This interesting piece caught my eye recently: a first-person account of an orthopedic surgeon’s visit to China. Its author relays a great deal about how the sports medicine specialists there accommodate the nation’s high volume of patients and occasionally insufficient supply of tissue:

When it comes to performing biologic orthopedic procedures using human donor tissue, the situation is challenging. Donor tissues are in short supply and the supply chain is not trusted. This has led to high doses of irradiation being used to sterilize the tissues. Unfortunately, the radiation also ruins the quality of the tissue by cooking it. This is possibly one area where we may be able to help by providing an off-the-shelf device solution.

Some feel that using animal tissues might represent at least one solution, although there is no question that improving the medical infrastructure overall would offer some essential relief throughout the nation.

What stands out from the piece is the singular dedication physicians and surgeons around the world bring to their practice, even when limitations render certain best practices difficult to follow.

I am grateful to serve my orthopedic surgery patients in San Diego, and to offer the gold standard in knee surgery and rehabilitation. To learn more about some ways you can relieve knee pain today, please contact a San Diego orthopedic surgeon.


Knee injuries are not only a ‘pain in the knee’.  It gets in the way of maintaining an active lifestyle.  I often tell my patients that the best way to avoid knee surgery is to practice good preventive habits – stretch well, warm up right, and limit direct impacts at both work and at play.

But injuries have a tendency to happen without warning, laying waste even to the best-laid plans. A knee injury can cause damage to the meniscus, cartilage, or ligaments of the knee.  Some recently published research has shown that the trauma leading an ACL tear causes damage to the cartilage that only manifests itself decades later.

The term “recovery time” has something of a fluid definition in orthopedic surgery. Typically it describes the wait time before a patient can resume his or her normal life, but it does not speak to the lingering aftereffects which may be more subtle, and which in the case of knee surgery can be far more extensive:

Famous athletes such as quarterback Tom Brady and alpine skier Lindsey Vonn have come back after ACL surgery, so how bad can it be? The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 15 to 20 years down the line. Regardless of whether an athlete has surgery, the risk of arthritis skyrockets later in life from an ACL tear. Kids who tear their ACL today are often left with 60-year-old knees when they’re 30.

My San Diego orthopedic knee surgery practice takes care to minimize pain and accelerate healing with a number of cutting edge technologies. If you’d like to learn more, please contact me here today.


Large-scale cohort studies have a tough time proving that one thing causes another, but they can raise interesting questions about strong correlations. This week, for instance, saw a published study which found that people who drink more milk may have less pain and slower progression of osteoarthritis, an affliction which strikes roughly a third of adults in the U.S.:

[The researchers] found that increasing milk consumption was associated with slower progression of the disease in women. In men, only those who consumed the most milk — seven or more glasses a week — saw the effect. More than 90 percent of the people in the study drank fat-free or low-fat milk, and the study did not find the effect with cheese and other dairy products.

It is possible, of course, that people who drink more milk are just healthier in every way, and that the milk is merely a signpost of that lifestyle than the cause of arthritis prevention. But we can safely assume that the milk isn’t causing any joint distress – and that upping your intake of liquid dairy may, in fact, represent a doorway to safer living.  That being said, it is extremely important for growing children, lactating women, and postmenopausal women to ensure adequate calcium intake.  That threshold may more easily be met with calcium supplements.  Most of the better quality supplements will also have the necessary Vitamin D dosage as well.  For further details reach out to your primary care physician or me to answer your questions.

We’ve spent lots of time in previous posts to discuss how to manage arthritis.  We have now also touched on measures to try to prevent it.  So try it if you like and see if that glass a day keeps the knee pain at bay. As an expert in orthopedic surgery, I have certainly seen enough chronic joint pain to know that every preventive measure is worth a shot.


The debate has been raging for some time: is walking or running better than an elliptical machine? And what does “better” mean, anyway?

As it happens, some talented physicians, technicians and orthopedic specialists have looked at the respective motions and benefits of both forms of exercise, and a few clear answers have emerged.

First things first: the calorie question seems to be a wash. That is to say that it takes roughly the same energy to propel your body forward no matter how you’re moving.  My advice is “Just move!”  and do what you like (by that, I mean exercise the way you enjoy to exercise).  Some feel better on a treadmill.  Some feel better in a spin class.  Some feel better running on the open road.  At the end of the day, the more you move the more calories you burn.  So, obviously you must walk longer or farther to make up for the slower pace, when compared to jogging.


But the larger questions surrounding musculoskeletal health get a bit trickier. Yes, ellipticals offer a more robust workout for your thighs and buttocks, while running offers a better workout for your calves. But for orthopedic surgeons such as myself, the real question is about joint pain. And here, the winner is clear:

According to a study published this month in The British Journal of Sports Medicine, walking causes 112 percent of someone’s body weight to strike the ground with every step, while only 73 percent does in elliptical training. This slighter jarring is an advantage for people with sore joints, but less so for those who hope that exercise will improve bone health.

In summary, while elliptical training is less ‘traumatic’ to joints, it does less to prevent osteoporosis (bone thinning).

And there it is. Sore joints such as knees and ankles are more likely to worsen by running on concrete, whereas joints are less likely to become inflamed on the comparatively smooth trajectory of an elliptical machine.  But I would recommend you do what you like, because that is what is gonna get you out to do it again.  And that is the best form of exercise.


Do you want to learn more about how you can prevent joint pain and head off the need for knee surgery? Please contact my San Diego orthopedic surgery offices to set up an appointment today.


3D Printed Orthopedic CastThe plaster cast is a mainstay of modern orthopedic medicine. It is the star of countless movies and memories in which an injured child returns to school and collects signatures from dozens of fawning friends. There is nothing like a cast.

Yet now the vaunted cast may be threatened. 3D printing promises to disrupt just about everything about the way objects are created, especially in medicine. Recently a graduate student created a prototype for a lightweight, printable cast made of polymer that includes low-intensity pulsed ultrasound (LIPUS) within its casing. The benefits are clear – far less weight, far more customization in form and appearance, and a greatly increased chance of faster healing thanks to the proven benefits of LIPUS.  Most importantly, depending on the 3D printed cast material, it may be safe to use in the water.

Think of this as just one of many new technologies that are changing the field of orthopedic surgery, giving patients across the country better access to more comfortable aftercare and healing. To learn more about some of the most advanced technologies in sports medicine, please contact my San Diego orthopedic surgery center today.


It is a question that has bedeviled physicians, nutritionists and trainers for generations: Why do some people hit the gym every day without fail, while others can barely find the motivation to hit the restroom in the morning?

Now scientists may have found a clue. A new study in the Journal of Physiology suggests genetic loading may influence the level of activity in which most of us engage on a daily basis. A rat study suggested that identical twins have a tendency to exercise a similar amount no matter what environment with which they are faced. Researchers then bred rats that were inclined to be highly active, and a separate group inclined to be more sedentary. Once again, the rats did as their genes predicted:

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

The silver lining in this particular study, however, is that rats who spent more time sedentary soon began to mimic their active counterparts; studies indicated that their brains actually began to look more like their motivated cousins across the lab. It seems possible that you, too, can raise your energy level just by, well, raising your energy level.  Just say to yourself “I will do it!”  Get out there and move!

We have plenty of hard data that tells us exercise can prevent knee pain and back pain, and prevent costly orthopedic knee surgeries. This study should be a strong reminder that exercise is a choice we can all make when necessary.


It is rare to find a folk remedy that cleanly defeats modern medicine in a head-to-head test of efficacy, but that’s precisely what sesame seeds recently pulled off. In a study published in the International Journal of Rheumatic Diseases, researchers announced that the humble sesame seed outperformed OTC stalwart Tylenol in a controlled experiment involving arthritic patients:

The researchers divided 50 people with arthritic knee pain into two groups. One received 2,000 milligrams of acetaminophen and 500 milligrams of glucosamine daily, while the other got 40 grams of sesame daily. After two months, those who had taken the sesame seed had significantly less pain and better function than those taking the drug. Other scientists have found that sesamin has a beneficial effect on cartilage (Glycoconjugate Journal online, December 2013).

It is a provocative finding which underscores just how little we still know about the science of inflammation, and how it impacts chronic joint pain. At minimum, this study should give pause to physicians who reach for the standard painkillers every time a new symptom arises.

Other holistic and naturally occurring anti-inflammatory foods include fish oil, turmeric, cherry juice, and devil’s claw. Many mature athletes have found knee pain relief with the use of glucosamine, chondroitin, and MSM. To learn more about effective treatments and procedures for knee pain, please contact my San Diego orthopedic surgery offices today.


Stem cell therapies are hardly new. In fact, they are perennially on the cusp of finding their way into mainstream orthopedic medicine. The problem has long been a lack of reproducible findings – and a prohibitive cost.

At least one half of that equation may finally be getting addressed. Doctors are seeing more consistent results with certain stem cell therapies for orthopedic issues such as knee pain and shoulder pain. The process has remained largely unchanged since the technology was invented/discovered:

Doctors use a needle to extract bone marrow from the crest of the hip bone. It’s then sent to a lab, where it is spun down to get at the layer of stem cells — cells that have the potential to become any type of cell.

The stem cells are then combined with the patient’s platelets, a type of blood cell involved in healing. Then, it’s given back to the patient. The idea is to have the stem cells turn into new tissue and improve pain and function. . . .

Typically, this is done for various inflammatory tendon problems, though it can be used  for hips, knees, shoulders, ankles, and spine. Patients usually notice improvement by three months, with full benefit in one year.

It is a promising approach, although the body of literature on stem cell therapies versus traditional knee surgeries remains in its infancy. The best bet if you’re experiencing chronic knee pain: Visit a San Diego Orthopedic Surgery Center and get a full workup.  You will be counseled on the risks and rewards of the various treatment options available to you, based on your unique situation.  We provide PRP (platelet rich plasma) injections among the other various conservative treatment measures. In addition, we are able to provide the complete array of surgical procedures. This broad and comprehensive approach to treating your pain and dysfunction puts us in a unique position of being able to provide you an honest appraisal of your options. Our goal is to make you better!


The injury tally continues to rise in Sochi, especially on some of the more dangerous, extreme-style downhill events. The grimmest and most terrifying moment of these Olympics came on Saturday, when a freestyle cross skier, Maria Komissarova, broke a vertebra and dislocated her back, leading to an emergency airlift to Germany for multiple orthopedic surgeries.

She is hardly alone. Numerous reports have noted the high numbers for these games, including concussions, knee injuries and plenty of falls:

Norway’s Helene Olafsen had to drop out after she suffered what has been initially reported as a knee injury. Worse still, American Jackie Hernandez will also be withdrawing after taking a fierce blow to the head. During her qualifying run, Hernandez was knocked completely unconscious after a violent impact with the snow. She regained consciousness a few minutes later, and was attempting to speak with the medics who had rushed to her aid. She was taken down the mountain on her own power, but was very unstable on her feet.

As the former Chief of Sports Medicine at the University of California, San Diego, I have spent much of my career tending to athletes and the injuries they incur from pushing the limits. But here in San Diego, orthopedic surgery is just as likely to be indicated for everyday shoulder injuries, knee injuries, and wrist and elbow injuries. The process is the same in either case: careful diagnosis, expert orthopedic surgery when indicated, followed by vigorous and supportive rehabilitation that takes the entire patient’s needs into account.

Such tools are readily available at San Diego Orthopedic Surgery center. Ms. Komissarova is receiving such care in Germany.


Effective shoulder surgery can be a long-lasting solution to certain symptoms of rheumatoid arthritis, researchers have found. A new study out this week in the Journal of Shoulder and Elbow Surgery found strong evidence to suggest that just one procedure may hold up for a decade or more without any need for further interventions:

Scientists from the Mayo Clinic found that 93 percent of rheumatoid arthritis patients who underwent a total shoulder replacement — in which both sides of a shoulder joint are replaced — needed no further surgery on the joint a decade later. The same was true for 88 percent of those undergoing a partial shoulder replacement.

“We were most happy to see the consistency of pain relief and improvement of function among patients,” said study author Dr. John Sperling, an orthopedic surgeon at the clinic in Rochester, Minn. “Shoulder replacement has come a long way over the past 20 to 25 years. It’s a one-hour surgery that requires one night in the hospital, and patients have a 90 percent chance of achieving excellent pain relief.”

And that last part is really the rub. One hour, one night, and you get a new ten-year lease on life.

My San Diego orthopedic surgery practice has long been at the forefront of sophisticated surgical techniques like these, informed largely by my personal experience as Chief of Sports Medicine at the University of California, San Diego.

If you’re suffering from rheumatoid arthritis or you simply do not relish the thought of enduring shoulder pain any longer, feel free to contact the San Diego shoulder surgery experts here.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow