News flash: Surgery doesn’t always work. The most important thing I tell my patients is that any effort to make a person better might make them worse.
There are a host of complex reasons for a surgical failure. Sometimes, it’s a combination of factors. At other times, the reason is very clear. Revising the surgery is often, but not always, the best approach. Here are some situations where a failed surgery can be fixed.
Having been in the field for over 30 years, I have seen almost all possible surgical problems—either from patients in my own care or in those referred to me, I know how to fix these problems—but only if you, the patient, have your head in a good space and the two of us have confidence in each other. If either quality is not present, a failure upon a failure is more likely to occur.
Surgeon-produced reasons for failures are either failures in logic about what to do or failures in surgical technique. A failure in logic may have to do with the bias of the surgeon: thinking, for example, that taking out the meniscus is not a real problem, or that articular cartilage cannot be repaired, or that all arthritic knees should get total knee replacements. These are errors of knowledge and may not be changeable unless the surgeon chooses to study, attend meetings, and think openly.
Errors in technique are often due to misplacement of tissues or devices. These may include placing the ACL reconstruction in non-anatomic positions, misaligning the total joint components, or injuring nerves by excessive exposure. These errors can be reduced, fortunately, by the adoption of pre-surgical 3D imaging and planning, robotic technology for artificial component placement, cadavers and virtual laboratories for surgeon training, and the ubiquitous YouTube instructional videos.
Patient-induced failures may be sometimes biologic. This may mean a tendency to develop an infection or an allergy to a device or tissue implant. More commonly, though, the failures are caused by post-operative activity errors. The patient might do too much and damage repaired tissues or do too little and develop scar tissue, leading to a loss of range of motion.
Most frustrating are wound-care errors: a failure to keep the incision site clean, which can lead to contamination and infection of the healing incision. (We recently saw a case where acupuncture needles were placed into the swollen post-operative knee!). But even the worst of these issues, often a joint infection, can be solved if treatment is immediate, thorough, and built on trust between the patient and the doctor.
Repeat surgery, which involves washing out the joint and replacing the infected tissues or implants, is not a journey anyone wishes to take. Yet all surgeons remember patients who treated this as part of the healing path, applied themselves rigorously to their physical therapy, and finished with superb results. We also remember those who did not—patients who were angry, frustrated, sometimes engaged lawyers, or were lawyers, and just never got the successful outcome they deserved. Sometimes, unfortunately, a surgeon will hesitate to undertake the dramatic surgical revisions that are necessary, due to a loss of confidence in the doctor-patient relationship.
These are not stories that anyone is proud of. They are often buried in a surgeon’s memory, and the lessons are not shared in a way that others might learn from. But if we can find a safe way to share, wonderful things will happen. To do this, we must all acknowledge that stuff happens and dedicate ourselves to open, creative thinking. This includes constant learning, the upgrading of our technology, and entering into our doctor-patient relationships with honest expectations, trust, and mutual commitment.
We try to love all of our patients and to love even more those with an unexpected problem. If the feeling is mutual, success occurs.