Thank you so much for your kind note, MaryAnn. Given my experience, I recommend the following:
1. Surgeons should be required to disclose the risk of limited functionality at the initial consultation. Mine didn’t and, months later, a knowledgeable acquaintance explained that many surgeons don’t because fewer people would opt for surgery. She told me this risk is disclosed in the consent form people are given when they’re already prepped for surgery.
2. Patients should be offered the opportunity to pay for a weekly call or Zoom with a case manager to discuss their progress and address their problems. Many of us are accustomed to paying weekly for professional services, such as therapists and personal trainers, and would jump at the chance to talk to someone who could make sure we’re progressing appropriately, at least during the first year post-op. In my case, I would have liked a case manager to make sure I had adequate physical therapy, adequate pain relief, and an effective sleep aid; and to immediately recognize and treat the keloid on my scar. My hospital-affiliated rehab facility scheduled me only once a week, which caused me to miss out at a critical phase of recovery and angered my surgeon when he found out at my six-week checkup. I was quite ill after surgery—I had a vasovagal episode on day 16 and many of my lab values were out of range—so maybe the therapist limited my PT for that reason. But he should have consulted with the surgeon. A case manager would have told me the PT was inadequate and sought the surgeon’s advice. On the subject of pain and sleep, I felt abandoned by the surgical team and ended up working with my personal physician, although she didn’t have expertise in joint replacement recovery. Given their specialized knowledge, I believe I would have had a better experience if the internal medicine physicians at the orthopedic hospital could have helped with recovery in addition to doing pre-surgical testing. A case manager could have sought their advice.
At any rate, these are my thoughts.