery after orthopaedic surgery

Working with your orthopaedic team to set realistic goals following surgery

An honest discussion between a patient and orthopaedic surgeon about an upcoming surgery, the necessary rehabilitation following the procedure, and a realistic time frame for when the patient can safely return to sports and daily activities, can help optimize surgical outcomes while ensuring realistic expectations on recovery.

“When I am talking with my patients about their upcoming surgery, I ask them: ‘What are your goals? When do you want to get back to doing what you were doing before,’” said Elizabeth G. Matzkin, MD, assistant professor at Harvard Medical School, and chief of Women’s Sports Medicine.

“Before surgery, it is really important that people understand how they are going to be afterward, and how they are going to return to what they want to do,” said Robert Stanton, MD, a Fairfield, Conn. orthopaedic surgeon.

All surgeries have a minimum recovery time, during which the patient will not be able to participate in all of the activities he or she did before the surgery, injury or onset of their orthopaedic condition. In addition, a patient’s age, weight, overall health, and how he or she reacted to the surgery and post-surgical pain, also can effect and extend the recovery time.

Someone with a desk job, or someone who “carries around a clip board and points and talks can get back to work a lot faster than someone who is a firefighter or someone who lifts heavy boxes,” said Dr. Matzkin. However, even someone who does not work outside the home will have constraints. If you have rotator cuff surgery, for example, the arm will most likely be in a sling for four to six weeks, and you may be taking narcotic pain medications for several weeks. Both can impair driving.

“You can’t alter biology,” said Dr. Stanton. For example, “there are athletes who return to sports four months after anterior cruciate ligament (ACL) surgery;” however, the reality is that rehabilitation and recovery will more likely take six to nine months, and it may be several years before the athlete fully recovers.

Patients who try to speed up their recovery with excessive exercise, or resume activities and sports before their doctor or physical therapist says it is OK to do so, risk reinjuring the surgical site or delaying recovery.

“They can work harder but they’re not helping themselves and they can injure or reinjure themselves,” said Dr. Stanton.

“Sometimes I tell people: ‘I’m so glad you’re not in any pain or that you’re not uncomfortable, but you need to take it easy so this heals.’ A lot of procedures take at least three months to heal,” said Dr. Matzkin. “I have patients who say, ‘I will work really hard; I’m a fast healer.’ And I say, ‘the recovery is still the recovery.’”

In addition, patients need to fully understand the frequency of rehabilitation appointments and the scope of exercises that will be required of them after surgery, and be willing to adhere to that schedule.

“If patients are not willing to do the rehabilitation, the surgery is pointless,” said Dr. Stanton.

Both Dr. Matzkin and Dr. Stanton initiate lengthy discussions with patients on their daily activities and when they can realistically resume them.

“I also try to have the patient meet the physical therapist before surgery so they can really understand what is involved,” said Dr. Stanton. The surgery may be “finished in an hour or so, but you have months of recovery ahead of you.”

“Patients need to ask the questions and physicians need to lay it out there before surgery,” said Dr. Matzkin.