Keeping an eye on the time frame even for elective surgery
An emergency is urgent and usually requires immediate surgery. Postponement is not possible. An elective - i.e. scheduled - procedure is a different matter. As a rule, this can be postponed. However, there are also limits to the time frame here, point out the doctors at the Hellersen Sports Clinic. "We are currently observing more and more frequently that patients come to us very late in order to have an operation," reports Dr. Joachim Hagenah, head physician for endoprosthetics at the Hellersen Sports Clinic. A postponement of a few weeks or even months is usually not a problem. In the meantime, however, it has become apparent that many people are pushing the time limit to the limit because they are afraid of the coronavirus. That can also have consequences. "In hip patients, very long waiting can lead in individual cases to a part of the bony socket breaking away and then no longer being available for the installation of the artificial joint," explains the chief physician. Just last week, he treated another patient in whom a piece of the acetabulum of the hip joint had already broken off. As a result, the surgery is more complex and the patient needs a different implant than if the surgery had been performed in time. "In these cases, the measures can already be compared to a replacement operation," explains Dr. Hagenah.
The accumulation of such cases reminds Dr. Hagenah of the situation about ten years ago. Due to the publication of reports that too much surgery was being performed in Germany, many patients would have decided too late for surgery back then as well. "If a significant increase in pain is detected, that is a sign that something is wrong and then the person concerned should also have it checked urgently," advises Dr. Hagenah.
In other orthopedic areas, too, postponing treatment can jeopardize the success of the therapy, confirms private lecturer Dr. Sascha Beck, chief physician at the Center for Special Joint and Trauma Surgery, and cites a few examples. "In the case of a tear of the tendon cap of the upper arm - the rotator cuff - treatment should always take place promptly. The tendon damage can only be repaired surgically. As the duration of the damage increases, the tendon defect successively enlarges. As a result, surgical repair of the tendon becomes more complicated, reduces the chances of success of the operation or, in the worst case, rotator cuff reconstruction is no longer possible."
Cartilage damage to the knee joint is similar, he said. "These, too, should be treated promptly. If treatment is delayed, the cartilage damage can increase or spread to the opposite cartilage. As a result, the chances of success of surgical cartilage therapy, in particular also cartilage cell transplantation, decrease. In the worst case, cartilage therapy is no longer possible. In both cases, treatment should therefore take place as early as possible," summarizes the chief physician.
In the back, the effects of waiting longer before treatment also vary greatly. "There are treatment patterns for which treatment does not have to be immediate, while for others immediate action is better," says Dr. Stefan Nolte, head physician of Conservative Orthopedics. In the case of a herniated disc, for example, the decisive factor is where it is located. Every fresh slipped disc can - depending on where it is located - lead to a nerve being damaged.
Usually, in such a case, the herniated disc makes itself felt and radiates into the legs and arms, and the patient experiences severe pain. "In such a case, of course, should not wait to see a doctor. This is because the nerve can also suffer permanent damage if it is not treated," explains Dr. Nolte. In principle, he says, it varies greatly whether treatment must be given immediately or whether there is still time. The chief physician agrees with his colleague: "It always has to be decided on a case-by-case basis."
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