Orthopedics – A trend toward less surgery
Trends in Sports Medicine
- As a field, sports medicine has moved from care for elite athletes to care for the general public.
- Demand has risen as procedures have become less invasive.
- Insurance coverage always is an important factor.
- Practices have boosted profitability with a greater utilization of aides and assistants and combining services.
- Historically, elite athletes paid big to go with an expert doctor. Now, doctors and hospitals push for the chance to secure status as a team’s official health care provider, relishing the exposure that comes with it or with being the doctor who prolongs a star athlete’s career.
- There’s a shortage of physical therapists.
Trend: Less Surgery
University of Central Florida sports medicine doctor Michael Seifert is among a growing cadre of physicians who now specialize in non-operative treatments of many sports and orthopedic conditions. “I try to keep people away from the surgeon’s table if I can,” he says. Florida orthopedists say that in recent years they’ve been operating less often on conditions such as rotator-cuff injuries and meniscus tears for some age groups and patients. Physical therapy has been shown in some cases to be just as effective. There’s also been a move toward “incision-less” treatments to prolong function and postpone knee and hip replacements.
Alternatives to Surgery
One long-emerging treatment is platelet rich plasma injection, in which a patient’s own platelets are injected into the knee or problem area. “It seems to work better in the lab than in people,” says Seifert, but it does show evidence of working. PRP started in dentistry and then in spinal care but took off when high-profile athletes used it. Quality studies supporting it have been slow to come, and insurance typically doesn’t cover it. At some places, it’s also used to treat hip ailments and tennis elbow.
At Cleveland Clinic Florida in Weston, Dr. David Westerdahl and colleagues have started using cooled radio frequency ablation to treat people who are not yet candidates for knee replacement surgery. It’s a technique that started with the spine and, as of April 2017, has been approved by the FDA for knees for non-narcotic pain relief — an important approach amid an opioid epidemic. “Right now it can provide pain relief for up to two years,” says Westerdahl. The technique knocks out the nerves that provide pain feedback in the knee while leaving motor nerves intact. It takes the body a long time to reroute the nerve pain signal, letting people be more active and continue working. It gets people active again, which helps with, among other things, weight management. “There have been lots of studies that for arthritis, being more active is better than less,” Westerdahl says.
Exercise More; Eat Less
In all things medical, it’s important for consumers to realize that what’s promising may not pan out. Doctors themselves have seen it in some surgical approaches that came about in recent years but now are out of favor. Meniscus tear surgery for older people now is viewed with more caution thanks to evidence showing that it accelerates arthritis and the need for a knee replacement.
Asked whether there’s a changing mindset in orthopedics, Dr. David Westerdahl prefaces his thoughts with “ask 10 different doctors …” Then he says, “I think overall what we’re seeing, there are many surgical treatments that over time have gone away in orthopedics. Many of the things we did 10 years ago weren’t always the best thing for patients.”
Of course, people should do what they can to minimize the chance of needing anything done. Seifert says first maintain a healthy weight to keep from stressing joints. Exercise to keep the muscles controlling joints strong. Vary exercise to stave off injury and to keep all muscles conditioned.
Supplements? Views conflict, and there’s no miracle drug. Certainly, the obvious strategy is to first make lifestyle changes. But USF’s Dr. Charles Nofsinger says turmeric and coenzyemeQ10 merit a look. He also notes there’s an epidemic of vitamin D deficiency in Florida. Even though it can be miserably hot out and we need to protect our skin, we still need sun.