Being a Holistic Orthopaedic Surgeon

By Chadwick C. Prodromos, M.D.

Holistic medicine is rapidly gaining in popularity nationwide. It emphasizes helping the body heal itself, eliminating the root causes of disease, and avoiding toxic drugs. It is practiced generally by primary care doctors or medical specialists. I believe strongly in these principles, and below I describe how I apply them to my practice of orthopaedics.

Avoid Unnecessary Surgery

Avoid unnecessary surgery, perform surgery only when absolutely necessary, and give patients non-surgical alternatives where they are reasonable.

Emphasize procedures that promote repair and avoid replacement when surgery is necessary such as

Osteotomy or distraction to promote joint healing
Microfracture or autologous chondrocyte transplant to repair

Avoid Joint Replacement Surgery

Unless other strategies have failed or are not appropriate
Avoid especially in patients under 65 years of age to lessen the chances of repeat joint replacement being necessary at a later time

Use only autologous tissue whenever possible and avoid allografts when a graft is necessary
e.g.

For ACL reconstruction avoid cadaver graft use, instead use autologous tendon grafts
When a bone graft is needed avoid allograft, use patient's own, usually iliac crest, bone

Avoid Pharmaceutical Medications

Follow the Dicta of the No Pills No Pain paradigm which states that suppression of symptoms while not addressing the underlying cause tends to aggravate rather than alleviate the condition.

Medicines to Especially Avoid

NSAIDs except in inflammatory arthritis or for occasional non-musculoskeletal pain
All antidepressants or anti-anxiety drugs â€“ use exercise instead to alleviate stress
Anti-resorptives for osteoporosis such as bisphosphonates or Prolia
Fluoroquinolone antibiotics unless other antibiotics are not suitable
Opiates

Use Nutritional Supplements instead of Drugs

To promote healing and fight inflammation
GMP tested products
Where evidence shows efficacy
In Doses that match those of studies showing efficacy

Avoid Cortisone Injections

AVOID CORTISONE INJECTION in joints or tendons, it is

Toxic to cartilage
Toxic to tendons
Increases risk of infection in subsequent joint replacement within a year of injection

AVOID LIDOCAINE or other "caine" anesthetics in joints, it is

Chondrotoxic

Use PRP or Stem Cell Injection

For Arthrosis of All Joints
For Tendon Strains/Tears of Rotator cuff, Achilles, Patellar, Tennis elbow, other
Where Evidence indicates efficacy
Avoid allogenic tissue such as amniotic fluid or cord blood unless it is your own tissue

Utilize Biomechanical Strategies
to allow the body to heal itself. For example

Ankle or Knee Sprain; knee, hip, or ankle arthrosis: Use partial weight-bearing ambulation with crutches or walker
Shoulder Pain: Teach the elbows in paradigm of avoidance of elbow elevation
Basilar Thumb Arthritis: (1st CM joint) Teach the Simian Grip technique
Bunions: Teach stretching, night splinting, and wider shoes
Tennis Elbow: Teach the Palms Up paradigm
Anterior Knee Pain: Teach avoidance of kneeling, squatting, excessive stairs, quadriceps exercises
Knee Arthrosis with Flexion Contracture: Teach home knee extensional exercises
Low Back and Neck Pain: Teach postural exercises
Osteoporosis: Prescribe weight-bearing exercise, calcium, and vitamin D, instead of anti-resorptives

Use Physical Therapy Judiciously

Use only when evidence shows efficacy
Emphasize home programs
Emphasize core strengthening
Avoid pain-causing treatments

Use Low Level Laser Treatment
where appropriate, especially for

Back and Neck Pain
Headache
Hamstring and other muscle Strain
Tennis elbow
TMJ pain

Emphasize Lifestyle

Weight Loss: emphasize for overweight patients without weight loss drugs
Diet: Emphasize organic, avoidance of carbohydrates and processed foods, reduced intake
Exercise: Emphasize not as a means to weight loss, but because exercise is independently correlated with good health
Smoking Cessation: Emphasize in all and require in surgical patients before surgery