Before having joint surgery, be sure you know the risks
It has been said that “all would be well if there were no buts.” Unfortunately, life is full of “buts.”
A prime example is joint surgery. Today, an increasing number of people are being relieved of chronic pain by hip and knee replacements. Others are being helped by lesser laparoscopic procedures.
But patients should be aware that these are major operations sometimes associated with unintended consequences.
For instance, several years ago Dr. Justin de Beer, an orthopedic surgeon at the Henderson site of Hamilton Health Services in Hamilton, Ont., reported an unexpected finding that a worrying number of patients had suffered heart attacks after hip and knee replacements.
The majority of these coronary attacks occurred within three to five days of the replacement. Equally important, 29 per cent of these patients had no previous history of cardiac disease.
To obtain this information, de Beer and his colleagues analyzed 3,471 hip and knee replacements performed at their hospital from 1998 to 2003. They found that 63 patients had suffered a heart attack and seven patients died.
Another study found a 12 per cent rate of silent heart attacks after surgery for non-cardiac conditions. Moreover 60 per cent of these patients experienced another major cardiac problem within the next six months.
Several other studies, one published by the Canadian Medical Association Journal in 2006, showed a significant downside to elective surgical procedures. In this study, 1.4 per cent of patients over 50 suffered major cardiac problems when they were not having surgery on their heart. Of these patients who had a heart attack, 25 per cent died, and for those who had a cardiac arrest during surgery, 65 per cent died.
Looking at the problem from a worldwide standpoint, the figures are more shocking. Of the 100 million operations carried out for non-cardiac reasons, 900,000 patients died from heart attack, suffered a non-fatal coronary or had a non-fatal cardiac arrest during the surgery.
But why are patients developing heart problems during surgery? Remember, these patients having hip and knee replacements are not children. One study showed that patients at greatest risk for a heart attack, even a silent one, are over 50, suffering from diabetes or have both a knee and hip replacement done at the same time.
The blunt fact is that it is impossible to provide new joints without placing the body under extreme stress. Moreover, the trauma of the surgery triggers a host of physiological changes that increases the risk of a fatal blood clot.
What about the risk of what is often referred to as keyhole surgery that is much less traumatic? These procedures can also greatly improve quality of life. But a report in Risk Management Magazine, published by the Canadian Medical Protective Association, shows even these lesser operations can be associated with significant risks.
For example, some patients were left with either temporary or permanent impairment that resulted in significant loss of function. Other patients complained of foot drop, a change in the length of their leg or continued persistent pain.
Others suffered from infection, blood clots in the leg, lungs or stroke. Still others had the sciatic nerve injured. A few surgeons operated on the wrong leg! And seven per cent in this study died.
So never forget this Gifford-Jones Law. If a joint is partially broken and causing only minor discomfort, think twice or a few times before agreeing to surgery. Surgery is best done only when joint pain is having a major effect on one’s quality of life.
Also, be an informed patient. Some patients complained they had not been advised of all possible complications.
So be certain to have a discussion about side-effects before the procedure. And also have the surgeon place his initials on the affected joint to avoid wrong-sided surgery.
You must also accept the fact that if you’re obese, have diabetes, hypertension or other medical problems, you always face a greater risk of complications. And that even under the best of conditions, no surgeon can ever guarantee there is no chance of complications.
There will always be “buts” in surgery.