MRI's for knee and hip surgery

Hi Cindi, the idea of 2 major surgeries can be pretty scary, but getting rid of pain would certainly improve your life.

I have had a number of hip replacements as well as ortho surgeries on both hands and wrists and no, no MRI was ever done. Bones show very well in x-rays, so further imaging usually isn't needed. My lungs, head and throat have often been examined using CT or MRI.

But, I would like to address your concern about upsetting the doctor by asking questions- you need full information to make decisions about your health. And to get the best results, you, the doctor, his staff and the physical therapists need to be a team.

I suggest that before your next appointment you write down all your questions and let the office know in advance that you are looking for answers. They may have a nurse or physicians assistant see you first to answer what they can, leaving the rest for the doctor. Often, it is helpful to be a second set of ears and your scribe, to write it all down. Do you have someone to be with you?

We can give you generalised answers based on our own experiences, but they have your x-rays and medical history and can give you specific information.

Also, after surgery and during therapy, many questions and concerns will come up. You need to practice now, so you will be comfortable raising them promptly with your team. After all, you need to be your own best advocate.

Do you feel comfortable trying this? And do you have someone to bring with you?
Sue

I'm going to see this doctor soon, but I will still wait to schedule surgery with him. I am just not comfortable with him (and frankly I haven't been comfortable with any of the orthopedic surgeons I've seen), but I want to know which joint does he think needs to be worked on first. Yes, I will go over my concerns with him, but my question here is whether or not it is standard practice (or rather appropriate practice) for a surgeon to take an MRI before surgery. I'm going to see another doctor after I see this one, who is a bit farther away, but who has a fabulous reputation as a kind and caring and skillful surgeon. So we'll see. thanks for your help.

OK, thanks for letting me know that you did not have an MRI, I appreciate that because I guess I don't have to ask him about that.

Hi Cindi - The Mayo Connect community is here to support you, so you can feel more confident as you approach your surgery.
I don't have any fear of asking questions of my docs, so I am going to throw this open to a few others who have had long and varied medical histories, to see if they have any suggestions for how to get more comfortable asking for the information you need.
@jenniferhunter, @artscaping & @loribmt do you have suggestions for Cindi about how to get more assertive in asking questions of her docs?
Sue

I have had THR and both TKR and never have had a MRI either. I did think it was odd also because when I first started injuring my knees I had several MRIs in 1990s and early 2000s. I had 4 prior knee surgeries before the replacement s & one hip surgery prior. I definitely needed them! All good. Pain so much better but not the 30 yr old you use to be!😀

Yes, I had MRI's on my knees when injured - but they were looking at meniscus, ligaments and muscles, not bones. Once the x-ray says the bone is the culprit, no other imaging is usually done - saving us both money & exposure!

Sue

Good morning @cindiwass Oh my goodness…..my grandmother would ask me …….has the cat got your tongue?……..when I was not forthcoming. As Sue mentioned, I am one of those orthopedic nightmares……facing surgery number 14 in a few weeks. I think this…..the more I know and understand, the better my recovery and recuperation will be. If I am transparent and open, the easier it will be for the medical team to be responsive to my needs even if it is just by increasing my knowledge of the process.

For example, I will have my first Mako Robotic surgery August 12. I am fascinated by this impressive option and have taken advantage of every opportunity to learn more. The PA understood and honored my request to meet with the surgeon directly.

So….it begins with the list of questions, concerns, fears and “wonderments.” Then it helps to practice. If you have a significant other around ask them to listen……sort of a rehearsal.

The real challenge is to be genuine and authentic. I had one of the first reverse shoulder surgeries about 12 years ago. Because it was a new procedure in the US…..my surgeon responded to my natural and normal concerns by taking time to watch a video with me, to show me the replacement pieces he would be using. Knowing that I was frightened, post surgery he came in the evening to my room and sat with me to answer questions and respond to concerns. Before surgery I let him know that I am very sensitive to anesthesia. The anesthesiologist met with me before surgery and actually showed up in my room after surgery to discuss any reaction I might be having,

Doctors, by their nature, and the famous hypocritical oath, are here to help. They don’t expect you to accept everything without concerns, and fears. If they can ameliorate or even acknowledge these issues, they too will feel better about your readiness for the procedure and your ability to be transparent.

May you be safe, protected and free from inner and outer harm.
Chris

Thank you Sue for asking me into this conversation. @sueinmn @cindiwass

Oh my, Cindy. I understand how you feel. I was a timid person and actually afraid of doctors for years. My dad had a temper and I was bullied a lot as a young person. I developed a very real fear of anyone who would do something to me that would hurt and I had so much anxiety about going to the dentist that I passed out. Do you think there was a connection between my childhood thinking and my fear of rocking the boat? Absolutely!

We carry with us all those past memories about what might be risky to do, or would make someone else upset with us. There is a reason that Mayo Clinic's directive is... "The needs of the patient come first." Be your own best friend, and have her tell you to put yourself first.

You need to be the most important because you are the patient and you have to live with the outcome of the medical procedures that you will undergo. The doctor will go on to other things.

You will heal better if you can reduce your stress and anxiety and that starts at your consultation with a surgeon. If you sense that the doctor isn't listening to your concerns, doesn't that make you worry about if that surgeon will take the proper care of you? To be fair to the doctor, you might not get an answer if you are not willing to ask a question. I used to get nervous in grade school when I raised my hand and worried what if I was wrong and then the whole class would know it?

Now, I will ask you to observe yourself.... do you think that you are listening to your own concerns now? or is it that your concerns are not important enough to merit discussion? (In saying this, I have to commend you for coming here to Connect for help. Connect is really a safe place where you can ask questions and learn from other patients.) When in your life have you been in a similar position and afraid to say anything? After you've answered this and written down your answers it's time to think about how far you have come since then. Give yourself credit for your progress with your challenges.

I have this book. It might help. .https://marketplace.mayoclinic.com/shop/healthy-lifestyle/book/the-mayo-clinic-handbook-for-happiness_450300

A few years ago, I found myself in a situation where I had to choose my future. I had an old damaged spinal disc in my neck that along with bone spurs was compressing my spinal cord and I was loosing the coordination and strength in my arms, among other things. As much as I feared major surgery, I didn't want to loose the ability to do what I loved the most which was to create art work. As much as I was afraid, I had to find the courage to advocate for myself and I saw several surgeons who were dismissive of me. I didn't understand.... clearly my MRI showed spinal cord compression, but why wouldn't they help me?

They were human, and afraid to take on a case they didn't understand. Surgeons are nervous too and they have to protect their reputation so they don't want to lower their success rate by talking a case that might not go well.. Their jobs are very stressful. The problem with my case was my symptoms were a bit unusual in that I had pain all over my body and they were expecting that I should only have arm pain. I tracked my pains since the beginning drawing it on a chart of the body, and I knew how it had developed over time. None of the surgeons listened to me when I told them that the pain started a few years earlier that when I turned my head, it gave me a pain in my ankle. It was totally reproducible... head sideways; ankle hurts and head straight; pain goes away.

These local surgeons (not Mayo surgeons) all had different excuses.

#1 didn't think the issues were significant.

#2 told me the central nervous system doesn't feel pain, so the pains I had must be something else. I talked him into a new MRI and took it elsewhere.

#3 told me I had significant spinal cord compression and recommended surgery, but the problem was he wanted me to go to a rehab doctor and fix the problems I was having with the weakness in my legs and the dizziness I was having. After I did that, I could come back to him for surgery. He wouldn't answer my questions and was running out of the room to avoid me at a ten minute appointment. I later got my records and he had written that I needed psychiatric help (because I was really nervous).

#4 told me my leg issues were not related to the cervical spine. He asked me to do a spinal injection as a diagnostic and nerve conduction tests. The spinal injection temporarily took away all the pains that I was having all over my body for a few days. He didn't understand the results and disregarded it. I was told to go back to the doctor who was treating my thoracic outlet syndrome because perhaps the issues were more related to that. I did that, but was told this was more likely a spine issue. To make it all worse, I was being refused appointment by his nurse. Later I did get them to do another MRI, but then was refused an appointment to discuss it. By this time, I was having trouble emptying my bladder and was told by the surgical nurse that she "legally" had to tell me to see a doctor about my bladder.

#5 was another surgeon who was a partner for #4 who filled in for a consult at the request of the neurologist because I could not schedule an appointment with #4. He had me repeat nerve conduction tests then told me to do another spinal injection. What he wasn't telling me was he was leaving his job to take a position at another hospital system so he didn't have interest in my case.

Finally, I was able to get another appointment with #4 and he told me that he didn't know if spine surgery would make me better or worse and with my all over pain, it might be an inflammatory problem like MS. When I later sent a message to him about having vertigo, he declined surgery and told me to stay in physical therapy.

All 5 of these surgeons got it wrong. To have doctors avoiding me and nurses reprimanding me over real spine symptoms they didn't understand was very stressful and demeaning and all the while I was getting worse. That is when I came to Mayo, and there I was treated with respect. I didn't have to waste time waiting for everything. I met surgeon, Dr. Jeremy Fogelson, and he understood all my crazy pain which is referred to as "funicular pain", and he offered to help me the first time I met him. For the first time I was at ease speaking to a surgeon, and I felt safe. I knew enough by this time to know that I was in good hands and getting good answers to my questions.

My story: https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

I didn't know medicine could be this way. I had not met doctors before who were direct with me and truly focused on my well being. It's the reason I'm here as a volunteer on Connect. I do not work for Mayo. Think about it...going through surgery and being under anesthesia is a very vulnerable place to be. You need to completely trust your surgical team to keep you safe. There are surgeons who place their importance high above their own patients. Aside from being doctors, I wouldn't like them as a person either. It is too easy to make mistakes, and people focus better when there are no personal issues involved. Surgeons need to really be able to focus on their jobs and forget about any outside stressors they may have. I just felt safer with a surgeon who was confident, down to earth and kind, and who happily answered my questions. Don't be afraid to ask questions. If you feel that way, maybe you are in the wrong place. No doctor should be offended by your questions. Sometimes there are issues of getting insurance approvals for expensive tests like MRIs. They should explain why they don't need an MRI if X-rays answer the question. Doctors try not to run up the expenses without necessity.

Here is a link if you wish to schedule an appointment at Mayo Clinic http://mayocl.in/1mtmR63

Cindy, what do you think of all of this? Was this helpful in helping you see another perspective? Do you think you would feel more comfortable if your doctors put your needs first? How will you begin to advocate for yourself?

Hi @cindiwass. My mom was 82 years old when she had a knee replacement. It changed her life from one of agony and exclusion to being active and outgoing for the remainder of her life! She was intimidated by the thought of her surgeon. He had an excellent reputation and she felt the typical white coat syndrome. But found out he was this amazingly caring, compassionate man who took the time to describe the whys, hows and recovery of the procedure.

I haven’t personally had a joint replacement but I did have a new immune system installed! Well, that was an adventure. And believe me, my husband and I had lists of questions…before, during and still now, 2 years after! My doctors did make it easy though as they were all extremely approachable. We became more like colleagues in managing my health than doctor/patient.

Not all doctors are that way. Some have the ‘bigger than life’ mystique around them. Don’t feel intimidated. I worked my entire career with dentists and oral surgeons. Some of them could be a bit stand-offish and not very warm and fuzzy. But you know what? After working with them I find out ‘they put their pants on one leg at time’ like the rest of us. (LOL yes one of them used to jog at noon then swap out clothing. 🙄) You’ll find most doctors are just like that!

But the one thing all doctors appreciate is having a plan. As @sueinmn and @artscaping suggested, it’s key to have a list of the questions most important to you. You can also express any concerns and apprehensions. They won’t bite and most welcome the discussion!

And above all, don’t be timid but just be yourself and ask those questions!! Practice with us! We’ll give you feedback! Knowledge is power.

I’ve been following your conversation with Sue and can understand your general reluctance for surgery. But you’ve suffered with the pain of these deteriorated joints for so long and they’re obviously limiting your movement and stealing your joy from each day. I’m concerned that you’re overthinking all of this. What is your biggest fear really?

I don't have a lot to add to this discussion but I just saw my rheumatologist today and we talked about my knees because they are giving me a lot of pain. I work on my feet 8 hours a day and can barely walk when I get home. I had elbow surgery May 7th and of course had to be off my Orencia for a month. I've taken the Orencia now for 9 weeks and can't get back to whatever normal is. We decided to do a prednisone taper and see if that will jump start the meds a bit. Anyway, he did mention an MRI on my knees. He said the dye in it would show if the pain is due to the osteoarthritis or the rheumatoid arthritis I have. I have no problem having one but that will be at a later time if and when I see an orthopedic doctor. My elbow surgery was at Mayo Clinic in MN. I'm very happy with them. I wish I was smarter at knowing what to ask them before a surgery.