How do I know when it's time to see a new orthopaedic surgeon?

January 28, 2009 6:48 PM

How do I know when it's time to see a new orthopaedic surgeon?

Here's the deal: I dislocated my patella about five weeks ago, and before it relocated it bounced around and caused some trauma to the surrounding area. Went to the ER and then went to an ortho surgeon who was recommended highly to me. First he thought I had ruptured my patellar tendon because I couldn't (and still pretty much can't) lift my leg up from my knee to my foot, i.e. if I'm sitting and I were to try to lift and straighten my leg it won't go farther than a few inches.

MRI showed (according to him) that my tendon is not ruptured. My knee was drained and I've started therapy, things are progressing OK except that I still can barely lift my leg. I went to see him for a follow-up two days ago, and he mentioned for the first time that a bone fragment is present which may be limiting my motion, and that there is a small chance I'll need surgery to remove it.

I guess in general, I am feeling like I don't know enough to either determine if my original diagnosis (therapy will make it all better) was made carefully, or to know if this guy is actually paying much attention to my condition.

Has anyone been in this position before with a similar injury, and at what point (if any) did you seek a second opinion?

posted by rollbiz to health & fitness (6 comments total)

Not in a similar position wrt the injury, but get a second opinion the moment you are not comfortable with you doctor. If you lose confidence for what ever reason, justified or not, get another opinion. I would ask another doctor for a consultation. Explain what has happened and ask whatever question is gnawing at you. It may turn out that you now think even more of your original doctor and cannot believe you ever doubted her or you think he is a putz.
posted by JohnnyGunn at 7:18 PM on January 28

Yeah, it sounds like a second opinion is probably warranted here. Odds are your surgeon is doing his best and giving you the attention you need, but your body is not cooperating. But if you're uneasy with your care, seek an assessment from someone else before you actually switch.

Physicians and surgeons--good ones anyways--aren't at all bothered by patients seeking second opinions. True, it can be a blow to the ego, and surgeons in particular are stereotypically egotistical, but most are decent enough people to realize that they're masters of a discipline of which most patients haven't the foggiest notion, so more than one person telling them the same thing is better for everyone int he long run.
posted by valkyryn at 7:31 PM on January 28

IANAD and IANYD. That said, I have a history of patellar dislocations and subluxations and an orthopedist for a father. Nothing like watching your knee repair surgery on VHS ("here you can see we're grafting your anterior cruciate ligament back together..."), but I digress...

When I subluxed my patella the first time, it also generated a bone fragment that healed in a weird way - think odd protrusion from my knee - but luckily doesn't interfere with movement. The second time I had multiple loose bodies of cartilage floating around my knee - front to back, interiot to exterior - and I consequently had a second surgery to remove those bodies.

Any loose bodies in your knee should be removed soon, before they either cause your knee to lock up (trick knee) or before the bone heals in a weird place. Again, IANYD, but I wonder why the doc didn't schedule some arthroscopic surgery to get the bone fragment and any other loose bodies out.

Second opinions are harder to come by when Dad is in the room with your orthopedist and they're comparing notes.
posted by squorch at 10:15 PM on January 28

When you say you can't move your leg, do you mean that it physically won't go, even if someone else flexes it for you? Or that you can't do it yourself? Because of pain, or because it just won't go?

Anyway, yeah, get a second opinion. Sometimes it's just a matter of getting a different xray tech who finds the right angle to spot what's going on in there.

My mom's a nurse, and she had a unique way of choosing surgeons. When she worked in the surgical recovery area, she could spot trends with the different surgeons. Some doctors' patients were always coming back for surgical revisions, and others never did. She chose the guy who never had any come-backs. Turns out, in addition to being a orthopedic surgeon, he is also a mechanical engineer. I talked to the guy, and he's just gifted with one of those minds that visualizes not just the motion of joints, but also the various mechanical stresses that the joints are saddled with. Saying things like "see, look, it's a lever. When you are walking, it's under the stress of your body weight. But when you are going up stairs, it multiplies by the weight times the length of your femur. Don't do that until it's healed!" That's the kind of doctor you want.

(If you are in Chicago, PM me for his name.)
posted by gjc at 6:11 AM on January 29

When you say you can't move your leg, do you mean that it physically won't go, even if someone else flexes it for you? Or that you can't do it yourself? Because of pain, or because it just won't go?

My leg will move, but I am unable to lift it using my own "leg power". The little bit that I can lift it while sitting is painful, but mostly it just feels like whatever is supposed to to the job isn't there. I do have fairly good range of motion though, I can go from a straight knee to a bent knee without pain or anything weird happening. It's hard to explain, does that make sense?
posted by rollbiz at 8:40 AM on January 29

Thanks to everyone so far, by the way...
posted by rollbiz at 8:41 AM on January 29