Non-surgical orthopaedics
Helping you improve musculoskeletal conditions — and delay or avoid surgery — by giving the body the right conditions to heal.
What is non-surgical orthopaedics?
Non-surgical orthopaedics is a rapidly expanding area of medicine devoted to offering non-operative options to patients who might once have been told that surgery was their only choice. We now understand far more about the body’s inherent capacity to heal when given the right conditions.
As a Sport and Exercise Medicine Physician, I see the full spectrum of musculoskeletal care — guiding patients through non-operative rehabilitation, and also assisting in theatre alongside surgeons. That perspective gives me a deep appreciation for what the body can achieve on its own, and my aim is to use it to maximise your chance of never needing an operation.
Why we need non-surgical orthopaedics
In Australia, we love our sport — and we love our food. Injuries and weight gain are increasingly common in younger people, and as a result we are seeing osteoarthritis appear earlier in life.
Helping younger patients avoid a joint replacement is a major priority, because registry data tells us that patients under 55 wear their replacements out faster. With an average Australian life expectancy of around 83 years, someone who has a joint replaced under 55 will most likely need a second, far more invasive “revision” operation later in life. Orthopaedic surgeons in this country pride themselves on evidence-based care and, like all doctors, want the best short- and long-term outcomes — which is why most will encourage a younger patient to delay surgery for as long as is feasible.
Conditions that often respond to non-surgical care
These are some of the conditions where the evidence increasingly supports a non-operative path — particularly when treatment starts early.
Early hip or knee osteoarthritis
Supervised, guided weight loss and exercise can make an enormous difference to pain and function — even in younger patients with severe osteoarthritis. My Longevity Program takes an Exercise-Medicine approach to improving your overall health and activity through comprehensive assessment and holistic management. You can also follow the Progressive Longevity educational series on YouTube.
Adjunctive measures can also help delay the need for joint replacement:
ACL rupture
The anterior cruciate ligament (ACL) is crucial for the rotational stability of the knee. It was long considered essential to reconstruct it in order to return to sport or pivoting movements. There is now increasing evidence that the ACL can — and does — heal when given the right conditions. When the meniscus and cartilage are intact, you may be a candidate for non-surgical management.
▶ Watch: Non-surgical ACL healing — Dr David SamraAchilles rupture
We used to believe an athletic patient with an Achilles rupture could only return to sport after surgical repair. The evidence now shows very similar results with non-surgical treatment and early mobilisation — provided the diagnosis is not delayed. Patients who have surgery are slightly stronger in the calf at an earlier stage, but I believe every patient should have the choice, especially when the rupture is diagnosed early (Achilles ruptures are commonly missed).
This is particularly valuable for patients with diabetes or obesity, who face a higher risk of wound breakdown, infection and failed surgery. I use an evidence-based protocol, studied extensively in the UK, that has shown excellent results:
Protective cast
A specialised cast holds the tendon in the correct position to begin healing.
Heel-lifted boot
Early functional mobilisation lets the tendon heal at the right length.
Physiotherapy
Progressive strength and range-of-motion rehabilitation.
Return to sport
Average return to sport, guided by your progress.
The right path is the one the evidence supports for your injury. I’ll give you an honest assessment of whether non-surgical care is likely to work — and recommend surgery when it genuinely offers the better outcome.
Treatments & programs that support non-surgical care
Non-surgical orthopaedics FAQs
For many conditions the long-term results are comparable — and sometimes better, once you account for surgical risks and recovery. For others, surgery remains the right choice. The honest answer is that it depends on your specific diagnosis, your goals and your circumstances, which is what an assessment is for.
Not always. The aim is to give your body the best possible chance to heal and to delay or avoid surgery where the evidence supports it. Sometimes an operation is genuinely the better option — and if that’s the case, I’ll tell you plainly and help arrange it.
Yes. I see the full spectrum of musculoskeletal care, including assisting in theatre, and I refer promptly when surgery is the better path. Non-surgical orthopaedics works best alongside surgical colleagues, not in opposition to them.
It depends on the condition and the findings. For an ACL rupture, for example, an intact meniscus and cartilage matter; for an Achilles rupture, an early diagnosis is key. A thorough assessment, usually with imaging, determines whether non-surgical care is suitable for you.
Explore your non-surgical options
Book an assessment with Dr David Samra to find out whether your condition can be managed without surgery — and to build a plan that gives your body the best chance to heal.
121 Norton Street, Leichhardt NSW 2040
