How Much of Elective Modern Orthopedic Surgery Makes Us Worse and Not Better?

by Chris Centeno, MD /

orthopedic surgery for pain

This weekend I was at a meeting where I met a colleague about my age whom I saw limping. He was heavier, stooped over, and looked physically beat up. I’ve known this person for many years, and I know that he has had a number of back and knee surgical procedures. This literally could have been me, as I’ve had a number of knee and back blowups through the years that we’ve managed with platelet and stem cell-based procedures. Let’s explore this a bit further.

Much of Elective Orthopedic Surgery Doesn’t Work

Mounds of research have made it quite clear that so much of elective orthopedic surgery just doesn’t work. In fact, the scientific evidence is “scandously poor,” according the British Journal of Medicine, with high-level research supporting only 20% of orthopedic surgeries being done. What are the findings of the other 80%? A lot of ineffective and unnecessary surgeries…

Those who had meniscus surgery, one study found, fared no better than those who had a sham surgery. Another study found that meniscus surgery worsened arthritis and increased the likelihood of needing a knee replacement later. Even more disturbing, a study a few years prior found that within one year after meniscus surgery, 81% of patients developed arthritis.

Moving to the shoulder, much of the research also hasn’t been supportive for rotator cuff surgery, finding that PT was just as effective at addressing function as rotator cuff surgery. Another showed that over 80% suffered retears following a rotator cuff surgery for a large tear. And as for professional-level athletes who rely on their shoulder for play (e.g., baseball, basketball, etc.)—50% who have rotator cuff surgery never return to the same playing level.

What about the spine? If you’re considering a laminectomy or discectomy for a herniated disc or some other disc issue, this one doesn’t look good either, with research showing that while you may experience some short-term relief, most of this relief has dissipated by one year post disc surgery. And with a disc replacement comes potential side effects such particles wearing off the synthetic disc and problems with adjoining segments, Taking spine surgery to a more extreme level, low-back fusion has been found to be no better for function and pain than just participating in physical therapy. In addition, fusion leads to adjacent segment disease (ASD), increasing the risk for more fusions in the future.

This isn’t an exhaustive list, but you get the idea – orthopedic surgery for pain is just not a successful plan…

My Friend’s Bad Choices

So now that you know meniscus surgery (and many other orthopedic surgeries) doesn’t work and that it probably causes more and not less arthritis over time, you can see why I believe that my friend was a limping testament to the harmful effects of modern, elective orthopedic surgery for pain. He began his surgery odyssey with multiple meniscus procedures for meniscus tears sustained while playing racket ball. Since he was middle-aged at the time and research shows that meniscus tears are also common in patients of that age without pain, who knows if any of these tears seen on MRI were even causing his pain? He then ended up with one knee replacement and now needs a second.

I, too, have had multiple knee blowups. One was caused by sitting too long at a conference, and I literally limped around the clinic for weeks. I, too, had a meniscus tear on MRI and could have gotten surgery, but instead I was cured by a simple trigger-point dry-needling session on my quadriceps trigger points. Since then I’ve had a few injuries and blowups, all treated with platelet rich plasma precise injections. Hence, I’ve never had any surgery. I don’t limp and can hike 4 miles and 1,000 vertical feet without issues.

My friend’s low back has also been a constant problem. He began with steroid epidurals and ended up with a laminectomy/discectomy. This procedure weakened his low back disc, which is still an issue, which is why he walks bent over. All of this inactivity has caused him to gain 50 pounds, which then makes all of this worse.

My back has had several blowups bigger than my friend’s. A few of those happened with lifting from the floor, and all were epic and left me nonfunctional. I had one steroid epidural but then switched to using platelet lysate (the growth factors isolated from my blood platelets). I’ve had ligament and facet injections and have worked hard for the last year to get my core strong with a trainer. I have disc bulges but have never gotten surgery. I can lift weights, run up the stairs, and work out without pain.

Why Modern Orthopedic Surgery for Pain Is Mostly a Failed Idea

Pain is a function of problems with structure, nerves, and the local chemical environment. Modern orthopedic surgery is focused on fixing structure and ignores the other two. In addition, it often lacks a way to fix structure (even though many patients believe that’s what’s happening) and instead focuses on cutting out broken pieces of tissue. This leads to more joint degeneration and what you see with my friend.

The upshot? Please don’t become like my friend just because your insurance covers the surgery and some surgeon sold it to you. Most elective orthopedic surgery for pain is a bad idea. I’m a living testimony that most of it simply isn’t necessary. Please find a Regenexx provider to see if you can avoid going under the knife.

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14 thoughts on “How Much of Elective Modern Orthopedic Surgery Makes Us Worse and Not Better?

  1. Nancy Thorne

    Dr. Chris…you are absolutely right.!
    Instead of meniscus surgery I had stem cell treatment with Dr. Handleman in California two years ago.
    All is well and I walk 40 miles a week and go to the gym.
    I am a Regenexx nut to friends.
    Thanks, Nancy

    1. Regenexx Team

      Nancy,
      Really wonderful news! “Regenexx nut” definitely best line of the day!

  2. Lorraine Munson

    From my own experience I do agree. One rotator cuff surgery and two other shoulder surgery. I have had three knee surgery. I have never been better off after any of these surgeries, I’m worse off than before. Now ortho is telling me I need both knees replaced.

  3. Katie Hammond

    Dr.Chris,
    I had stem cell therapy to treat a traumatic meniscus tear a few years ago. Unfortunately it didn’t improve my knee pain associated with the tear. I continue to limp and my still knee clicks. I’m considering meniscus surgery. I don’t seem to have any other options left. The surgeon said that the tear is a small flap tear and that in my case surgery would be beneficial. The stem cell therapy in my case only mediated the symptoms in the short term and seemed to act as a powerful anti inflammatory but failed to heal it as was shown in a repeat MRI of my knee 6 months after treatment. It seems that stem cell therapy is not yet capable of healing a torn meniscus where there is no blood supply on the inside of the meniscus? Does your blog demonstrate a case of healing in the inside of the meniscus using MRI’s?

    1. Regenexx Team

      Katie,
      Meniscus tears in those areas can respond well to the right type of stem cell therapy. Here are some examples: https://regenexx.com/blog/can-you-treat-a-meniscus-tear-without-surgery/ and https://regenexx.com/blog/all-i-want-to-do-is-dance/ and https://regenexx.com/blog/meniscus-stem-cell-treatment/ and https://regenexx.com/blog/stem-cell-treatment-for-knees/ We’re focused on pain and function to return people to what they need and want to do. The hyper-focus on meniscus tears on MRI has been responsible for millions of unnecessary surgeries, unfortunately leaving patients worse in the long run. Here is a (very old) before and after series. Please see:https://regenexx.com/results/before-and-after-mri-library/knee-mri/

  4. ken burden

    Hello, I was wondering what your opinion on this procedure might be: intracept® intraosseous nerve ablation system. I read that they have just finished a clinical trial with good results.

    thank you

    1. Regenexx Team

      ken,
      Treating the nerve is a better long term strategy than killing the nerve as once “ablated” the nerve can’t control the muscles that stabilize the area, which has long term negative consequences. Please see: https://regenexx.com/blog/burn-nerves-in-low-back/

  5. Bob

    Hi Chris,

    I had a question about this article:

    https://regenexx.com/blog/meniscus-tear-arthritis/

    I doesn’t make logical sense to me when people say you will eventually develop osteoarthritis if you have a torn meniscus (injury) untreated… Their explanation is that the torn meniscus is rubbing against the articular cartilage and somehow over time it wears it out??? However what makes more sense to me is if people go for surgery and they get that section of the meniscus removed, well, you don’t really have ANY padding anymore… Wouldn’t that make it worse?!?! As the articular cartilage is now rubbing against . . . not a torn meniscus, but something else?? I rather live with a torn meniscus than a removed one… Doesn’t that make sense?

    Are there no supplements out there to help “preserve” or maintain whatever articular cartilage we have now? Or even better, regrow?

    1. Regenexx Team

      Bob,

      You and the article are saying the same thing, and are correct. Don’t know of any supplement that regrows cartilage, but for cartilage protection, please see: https://regenexx.com/regenexx-advanced-stem-cell-support-formula/, which contains all of these ingredients https://regenexx.com/blog/supplement-for-cartilage-protection/ and https://regenexx.com/blog/supplements-to-save-cartilage/ and https://regenexx.com/blog/tumeric-curcumin-arthritis-regenexx-supplement-smell-like-indian-restaurant/.. Fish oil, can flip the switch from inflammation to healing: https://regenexx.com/blog/new-research-fish-oil-can-turn-bad-inflammation-into-healing/

  6. Bob

    Hi Chris,

    Thanks for the follow up. How does having a torn meniscus lead to having crepitus? Is it because everything is misaligned as soon as a meniscus is torn? Thus, creating the grinding sound when your knee is flexed/extended? I assume this would eventually lead to arthritis?

    Bob

    1. Regenexx Team

      Bob,
      It depends on what type of meniscus tear, as most middle age people have meniscus tears which are no more significant than grey hair. The most common cause of knee crepitus is instability, so if the tear is significant enough to cause instability, or tendons or ligaments were damaged in the inury, then yes. Instability leads to arthritis as it increases wear and tear on the joint. There are some good knee stability tests here: https://regenexx.com/blog/knee-popping-after-injury/

  7. Bob

    Chris,
    With instability in the knee (failing the squat test but able to pass the others), if the person is able to walk perfectly fine without pain – would they be subjected to arthritis? I do have a complex flap tear on the posterior horn. All other tendons or ligaments are intact… The only time I hear the grinding noise is if I lift my knee past the hip level and take one giant step forward… Which is… rare to have that movement in my everyday life… Walking and climbing stairs do not make those grinding noises… Of course, I try and avoid at all cost to NOT make those noises possible as I think it’s grinding off cartilage every time, correct?…

  8. Bob

    Hi Chris,

    But if you are able to walk normal or climb stairs/descend without any pain, would there still be any wear and tear even if you have a tear in the meniscus (injury)…. Specifically, a complex flap tear on posterior horn…

    Bob

    1. Chris Centeno Post author

      Meniscus tears in people over age 35 are as common as wrinkles and about as meaningful, so you would need to get an exam to make sure the knee is stable, which is a bigger deal. If stable, then no issues.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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