In this segment:

  • What’s the difference between elective and emergency surgery?
  • What can lead to a patient thinking they need an unnecessary surgery.
  • The true costs of surgery.

Welcome to Living Pain-Free with Dr. Marc Darrow, MD, and Dr. Thomas Grove, DO, from the Stem Cell Institute in West Los Angeles. This program offers effective solutions for managing and alleviating the pain you have been living with.

Dr. Darrow is a board-certified medical doctor, having completed his studies at UCLA. Dr. Grove specializes in regenerative medicine and is an expert in ultrasound-guided injections, with extensive experience as an athlete and strength and conditioning coach. Together, they utilize advanced therapies such as stem cell treatments, platelet-rich plasma (PRP), and prolotherapy to promote natural healing.

In this program, Dr. Grove addresses common concerns about elective surgeries, when surgery may or may not be necessary, and explains how regenerative medicine can offer a safe, effective alternative for many patients.

Introduction

Today’s discussion centers on elective surgery and the recurring theme of avoiding unnecessary procedures. Recently, there have been several interesting cases in our clinic, highlighting the importance of considering alternatives to surgery, especially for ligament, tendon, or joint issues. One of the main patient concerns in our clinic is how they may be able to avoid invasive procedures and surgeries whenever possible. It is not emergency surgery we are talking about, it is elective surgery we are discussing. Elective surgeries are planned interventions for issues that are not immediately life-threatening. In contrast, emergency surgeries, such as those for severe fractures, require immediate attention to preserve life or function.

Common Misconceptions and Language in Surgical Consultations

Patients often encounter language during surgical consultations that makes them feel surgery is inevitable or absolute. It is crucial to be vigilant about phrases that suggest surgery is the only solution. For example, being told “you need a joint replacement because you have bone-on-bone arthritis” can be misleading.

True bone-on-bone arthritis, where cartilage is completely worn out and bones are touching directly, is clinically rare. Most patients labeled as “bone-on-bone” simply have arthritis, but not a complete loss of cartilage or function. A thorough evaluation using modern diagnostic tools like musculoskeletal ultrasound provides a clearer picture of the joint anatomy and arthritis severity, often more accurately than X-rays.

Dr. Grove stresses it is important to find a healthcare provider who understands both surgical and regenerative medicine approaches. Some practitioners might favor one over the other due to limited exposure. Providers who lack familiarity with regenerative medicine may not recommend it, and vice versa for those without surgical experience.

As a general rule, if a provider is not knowledgeable about a treatment, they are less likely to support it. Patients should therefore seek balanced advice, weighing both surgical and non-surgical options to make informed decisions.

Understanding Tears and the Need for Surgery

One phrase often heard from patients is: “Well, there’s a tear. We have to go and surgically repair it.” It’s important to remember that tears can involve many different elements. For example, you may experience a full rupture of a tendon or ligament, such as the quadriceps tendon or Achilles tendon. Sometimes, there may be a minor tear or a ligament injury like an ACL tear.

However, unless the injury is a complete rupture—meaning the tissue is totally cut and has lost all integrity, resulting in an unstable joint—surgery is not always necessary. In such cases, surgical intervention could be warranted, but partial tears and strains are far more common. Unfortunately, many patients are advised to undergo surgeries for these minor injuries, which often aren’t needed.

Just because a tear is detected does not automatically mean that surgery is the only solution. These types of injuries are addressed daily, and alternative treatments are frequently effective.

Cleanout Surgeries: Risks and Considerations

Another common recommendation arises when pain and imaging reveal features like bone spurs or roughening of tissue. Patients are often told that a “cleanout surgery” should be performed. This procedure involves inserting a small scope into the joint, which necessitates piercing tissue and compromising the joint capsule, a structure that provides stability.

Introducing the scope can make the knee, shoulder, or hip more unstable. Additionally, the scope may damage healthy cartilage, potentially worsening arthritis. Although the procedure creates visually appealing images—such as cleaning up the roughened cartilage—the actual function of the joint often deteriorates. Removing some of the joint’s cushion can further destabilize the area.

Cleanout surgeries are often presented as simple solutions, but many patients who undergo them end up worse off than before. Unless there is a large “loose body”—such as a chunk of cartilage or bone floating around and causing the joint to lock up—these surgeries are typically not recommended.

Body Parts Frequently Operated On Inappropriately

Several body parts tend to be operated on unnecessarily. Rotator cuff tears in the shoulder are a prime example. The rotator cuff consists of four muscles crossing the shoulder joint, and most tears are small and partial, not requiring surgical intervention. These minor injuries often respond well to regenerative medicine.

The knee is another area commonly subjected to unnecessary surgery, especially for meniscus tears. The standard cleanout procedure, called a meniscectomy, involves removing meniscus tissue that is not perfectly sealed to the bone. Despite substantial data, routine surgery for small meniscus tears isn’t recommended. The function of the meniscus as a shock absorber between the thigh bone and shin bone is crucial, and retaining as much of it as possible is preferred.

If the meniscus tear is large enough to cause the knee to lock up—such as being stuck at a 90° bend and unable to bear weight—surgical intervention may be warranted. In these cases, the tear may be repaired or trimmed. However, preserving the meniscus is vital, and frequent trimming is discouraged.

Patients who undergo repeated meniscectomies often experience worsening joint conditions. Over time, the cartilage wears out, the meniscus is lost, and the next step becomes joint replacement surgery. This cycle underscores the importance of careful evaluation before proceeding with surgical intervention for tears and strains.

Part 2

Understanding the realities of elective surgery and the alternatives available empowers patients to make informed decisions about their health. By consulting providers with comprehensive experience and utilizing advanced diagnostics, patients can avoid unnecessary procedures and pursue the best treatment plan for their needs.

Identifying the Real Source of Pain | Stem Cell Institute Radio 2-14-26 Part 2