LA Times Orthopaedic Health Panel of Experts

Non-Surgical Options: Orthopaedic Conditions
Millions of Americans have problems with their bones and joints. For starters the
American Association of Orthopaedic Surgeons says that nearly 12 percent of
the population suffer from osteoarthritis. As the population ages that number is
expected to grow.
esides arthritis there are other
common bone-and-joint issues affecting many other
Americans—especially among athletes.These include tennis elbow (one
to two percent of the population) and
knee problems (they account for 26
percent of all injuries).
Despite all this dire news about
medical afflictions, there is some
good news: You can treat most of
these conditions successfully with a
non-surgical approach when working with specialists in non-surgical
One such specialist is Steven
Sampson, a board-certified Physical
Medicine and Rehabilitation doctor
in Los Angeles. Patients who end up
in his office do so because they want
to work with a doctor “who is not
biased towards surgery and is open
to other options,” says Sampson. One
of “Sampson’s approaches that patients seem to like is that he doesn’t
just look to treat the symptoms and
pain; he looks to heal them. “People
are looking for more cost-effective
ways to reduce pain and address the
underlying biomechanical problem,”
says Sampson.
Take cortisone shots, a non-surgical
mainstay for orthopedic problems.
While patients feel better in two
to three days after a cortisone shot,
“the effects wear off over the long
term,” says Dr. Sampson. “Cortisone
has been shown to cause more injury
with scarring and calcifications, causing damage to tendon and cartilage.
Then people need more cortisone
and the response is less powerful
each time.”
These days there are many more
options than just cortisone shots,
including some that offer healing
options along with pain relief. One
such procedure that shows the greatest promise focuses on platelet-rich
plasma (PRP).
“We know that platelets do blood
clotting and form scabs,” says Dr.
Sampson. “But it turns out that
platelets help the body heal itself
and that they facilitate soft tissue
regeneration.” He explains that doctors started using PRP in dentistry to
reduce bleeding but then the doctors
realized that it was promoting healing, too. Soon PRP use expanded to
cosmetic surgery and cardio-thoracic
surgery. More recently it made its way
into the world of orthopedics.
“I first learned about [PRP] three
and a half years ago when I was working with a orthopedist who treated
European soccer players that were
using [PRP] as an injectible,” says
Sampson. “People that had hurt their
knee ligament and had PRP injected
into the injured area cut their recovery time in half.”
PRP soon became the go-to treat-
ment for tennis elbow, groin injuries,
hurt hamstrings and problems with
Achilles tendons as well as rotator
Here is how doctors like Sampson
use PRP.
They begin with the patient’s
own blood. When a patient arrives
for the procedure, the doctor draws
blood from the patient’s arm, and
then places it in a centrifuge. About
30 minutes later the centrifuge has
“spun out” the blood and removed
unnecessary parts of it, leaving behind the platelets. After applying a
local anesthetic to the area the doctor is going to treat, the doctor injects
the platelet-rich blood into the injury
site. Doctor’s like Sampson use ultrasound to guide the injection so that
it’s “within a millimeter of the injury,”
he says. From start (the blood draw)
to finish (after the injection), the treatment takes 45 minutes.
Unlike cortisone shots patients
often do not feel immediate relief.
Many times they have to understand
People that had hurt their knee ligament and
had PRP injected into the injured area cut
their recovery time in half. People that had hurt
their knee ligament and had PRP injected into the
injured area cut their recovery time in half.
that things have to get worse before
they get better—meaning that as the
healing begins, they may feel more
pain. “This is not a quick fix; it takes
time to regenerate,” says Sampson.
But in the long run, they will feel
better because they will have healed
their injury on a cellular level. “We’ve
seen remarkable results with a single
injection,” he adds. However, most
people require one to three PRP injections at four-week intervals.
The one area where PRP doesn’t
always provide long-term relief is
in severe cases of arthritis or other
joint injuries. “It’s not the age of the
patient but the degree of cartilage
viability,” says Sampson. “We can determine the outcome better to treat
someone with mild to moderate
arthritis rather than bone on bone
arthritis. In these instances we tell
people from the outset that we’re
guardedly optimistic.” In instances
where PRP brings “less promising
outcomes,” says Sampson, surgery is
the likely outcome.
It should bring patients peace of
mind knowing that these non-surgical options are out there. The only
downside to some of them? Insurance companies currently consider
PRP to be an experimental treatment
and, therefore, don’t cover them. But
given the cost of surgery—both in
terms of dollars, pain, recovery time
and more—even without insurance
coverage, non-surgical treatment options like PRP are still probably less
expensive in the long run.
Specializing in non-surgical
orthopaedic treatments
Steven Sampson D.O. and Danielle Aufiero MD • 310-453-5404
10780 Santa Monica Blvd, Suite 440, Los Angeles, CA 90025
Orth Opaedic h ealth
Panel Of Experts
Orthopaedic Surgery (Board Certified)
Joint Replacement Institute at St. Vincent
Medical Center
Orthohealing Center
Lowman Professor and Chief
Pediatric Orthopaedics
Los Angeles Orthopaedic Hospital
Q: What are the top three things a patient should look for when
doing their homework on finding the best Orthopedic Surgeon to
perform their Surgery?
A: When a patient is looking for a surgeon, perhaps the best credential is that the surgeon is known and respected by other surgeons. The “surgeons’ surgeon,” if you will. Ask other doctors what
they know about a prospective surgeon. Another good credential
is an independent recommendation from another patient who
has had surgery with that doctor. The doctor’s office can put a
prospective patient in touch with post-surgical patients, which is
helpful. But for obvious reasons, an independent recommendation
is stronger. The surgeon should have current experience with the
procedure in question.Currently doing the procedure (on a weekly
basis) is probably more important for surgical skills than having
done hundreds sometime in the past. Patients should be cautious
in the interpretation of surgical volume. Just because a surgeon
has done lots of cases does not mean that he has done them well!
Get information about the outcomes of those procedures. Top
surgeons will have data to share and may have even published
their results.
Q: There are various benefits to using PRP. What do you find the
most valuable benefit for your patient?
A: PRP revolutionizes the way we think about and treat common
orthopedic injuries. When I first began using PRP over 3 years ago
I was seeing remarkable results in patients that had been to other
doctors and were told that there were few conservative treatment
options and surgery was imminent. While some treatments such
as cortisone often provide short-term benefits, they may actually
be causing further damage by promoting scarring, calcification,
tendon tearing and cartilage destruction. There is a distinct need
for alternative therapies that are naturally based and pose little
threat of worsening the condition, while restoring function to the
affected area.
The human body has a remarkable ability to heal itself and PRP
facilitates this organic response by releasing concentrated growth
factors into the affected area to stimulate tendon and cartilage repair.By integrating state of the art technology we are able to locate
the injury site within a millimeter to ensure precise treatment.
There is a growing demand to remain physically active in the Los
Angeles community.After all, where else can you surf and ski and in
the same day! PRP is particularly appealing because there are few
activity restrictions. In fact activity is often encouraged to promote
circulation and healing. Patients with new injuries can maximize
their healing potential with a PRP treatment and potentially avoid
surgery. In chronic injuries, when all else has failed, PRP is a viable
option to avoiding surgery. Currently, we are conducting extensive
research on PRP to better understand which orthopedic conditions
can maximally improve.
Q: How can I find the most appropriate orthopaedic specialist for
my child?
A: Although the field of orthopaedic surgery originally focused
on treating children, pediatric orthopaedic surgeons represent
only about 10-15 percent of the field today. Studies in the United
States show there is a shortage of well-trained pediatric orthopaedic surgeons.
Parents should endeavor to find a fellowship-trained pediatric
orthopaedist for their children.These are surgeons who take additional fellowships in pediatric orthopaedics after completing their
five year residency. Many, but not all fellowships are accredited by
the Accreditation Council for Graduate Medical Education (ACGME).
Qualified pediatric orthopaedic surgeons may not be available in
certain communities. In that case, a general orthopaedic surgeon
who treats a large number of children with traumatic disorders,
such as common fractures, would be a very capable alternative.
Los Angeles Orthopaedic Hospital offers two ACGME accredited
fellowship positions in pediatric orthopaedics.
Another way of knowing if your orthopaedic surgeon is experienced in treating children is if he or she is a member of the Pediatric Orthopaedic Society of North America. Members dedicate
at least 75 percent of their medical practice to the treatment of
children and attend educational conferences devoted to pediatric
orthopaedic surgery.
Treatment of fractures and sports injuries in children can be
quite different than for adults due to the presence of growth
plates. If not treated properly, the child’s bone may grow crooked
resulting in permanent deformity. This is another reason to seek a
fellowship-trained pediatric orthopaedic surgeon. For more severe
problems, children will probably be referred to a center like Los
Angeles Orthopaedic Hospital for further evaluation.
Orthopedic Specialties
Here are the top 10 orthopedic specialty areas, with the percent of AAOS members with
fellowships in that area, according to the AAOS report Orthopaedic Practice in the U.S.
2008. Note: Surgeons may have selected more than one specialty area, so percentages do not
total 100 percent.
• Adult knee (34.4 percent)
• Arthroscopy (34.3 percent)
• Sports medicine
(33.4 percent)
Total joint (28.4 percent)
Shoulder (25.1 percent)
Adult hip (24.9 percent)
Trauma (16.5 percent)
• Hand (15.4 percent)
• Adult spine (11.0 percent)
• Foot and ankle
(10.2 percent)