SURGERY: Not Always The First Option

Trey Nolen Articles From Our Physicians

By: Andrew B. Hester, MD
Gadsden Orthopedics

I think there is a misnomer that visiting a surgeon means you are getting surgery. For the most part, this couldn’t be farther from the truth. Most surgeons worth their weight in salt will do everything in their power to keep you out of the operating room. Our oath states “First do no harm.” Though surgery may be curative, it is painful and, although rare, complications can arise. Ethics dictate that we exhaust non-operative means before we decide to pick up a scalpel. That is not to say that it always occurs, but most orthopedic surgeons hold this common belief.

There is not a day that goes by that I don’t see a patient in my office with knee pain,specifically, knee arthritis. Knee arthritis is a relatively simple term for a complex problem. Having knee arthritis does not automatically equate to a knee replacement, however. Arthritis is a process by which cartilage in your knee is injured. Small cartilage particles are released into your joint fluid. As your body responds to this, your own immune system releases chemicals to dissolve these particles. These chemicals both cause pain and further progression of your arthritis.

There are a multitude of options for knee pain and knee arthritis. The first step is to control the inflammation. Oral medications in the form of ibuprofen, Aleve, or prescription anti-inflammatories are frequently used. These medications sometimes need to be tried and changed to find the one that works for your body. I change anti-inflammatory medicines for my patients daily. Sometimes injections of medicines are necessary. This is not the painful experience one would expect. The benefits from injections greatly outweigh the momentary discomfort. Steroids, anti-inflammatories, and artificial joint fluid can be used very successfully. Step number two is to increase your muscle strength. Simple at home exercises can improve your strength and decrease your pain. Third is bracing. Frequently a simple brace can provide support and help control swelling. Fourth, and most importantly, is simple low impact aerobic exercise such as walking, bike riding, or an elliptical machine.

Should all these efforts fail, surgery is an option, though not always our first choice. I regularly see patients who come in every few months for injections or medicine refills, some of whom I have seen for 5 years or more. They still have not had a knee replacement.

So, should your knee, shoulder, hips, hand or feet become painful, don’t fret that a visit to your surgeon means you are having surgery. We, as orthopedic surgeons, do many things to help and cure our patients without a scalpel in hand.