Being a Functional Orthopaedic Surgeon

By Chadwick C. Prodromos MD

Functional 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, 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 necesssary
e.g.

  • For ACL reconstruction avoid cadaver graft use, instead use autologous tendon grafts
  • When bone graft is needed avoid allograft, use patients 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 anti-depresssant or anti-anxiety drugs – use exercise instead to alleviate stress
  • Anti-Resorptives for osteoporosis such as bisphosphonates or Prolia
  • Fluroquinolone 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, 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
  • American Academy Regenerative Medicine
  • American Academy and Board of Regenerative Medicine
  • American Orthopaedic Society for Sports Medicine
  • isakos
  • Rush University Medical Center
  • American Association of Nurse Anesthetists
  • American Academy of Orthopaedic Surgeons
  • European Society of Sports Traumatology, Knee Surgery Academy
  • International Cartilage Repair Society