Knee, shoulder and hip surgeries are the most common of the millions of orthopedic surgeries performed every year in the U.S. But is surgery always the go-to recommendation for orthopedic injuries – those injuries related to the bones and joints? If you see a surgeon, is surgery imminent?

Dr. Matthew Spivey at Novant Health Orthopedics & Sports Medicine - Clemmons specializes in orthopedic sports medicine for shoulders, knees and hips. He treats all ages, and, in his mind, everyone is an “athlete” in some way. Spivey answers a few key questions about orthopedic surgery.

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When you have a joint injury or joint pain, how do you know it’s actually time to see a doctor?

Dr Spivey
Dr. Matthew Spivey

A few symptoms merit at least seeing a primary care doctor or someone at an urgent care. If someone has a significant event or injury where their joint was normal leading up to it and now that joint is experiencing pain, swelling or limited movement, they should probably see a doctor. Also, if they can’t bear weight on it, if it’s a knee or a hip for example, they should see a doctor. It would help to get an X-ray to at least make sure nothing is going on that’s going to get worse.

When you’re referred to an orthopedic surgeon, does the discussion always turn to surgery?

Based on an individual patient’s situation, I try to always talk about both the operative and nonoperative options. For example, injuries like hip fractures, large acute rotator cuff tears and anterior cruciate ligament (ACL) ruptures are structural mechanical problems that, even if they can heal without surgery, can lead to dysfunction or problems down the line.

We explain the concept and the risks of deciding against surgery, and the potential benefits of surgery. Part of my job is to teach patients every day about risks and benefits of different approaches. I think it’s important that they are empowered to make well-informed decisions about their care.

Surprisingly, even an ACL tear doesn’t automatically require surgery. What do you base your recommendation on?

The ACL gives your knee stability in the front to back plane, and additional structures around the knee contribute to that. So, you generally don’t need an ACL that functions normally to do straight-line walking, standing, day-to-day activities and to live a more sedentary lifestyle where you’re not doing higher impact exercise. It’s possible to do quite well without a functional ACL.

But people who do sprinting, cutting, pivoting, side-to-side movements, higher velocity movements and change of direction definitely need a functional ACL. It depends on your activities. If a tennis player doesn’t choose ACL surgery for example, they are likely to experience some degree of knee instability front to back and where rotation is involved, so they risk additional injury to structures in the knee like the meniscus, cartilage or another ligament.

And over a long period of time, they may be at increased risk of developing post-traumatic arthritis in the knee.

Why is there generally a waiting period when orthopedic surgery is recommended?

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