Questions to ask your doctor before surgery

If you have RA and are considering surgery to repair or replace a damaged joint or related structure, it is important that you get as much information as you can before making your decision. If you are living with severe joint pain and loss of normal joint function, surgery can make a big difference and provide dramatic results, including relief of pain and restoration of at least some joint function.

Having surgery is not always the best decision. There may be other noninvasive treatments or management approaches, including medications, physical therapy, medication, exercise, or diet, that may provide relief of symptoms without the trauma of surgery. However, if you’ve tried everything and still suffer from pain and disability, surgery may be the answer.

Getting informed about surgery

There are a number of questions that you should ask your doctor and/or orthopedic surgeon to make sure that you are fully educated about the risks and benefits of surgery, as well as how best to prepare for surgery and what to expect afterwards.

We’ve included a selection of important questions below, with answers and advice that should serve not as an end, but as a starting point for discussion with your doctor. As is the case whenever you are having an important discussion with your doctor, remember to bring pen and paper for notes, so that you can get the answers you need and so that you’ll be able to remember them later on when you get home. Having an extra set of ears with you (in the form of a friend or family member) can also be helpful in terms of capturing the content of what you discuss.

Questions to ask your doctor if you are considering surgery

  • How can I decide whether surgery is the right option for me?
  • What are my options and prospects if I decide not to have surgery?
  • Is there any risk in delaying surgery?
  • How do I know if I’m well enough to have surgery?
  • Are there things that I can do to prepare for surgery and increase my chances for a successful outcome?
  • What can I expect from surgery?
  • What are the success rates and rates of complications with the type of surgery I’m having?
  • How long will it take for me to recover from surgery and what sort of rehabilitation will I need to do?

How can I decide whether surgery is the right option for me?

There are some key factors that are important in helping you determine whether you should consider surgery for RA-related joint damage. Your level of pain and discomfort and your level of disability are very important factors. If you are considering surgery, you have probably tried other strategies including pain medication, physical therapy, and perhaps assistive devices to help you cope with your symptoms.

Generally, surgery should only be considered after you have exhausted nonsurgical options, such as changes in disease-modifying anti-rheumatic drug (DMARD) treatments, use of potent pain medications, and rehabilitation approaches. If your pain and disability persists during activity and rest and has a significant negative impact on your quality of life, then surgery may be a good treatment option for you. Try asking yourself the following questions to gauge whether you are ready for surgery:

  • How much is pain interfering with my ability to enjoy a productive and fulfilling life?
  • Am I relying on the maximum dosage of pain relievers to make it through the day?
  • Have I exhausted other methods of pain relief, including physical therapy or alternative methods of pain management?
  • What do I hope to achieve with surgery and is this hope realistic?
  • Am I willing to do the work involved in rehabilitation after surgery?

Another important factor in determining whether you should have surgery is your general health. Your risk for complications during surgery increases if you are overweight or have medical conditions, including hypertension, cardiovascular disease, diabetes, or bleeding disorders.

In making your decision whether you will or will not have surgery, you should weigh the risks (complications) against the possible benefits (relief of pain and improved function).

What are my options and prospects if I decide not to have surgery?

In order to be able to truly weigh the risks and benefits of having surgery, you will need to have a sense of what to expect if you decide not to have surgery. There may be other nonsurgical options for coping with pain and improving joint function (eg. splinting, orthotics) or adjusting to disability (eg. use of assistive devices such as mobility aids). Your doctor should also be able to tell you whether your condition will continue to worsen over time and what this will mean in terms of function and quality of life. Try to get a complete picture of your options, both with and without surgery, before making your decision.

Is there any risk in delaying surgery?

If you are considering having surgery for an RA-related joint problem, you are probably struggling with significant disability and loss of function. However, your surgery may not be an immediate emergency (unless you’ve torn or injured a tendon or ligament) and you certainly have time to consider the risks and benefits. One of the factors that you should think about is the increased risk associated with waiting too long before having your surgery. For instance, if you are considering hip or knee replacement and have active RA, delaying the procedure increases the risk of the muscles contracting over time and other structural changes occurring that may make surgery more difficult and decrease the chances of success.

How do I know if I’m well enough to have surgery?

Before you have surgery, your doctor will give you a complete physical examination, including a range of laboratory tests, to determine whether you are healthy enough to undergo surgery.

Are there things that I can do to prepare for surgery and increase my chances for a successful outcome?

If you think you may eventually need surgery to repair a damaged joint, there are things that you can do to decrease your risk of complications and increase your chances for success.

Get in shape. Getting in good shape before surgery will pay dividends during and after your procedure. If you are engaged in a regular program of exercise before surgery, your body will have an easier time recuperating from the trauma of surgery and you will be more prepared for a program of post-surgery rehabilitation. Also, exercise is a way of improving your general health and this will decrease your risk for complications, including infections and clotting. If you are not already getting regular exercise, start a program of exercise. You can work with a physical therapist to tailor a program that is suited to your abilities, including your level of pain and physical limitations.

Lose weight. Being overweight is one big factor that increases your risk of complications and decreases the chances that your surgery will be a success. Make a goal of losing weight before you have surgery. You should use a combination of exercise and a careful, balanced diet. While you want to lose weight, you also need to get the nutrition that your body requires to maintain optimal health.

What can I expect from surgery?

Ask your doctor to describe the goals of surgery and what you can expect in terms of both relief of pain and restoration of joint function (this includes range of motion and stability). Of course the answer to this question will depend on the joint(s) involved and the type of surgery you require. Your doctor should be able to tell you what sorts of activities you’ll be able to engage in after surgery and what limitations you may have.

What are the success rates and rates of complications for my type of surgery?

Your doctor should also be able to give you an idea of the chances of success with any given surgical procedure, including the following statistics:

  • How long a surgical correction is likely to last (for instance, what percentage of patients needed another similar procedure 1, 2, 5 and 10 years later)?
  • What percentage of patients have complications, such as blood clots (for major joint replacement surgery), infections, or cardiac events?

How long will it take for me to recover from surgery and what sort of rehabilitation will I need to do?

The length of recovery and the intensity of rehabilitation will vary widely depending on the type of surgery and the joint or joints involved. For instance, tendon repair may require only weeks before function is restored, while major total joint replacement may require several months and a lengthy program of rehabilitation. Your doctor should be able to give you a time table for recovery and a sense of how much rehabilitation you’ll need to do to restore joint function.

Written by: Jonathan Simmons and Emily Downward | Last reviewed: June 2018.