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CONCORD, New Hampshire /
The Concord Monitor / Books / August 31, 2009
Doctor's book offers advice for before, after surgery
By Margot Sanger-Katz, Monitor staff
Dr. Daniel Fulham O'Neill has been performing knee surgeries for more than 20 years, many for members of the U.S. national ski and ski jumping teams. For him, knee surgeries are old hat, but he started to realize that his patients were often confused and unprepared for their surgeries and their aftermaths, so he started putting together handouts.
His handouts grew into a big packet, and many colleagues started asking for copies. Recently, he decided it was time to collect his notes into a book for patients facing knee surgeries. The book, Knee Surgery, describes how knees work and what knee surgeries are designed to do. It also recommends ways to prepare - physically and mentally - for surgery and suggests an exercise and stretching plan to help with recovery.
Less than a year after his knee injury, Tom Brady is playing in the NFL again. For many of the same reasons that recreational athletes shouldn’t expect to play as well as Brady, they also shouldn’t expect to recover from major surgery as quickly. AP file photo
O'Neill, who spoke with us about his book and his experiences, practices with the Alpine Clinic in Plymouth. He is an orthopedic surgeon with a master's degree in sports psychology.
How common are knee surgeries?
Incredibly common. Literally, a half million total knee replacements in a year. That's just in the U.S. One hundred thousand anterior cruciate ligament reconstructions, and literally millions of knee scopes, knee arthroscopies.
Why? Is there something about knees that makes them particularly fragile?
Absolutely. They're just not a particularly good design. You have these meniscal cartilage - these little pieces of gristle in there that get torn. Your ACL - for the sports we're doing - is just not good.
How many knee surgeries have you performed?
I've performed thousands. Right now, the vast majority of the surgeries I do - 99
percent - are knee surgeries. I don't want to say it's epidemic in the country, but it's huge.
How different are surgical techniques compared to when you started practicing?
Techniques have just gotten better and better and better over the years, and we've just gotten smarter. That having been said, we're still dealing with human knees that have to deal with biology. So even though our technology has gotten better, the damage people are doing to their knees is still significant.
We're better at it, but it's not a revolution. You're still much better off not hurting your knee.
Why did you feel the need to write this book?
The problem is that you go into the doctor's office, and as soon as you've heard the word surgery, most people just shut down. I say nothing makes you feel old like getting bald and having a knee replacement. There's just so much going on, and there's a certain amount of stress involved, of course. So I think the way I assimilate information, and most people do, is when you're able to sit in the comfort of your own home.
What are some common mistakes or misimpressions that you wanted to correct?
One big thing is that there is no such thing as minor surgery if it's your body. And believe it or not, we all think that the other person is a wimp and we're tougher than they are, and we go in there and we think it's no big deal. . . . Any time somebody touches you with a knife, it's a big deal, because it's your body. Even with the knee arthroscopies, I want people to take it seriously and to work not just after surgery but before surgery, getting better.
We talk about Tom Brady and Tiger Woods. These guys took many months to get better, and yet when my patients come in a few weeks after their ACL surgery, they're disappointed that they're not playing basketball yet.
A lot of the book focuses on what you should do before a knee surgery. Can you tell us about some preparations that make a big difference?
The best you can do is just getting as strong as possible, getting as good a knee as possible. For the arthritic knees, for the 75-year-old who's had arthritis for 50 years, you can only do so much. But you really want to maximize it.
Your book also touches on how to prepare mentally for surgeries. Why did you think that was important?
You're being presented with an incredible stress to your body, and again with jobs, with family. And you feel vulnerable, and for a lot of people, especially my younger patients, this is the first time they've been through this. So when I get this 13-year-old kid in there, they're 13, they're incredibly young, and now they're faced with a major surgery, and they get nauseated by the medications, and they get pain, and they're on crutches, and they can't go to the movies with Billy tonight, and all this stuff they're not ready for. The mental preparation is huge.
How important is rehabilitation treatment to the final outcome?
A lot of the studies show that you can do it on your own. We're talking about knees here, which is not really complicated. You can do it on your own by following the book. You don't actually need a physical therapist. But, of course, we use physical therapists a lot, because people need that additional guidance. But if you have an ACL or an arthroscopy, and if you don't do anything that anybody tells you to do, it'll probably be reasonably good. On the other hand, if you have a total knee replacement and you don't do anything we tell you to do, it probably won't work out too well.
After that, a lot of it is a question of speed. If you're more dedicated to the program, things will go a little bit faster, for sure.
When should you think about surgery?
That's a really good question. My theory is that you can't live your life without any kind of discomfort, but you shouldn't be keeping yourself from doing fun things, like dancing at you grandson's wedding, or taking that trip to Texas, because it's too painful to get into the plane.
How should you pick a surgeon?
I never hesitate to ask my doctor, 'How many of these operations do you do? How often do you do this?' They should say, 'I do a lot.' How many ACLs do you do a year? They should say, 'I do dozens a year.' How many total knee replacements do you do a year? They should say dozens. These are incredibly common operations, so if your doctor says, 'I do three or four,' that's a red flag. These doctors should also be able to answer your questions. [
rc]
Knee Surgery
The Essential Guide to Total Knee Recovery
Daniel Fulham O'Neill, M.D., Ed.D.
St. Martin's Griffin
ISBN: 978-0-312-36293-5
ISBN10: 0-312-36293-5
240 pages
82 b&w illustrations and photos
Copyright 1997-2009
Concord Monitor and New Hampshire Patriot
Dr. Daniel Fulham O'Neill has been performing knee surgeries for more than 20 years, many for members of the U.S. national ski and ski jumping teams. For him, knee surgeries are old hat, but he started to realize that his patients were often confused and unprepared for their surgeries and their aftermaths, so he started putting together handouts.
His handouts grew into a big packet, and many colleagues started asking for copies. Recently, he decided it was time to collect his notes into a book for patients facing knee surgeries. The book, Knee Surgery, describes how knees work and what knee surgeries are designed to do. It also recommends ways to prepare - physically and mentally - for surgery and suggests an exercise and stretching plan to help with recovery.
Less than a year after his knee injury, Tom Brady is playing in the NFL again. For many of the same reasons that recreational athletes shouldn’t expect to play as well as Brady, they also shouldn’t expect to recover from major surgery as quickly. AP file photo
O'Neill, who spoke with us about his book and his experiences, practices with the Alpine Clinic in Plymouth. He is an orthopedic surgeon with a master's degree in sports psychology.
How common are knee surgeries?
Incredibly common. Literally, a half million total knee replacements in a year. That's just in the U.S. One hundred thousand anterior cruciate ligament reconstructions, and literally millions of knee scopes, knee arthroscopies.
Why? Is there something about knees that makes them particularly fragile?
Absolutely. They're just not a particularly good design. You have these meniscal cartilage - these little pieces of gristle in there that get torn. Your ACL - for the sports we're doing - is just not good.
How many knee surgeries have you performed?
I've performed thousands. Right now, the vast majority of the surgeries I do - 99
percent - are knee surgeries. I don't want to say it's epidemic in the country, but it's huge.
How different are surgical techniques compared to when you started practicing?
Techniques have just gotten better and better and better over the years, and we've just gotten smarter. That having been said, we're still dealing with human knees that have to deal with biology. So even though our technology has gotten better, the damage people are doing to their knees is still significant.
We're better at it, but it's not a revolution. You're still much better off not hurting your knee.
Why did you feel the need to write this book?
The problem is that you go into the doctor's office, and as soon as you've heard the word surgery, most people just shut down. I say nothing makes you feel old like getting bald and having a knee replacement. There's just so much going on, and there's a certain amount of stress involved, of course. So I think the way I assimilate information, and most people do, is when you're able to sit in the comfort of your own home.
What are some common mistakes or misimpressions that you wanted to correct?
One big thing is that there is no such thing as minor surgery if it's your body. And believe it or not, we all think that the other person is a wimp and we're tougher than they are, and we go in there and we think it's no big deal. . . . Any time somebody touches you with a knife, it's a big deal, because it's your body. Even with the knee arthroscopies, I want people to take it seriously and to work not just after surgery but before surgery, getting better.
We talk about Tom Brady and Tiger Woods. These guys took many months to get better, and yet when my patients come in a few weeks after their ACL surgery, they're disappointed that they're not playing basketball yet.
A lot of the book focuses on what you should do before a knee surgery. Can you tell us about some preparations that make a big difference?
The best you can do is just getting as strong as possible, getting as good a knee as possible. For the arthritic knees, for the 75-year-old who's had arthritis for 50 years, you can only do so much. But you really want to maximize it.
Your book also touches on how to prepare mentally for surgeries. Why did you think that was important?
You're being presented with an incredible stress to your body, and again with jobs, with family. And you feel vulnerable, and for a lot of people, especially my younger patients, this is the first time they've been through this. So when I get this 13-year-old kid in there, they're 13, they're incredibly young, and now they're faced with a major surgery, and they get nauseated by the medications, and they get pain, and they're on crutches, and they can't go to the movies with Billy tonight, and all this stuff they're not ready for. The mental preparation is huge.
How important is rehabilitation treatment to the final outcome?
A lot of the studies show that you can do it on your own. We're talking about knees here, which is not really complicated. You can do it on your own by following the book. You don't actually need a physical therapist. But, of course, we use physical therapists a lot, because people need that additional guidance. But if you have an ACL or an arthroscopy, and if you don't do anything that anybody tells you to do, it'll probably be reasonably good. On the other hand, if you have a total knee replacement and you don't do anything we tell you to do, it probably won't work out too well.
After that, a lot of it is a question of speed. If you're more dedicated to the program, things will go a little bit faster, for sure.
When should you think about surgery?
That's a really good question. My theory is that you can't live your life without any kind of discomfort, but you shouldn't be keeping yourself from doing fun things, like dancing at you grandson's wedding, or taking that trip to Texas, because it's too painful to get into the plane.
How should you pick a surgeon?
I never hesitate to ask my doctor, 'How many of these operations do you do? How often do you do this?' They should say, 'I do a lot.' How many ACLs do you do a year? They should say, 'I do dozens a year.' How many total knee replacements do you do a year? They should say dozens. These are incredibly common operations, so if your doctor says, 'I do three or four,' that's a red flag. These doctors should also be able to answer your questions. [rc]
Knee Surgery
The Essential Guide to Total Knee Recovery
Daniel Fulham O'Neill, M.D., Ed.D.
St. Martin's Griffin
ISBN: 978-0-312-36293-5
ISBN10: 0-312-36293-5
240 pages
82 b&w illustrations and photos
Copyright 1997-2009
Concord Monitor and New Hampshire Patriot
