Frederick G. Dalzell, an orthopaedic surgeon based in Atlantic County, begins setting expectations with his patients as soon as they start discussing total knee replacement. It’s the doctor’s standard procedure to inform them which activities he thinks they will be able to resume after such a significant operation, and which may be difficult, always keeping reality in mind.
“Sometimes now, with advertising in medicine, we create unrealistic expectations,” says Dalzell, of Shore Orthopaedic University Associates in Somers Point, Cape May Court House and Galloway. “We all have the patients who come back and play basketball and do skiing, and runners (who) set records. Those are the ones you like to publicize.
“But I try and keep it more realistic with the middle patient and tell them, ‘There’s a chance you can do better or a chance you could do a little bit worse. But this is what I think the average knee is and should be doing.’ ”
Managing patient expectations can be one of the most challenging aspects of total joint replacement surgery, whether the knee or hip, doctors say. Some patients expect to resume high-intensity training or activities soon after surgery, and, while some do, many others must switch to lower-impact exercises that are easier on their joints.
In some cases, the lifelong distance runners or pickup basketball warriors might be better served transitioning to cycling, swimming or power walking. And while it is not always easy to have those conversations with patients, Dalzell and other surgeons say, tempering post-surgery outlook is important.
“Sometimes in medicine, like other things where there’s competition, you’re almost doing a disservice trying to push the patients toward those types of (high-impact exercises),” Dalzell says. “There’s one group that advertises two brothers playing basketball against each other, running up and down the court. That happens, but that’s probably not the usual in hip replacement.”
As with most serious procedures, prior circumstances play a major role in post-surgery expectations. Some older patients may have already developed significant arthritis that can result in lingering pain or discomfort after joint replacement surgery. And artificial joints have a shelf life; many can last a baseline of about 25 years, give or take five to 10 years, depending on the patient’s level of activity post-surgery.
Timothy Henderson, an orthopaedic surgeon who performs total knee and hip replacements at St. Barnabas Medical Center in Livingston, among other locations, says he doesn’t “put any restrictions” on his patients.
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