When is surgery an option?

With Bruce Faure, M.D., Orthopedic Surgeon with Advanced Healthcare

Last Updated: Sept. 1, 2003

Bruce Faure, M.D., Orthopedic Surgeon with Advanced Healthcare "When deciding if surgery is appropriate, the surgeon looks at whether or not pain can be eliminated."

“The goal of orthopedic surgery is permanent relief from pain,” says Dr. Bruce Faure, orthopedic surgeon with Advanced Healthcare.

Pain does not exist independently; it always stems from some other cause. The first step is to determine if there is a fixable cause such as arthritis, a nerve injury, a slipped disc or some other mechanical problem. “When you go to a surgeon, the initial work-up is to identify the cause,” says Dr. Faure. If the examination determines that arthritis is the culprit for the pain, the next step is to clearly diagnosis which type of arthritis.

Precise identification of the cause is essential in determining whether a patient is a candidate for surgery. During the identification process, a surgeon will strive to answer three key questions: Where is the pain coming from? What’s causing the pain? Is the pain reversible?

Surgery is often not the first course of treatment. There are other measures for managing pain and steps that should be taken before surgery becomes an option:

Avoid activity. If climbing stairs causes pain, try to avoid staircases and look for elevators or escalators, or combine trips so you don’t have to take the stairs so often.

Condition. Ask your doctor or therapist for a conditioning program that will build your endurance and strength and possibly reduce pain. You may also find that weight loss and physical fitness can help take some of the pain away.

Use aids. Special shoes and adaptive devices such as braces can sometimes help correct problems that may be causing your pain.

Take your medicine. Anti-inflammatory drugs such as aspirin or ibuprofen can “markedly reduce the inflammatory response to injury,” says Dr. Faure. For serious pain, cortisone injections may be needed.

In cases where pain cannot be managed through other means, surgery becomes an option. Surgery often offers the best hope for permanently relieving pain. “If you’ve tried all of the above, then you’ll come into the surgical realm,” says Dr. Faure.

He adds that, “When deciding if surgery is appropriate, the surgeon looks at whether or not pain can be eliminated.” One simple test is to use an anesthetic on the affected area. The anesthetic is injected into the surface of the joint. If the anesthetic takes the pain away, the pain is probably in a specific joint. That joint can then be repaired or replaced through surgery.

Arthoscopy is a minimally invasive surgery that uses special tools to go in and remove torn cartilage. More invasive surgery includes procedures to repair or replace joints. Says Dr, Faure, “Replacements can be done successfully in most of the mobile joints, particularly the larger joints such as hips or knees.” Other, smaller joints can also be repaired or replaced through surgery.

Unlike pain management, surgery is intended to completely eliminate pain. It may not be necessary for everyone who lives with chronic pain, but it has proven to be successful for many pain sufferers.

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