It has long been a topic of some debate in the world of sports medicine whether partial orthopedic knee replacement surgery is safer than a complete knee replacement procedure.

Now a new epidemiological study published in the Lancet found that complications were far more common in total knee replacements than in partial procedures:

Researchers at the University of Oxford analyzed the outcomes of over 100,000 knee replacement surgeries and found that – while the risk of serious complications is small — TKR patients are twice as likely to have a blood clot, heart attack or deep infection, three times as likely to have a stroke, and four times as likely to need blood transfusions, compared to those having partial knee replacement.

It is an interesting finding that will almost certainly inspire more detailed research, including, one hopes, a randomized study which should yield better data. But this remains a strong signal that doing less can be more effective than doing more, especially in cases where the orthopedic injury doesn’t necessitate a full replacement.  The advantage of consulting with a sports medicine orthopedic surgeon is that we can treat the particular knee condition with an appropriate intervention (i.e., we have more tricks in our bags than simply doing a total knee replacement on every patient that walks in the door).

If you have suffered with knee pain in San Diego for some time, I urge you to see a  sports specialist. Please contact my orthopedic knee surgery offices in San Diego today.


Shoulder injury is common in the NFL, as any diehard sports fans can testify.  The video showing such injuries may be so graphic that many fans even wonder if the player will ever return to form, especially for NFL quarterbacks.

A new study has found encouraging news. Orthopedic shoulder surgery shows an overwhelming success rate among professional athletes:

The new study included 60 players who had shoulder stabilization surgery. Ninety percent of those who had this procedure successfully returned to play, defined as playing in at least one regular season game. The return rate was 82 percent for those who had open surgery and 92 percent for those who had minimally invasive (arthroscopic) surgery

These are numbers which should please anyone who plays, or is invested in, football on a competitive level. They also serve as a reminder that shoulder surgery is a safe and effective way to relieve pain and reclaim movement, no matter if you are a weekend warrior or a professional linebacker.

To learn more about shoulder surgery in San Diego, contact my practice today.


Knee injury while at rest.  Seemingly contradictory.   It has long been suspected that an active life and daily movement represent good ways to reduce your likelihood of getting arthritis. Now some researchers have finally looked at the numbers to see if this popular notion withstood statistical scrutiny. Their conclusion?

When they analyzed the step data from the pedometers, they found a strong link between participants’ activity level and knee health. Their results suggest 6,000 steps marks an important threshold: 70% of participants who developed knee impairments walked less than this amount while 70% of those who remained healthy walked more.

Using nothing more advanced than off-the-shelf fitness trackers, these researchers were able to study and control for a variety of factors in a population of about 2,000 people. Sure enough, the more active participants seemed considerably less likely to develop knee pain and other symptoms associated with this progressive disorder.  From a scientific standpoint, this makes sense.  Cartilage and the locomotion machine (i.e., body) function better when the ‘engine’ is kept warm.  Not turned off and allowed to collect dust; and not when the engine is ‘revved’ too high, wherein the parts fall into disrepair.  For example, the fascinating thing about cartilage is that cartilage requires, as a part of its normal maintenance, it’s use (such as with walking) to deliver the nutrients from the joint fluid into the cartilage structure.  It’s use actually prolongs it’s longevity!

Of course a cohort study like this cannot officially separate causation from correlation; it is possible, for instance, that people who walk fewer steps do so because they already have bad knees. Yet this study remains a tantalizing clue in support of the idea that sedentary lives can be injurious lives, and that we would all do better to move around more during our active years.


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.


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.


The medical community is never short on opinions on how to manage chronic pain. Common recommendations range from the use of anti-inflammatories such as NSAIDs, to stretches, exercises, even meditation. One effective fix that isn’t usually mentioned: weight loss. Now a new study has appeared which suggests the effects can be profound:

The study included 20 obese patients who had weight-loss surgery and 40 patients who had total knee replacement due to arthritis.

One year after their procedure, the patients who had weight-loss surgery reported significant improvements in knee pain. Their results were comparable to the patients who had a knee replacement, according to the study, which was presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.

It is yet another reminder that our knees are complex mechanical systems, and that ensuring their safe operation has as much to do with reducing loads as reducing stress. The collateral health benefits of weight loss only shore up the case, of course, and lend credence to a holistic view of sports medicine that incorporates the entire body as a single system.

Furthermore, there is growing scientific evidence that injections of PRP (platelet rich plasma) and/or stem cells into the arthritic knee provide significant pain improvement.  In fact more and more evidence seems to indicate that PRP is more effective in reducing knee pain than the highly touted hyaluronic acid (HA) injections, such as Synvisc, Hyalgan, Orthovisc, and Suppartz.

Want to learn more about knee pain or knee surgery in San Diego? Please contact my orthopedic surgery offices here today.


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