http://orcid.org/0000-0003-1854-309X
During the last few decades, we’ve witnessed a progressive advance in joint surgeries, especially the hip and knee ones, which are performed all over the world [Citation1, Citation2].
This advance is, definitely, the result of technical improvements, better knowledge and skills from surgeons, and a better global medical assistance in preoperative, intra-surgical, and postoperative phases [Citation3].
However, this might be a double-edged sword. Many patients of ours can’t put up with some surgeries due to their associated pathologies. Their deteriorated general condition, a limb with severe circulatory alterations, serious deformities, etc., are limits that we are not willing to ignore, since we don’t want to put our patients at risk [Citation1, Citation2].
Where should we put this limit? This is the question. Which is the limit to decide if a patient can or can’t get a surgery? Whether to take a risky surgery or not, that is the matter.
A clear example can be found in the revision of arthroplasties related to kidney problems [Citation4], where there are coherent results that may put us to think. The presence of kidney diseases means more complications during the surgery, therefore, more risks for the patient [Citation4]. Despite that, we are still taking the risk.
It stands to reason that we try to improve patients’ quality of life as long as it is in our hands. Obviously, we’ll find complicated cases even in the patients with the best prognosis. Some of these cases are not under our control, because we can’t prevent every issue and every disease or complication, such as infections or thrombosis.
The main problem persists in the patients with chronic diseases which deteriorates their quality of life; and during the surgery, when, we know, many problems not related to those patients can also appear [Citation1, Citation2, Citation4].
However, not only this concern medicine, but it also concerns ethics. One of the questions is to find the limits of risk during a surgery. This is not a serious problem as far as the disease we’re trying to put up with put at risk patient’s life, such as valvulopathy or vascular stenosis. But what if our main objective is to improve patient’s life (and not saving him, since his life is not at risk) with an improved articulation?
Here we should consider many elements, not only the sanitary ones, the degree of mobility, the presence of pain, the use of medicines to reduce the pain, stiffness, functional capacities…. We are used to work with those elements that pretend to objectify our decisions. However, even though we try to help and assess with image tests the articulations, the moment comes when our patients look at us and they ask: ‘What do I have to do?’
Medical practice must concern both, science at the highest level and humanism. The art of medicine consists in knowing all the relevant information about the pathology of our patient and advise him in order to take the best decisions for THAT patient.
Medicine based on evidence, including artificial intelligence and more technical advances that are to come are important instruments that help us so much. But it will neither replace a sincere look nor the advices that a doctor can provide to their patients. We must never forget that our profession is science and art, where the human relationship is essential.
Declaration of Interest
The authors report no conflicts of interest.
REFERENCES
- Vakharia AM, Cohen-Levy WB, Vakharia RM, Sodhi N, Mont MA, Roche MW. Perioperative complications in patients with rheumatoid arthritis following primary total knee arthroplasty: an analysis of 102,898 patients. J Knee Surg. 2019. doi:10.1055/s-0039-1692397.
- Boyce L, Prasad A, Barrett M, et al. The outcomes of total knee arthroplasty in morbidly obese patients: a systematic review of the literature. Arch Orthop Trauma Surg. 2019;139(4):553–560. doi:10.1007/s00402-019-03127-5.
- Campbell KJ, Louie PK, Bohl DD, et al. A Novel, Automated text-messaging system is effective in patients undergoing total joint arthroplasty. J Bone Joint Surg Am. 2019;101(2):145–151.
- Influence of chronic kidney disease on patients undergoing elective hip and knee orthopedic surgery. J Invest Surg. 2021;34(3):346–356. doi: 10.1080/08941939.2019.1631412.