For some advanced musculoskeletal problems surgery is necessary. Joint replacement surgery is done if a joint is beyond repair and multiple other nonsurgical options have failed. In such individuals surgery should be considered. But what should someone do if they’ve had surgery and have persistent pain?

The first question to ask is whether the correct region has been identified as the true pain generator. Reevaluating whenever an unexpected outcome occurs is appropriate. A classic example is someone with hip pain who has arthritis affecting the hip and spine. If this individual’s pain derives primarily from the back, then hip surgery may not adequately control his pain. In this case treating the spine now with physical therapy, acupuncture, or a targeted spine injection may be beneficial.

An alternative approach prior to surgery would be to treat the hip or spine with a non surgical approach first. If significant improvement occurs, then avoiding surgery may be possible. This approach is safer than the surgery first approach, and may be more accurate as well.

Another novel approach to consider would be to use a cell based treatment after surgery. In theory using stem cells or PRP to accelerate the healing process after surgery sounds good. This can not be used in the setting of a joint replacement, but this can be considered in the setting of microfracture surgery or a tendon repair procedure. The evidence of this approach is limited at this time, but intuitively it makes sense and may be something to look forward to in the future.

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