Categories: Health InformationMSK articles

Surgery and musculoskeletal conditions

The thought that you might need surgery one day because of your musculoskeletal condition can be a frightening one. The good news is that most people can manage their condition with the usual treatments of medical care (e.g. GP, specialist, medications and allied health) and self-management (e.g. exercise, weight management, relaxation, aids and equipment).

Surgery is usually only required when all other treatments have failed to bring any relief.

Reasons for surgery

For some people, surgery may be an option to:

relieve pain that’s no longer controlled with treatments such as medications, heat and cold, massage or exercise
improve joint movement
improve mobility and independence
correct the position of joints that have become misaligned
improve their health and wellbeing if joint pain affects their sleep, mental health, ability to work or take part in other important activities or events.

Is surgery right for you?

That’s something only you can answer, after consultation with your doctor and an orthopaedic surgeon, and weighing up the benefits and risks. In the end, it’s your choice whether you have surgery.

If you’re not sure or don’t feel comfortable about the information you’re receiving from the surgeon, ask your doctor to refer you to another surgeon for a second opinion.

Types of surgery

There are many types of surgery that people with musculoskeletal conditions may undergo. Your surgeon will discuss which one is right for you. We’ve focused on the most common and provided links to websites with information on others in the More to Explore section.

Arthroscopy – allows surgeons to look inside the joint and see any damage. The surgeon makes a small cut (or incision) into the site (e.g. your ankle) and inserts the arthroscope. It has a tiny camera that provides images from inside the joint. The surgeon can then diagnose the problem (e.g. damage to the ligament or cartilage) and/or treat the problem. Arthroscopy is most commonly used for conditions affecting knees, shoulders, elbows, ankles, hips and wrists. It’s important to note that arthroscopy is not recommended to treat osteoarthritis (OA) of the knee. Evidence shows that it’s not effective in improving OA knee pain.
Joint fusion (arthrodesis) – involves fusing two or more bones in a painful joint together. This essentially turns them into one bone and relieves pain because the joint no longer moves. Joint fusion is often done in the ankles, spine, feet, fingers, thumbs and wrists.
Joint replacement – is exactly what it sounds like. A damaged joint is replaced with a metal, ceramic or plastic device (prosthesis). The entire joint may be replaced (total joint replacement), or only a section (partial joint replacement). The replacement is designed to replicate a healthy joint and allow you to move it freely and without pain. The most commonly replaced joints are the hip and knee; however other joints such as shoulders, elbows, fingers, ankles, toes can also be replaced.
Joint resection – involves removing part of the bone from a joint, or the entire joint, to improve the range of motion and relieve pain. Resection is often done in toes, thumbs and shoulders.
Joint revision – involves a prosthesis from an earlier joint replacement being removed and replaced. This may occur because the joint has worn out (most modern prostheses last 15-20 years), an infection has developed at the site, or the replacement has become unstable.
Osteotomy – is surgery that involves cutting, shaping and repositioning bone. This may be done if, for example, a knee joint is wearing unevenly, and there’s more pressure on one side than the other, causing pain and instability. The surgeon will cut and reshape bone in the knee so that pressure is distributed more evenly across the joint. Osteotomy is most commonly used for knees and hips but can also be helpful in other areas such as the spine or jaw.
Synovectomy – is the removal of tissue (synovium) from the inside of a joint. In inflammatory forms of arthritis such as rheumatoid arthritis, the synovium can become inflamed and excessively thick. This causes pain and may limit joint movement. A surgeon can remove some of this synovium, relieving pain and improving joint function. This surgery is often performed using an arthroscope. The most commonly treated joints are ankles, knees, hips, elbows, shoulders, wrists and fingers.

Understanding your surgery

All surgeries have an element of risk and the potential for complications. That’s why it’s essential that you know as much as you can before you have surgery. And while it can sometimes be intimidating asking questions, it’s your right as a patient to be fully informed.

You should discuss the risks of your specific surgery with your surgeon and anaesthetist before you decide whether to go ahead with it. And if you don’t understand something, ask them to explain it some more.

As well as understanding the procedure and what to expect, don’t forget to ask your doctor about any rehabilitation required, the costs involved with surgery and for an idea of how long you may be waiting for your surgery. Both may factor into whether you decide to go public or private (if you have private hospital cover with your health insurance).

You should also find out if you can do things before surgery to minimise these risks – for example, lose weight or quit smoking. Knowing and understanding potential risks enables you to make an informed decision about surgery.

Finally, it can be helpful to take someone with you to these consultations. There can be a lot to take in, so an extra set of eyes and ears can help you make sense of it all. They can also provide you with support if you feel anxious or stressed (which is completely understandable!).

Getting ready for surgery

Once you’ve made the decision to have surgery, you need to get ready. You’ll have the best outcomes from surgery if you’re at your healthiest and fittest. Your GP and healthcare team (physio, dietitian, exercise physiologist, psychologist) can help you do this safely. Depending on your own circumstances, you may need to:

Meet with your surgeon and healthcare team – they’ll give you information and advice so you know what to expect during and after surgery. Depending on your surgery, you may need to undergo an assessment before you have surgery.
Exercise – to strengthen your body and help you manage your pain and mental health before surgery. An exercise physiologist or physiotherapist can provide you with an exercise plan to suit your needs.
Lose weight – if you’re overweight, losing some extra kilos will aid your recovery. Eating a healthy, well-balanced diet is the best way to lose weight and get the nutrients you need for good health. Talk with a dietitian for a dietary plan to help you lose weight, or join a weight loss group.
Quit smoking – as smoking can increase your risk of complications during and after surgery.
Have some meals prepped in your fridge and freezer – so you don’t have to worry about cooking healthy meals when you come home after surgery.
Prepare your home – remove any trip hazards (e.g., rugs, loose cables, cords), ensure your lighting works in all areas, and if necessary, install handrails in your shower, beside the toilet and beside any steps or stairs to provide you with extra support.
Get your family or friends involved – you may be in some discomfort when you return home from the hospital and may need help. Enlist the aid of your family and/or friends to help with things such as taking you to medical appointments, running errands, getting dressed, doing housework, or cooking.

After surgery

Monitor your wound as instructed by your surgeon.
Talk to an occupational therapist about aids and equipment – depending on the surgery you’re having, you may require some aids to help you out in the short or long term, such as walking aids, shower stools, tap turners etc. They can also give you information and advice about things such as your bed and chair heights and ways to save your energy while recovering from surgery.
Stay active – exercise is essential after surgery, especially those prescribed by the physiotherapist at the hospital. Perform these exercises as instructed and check in with the physio as required. This will ensure you get the most benefit out of your surgery.
Take any medication as prescribed.
Look after yourself – eat healthy, balanced meals, drink plenty of water, sleep well, don’t smoke and deal with your emotions. It’s ok to have some ups and downs after surgery, so acknowledge how you’re feeling.
Write down any questions you have for your surgeon, doctor and allied health team, so you don’t forget them when you get to your appointments.

What are the costs of surgery?

If you’re a public patient having your surgery at a public hospital you don’t pay anything for your medical treatments.

Costs for many private treatments are also fully covered by Medicare and private health insurers.

However, you may have to pay out-of-pocket costs if you have medical treatment as a private patient in a private or public hospital. This can include costs for:

doctors or other health care providers
hospital charges such as accommodation and theatre fees
costs incurred outside a hospital, for example for appointments or diagnostic tests.

For more information on out-of-pocket costs visit the Department of Health Website.

If you have health insurance and you plan to go through the private health system to have your surgery, contact your health insurer to find out if your procedure is covered by your level of cover, and if you’ll be facing any out-of-pocket costs and waiting periods. We’ve listed different levels of cover and what they include on our website.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.