Orthopedic Physician Shares Why He Chose Repair Over Replacement

Mark White | The Mark White Show

Franklin, Tennessee. - Dr. Marc Patrick Pietropaoli did not set out to challenge one of modern medicine’s most common assumptions, but a moment early in his medical training changed the course of his career.

More than 30 years ago, as a third-year medical student, Pietropaoli observed one of the earliest knee replacement surgeries while rotating through orthopedics. The procedure was considered cutting-edge at the time, but what he saw left him unsettled.

“I watched surgeons remove large portions of bone and cartilage and replace them with metal and plastic,” Pietropaoli said in a recent interview on The Mark White Show. “At first it seemed impressive. At that moment, I realized how extreme it was.”

During the operation, Pietropaoli asked whether it was possible to cure arthritis, regrow cartilage, or repair a knee instead of replacing it. The question was dismissed by others in the room.

Later, however, the surgeon performing the procedure, Dr. David Murray, approached him privately. “He told me, ‘We don’t have the answer yet, but maybe someday you will,’” Pietropaoli said.

That exchange became a defining moment.

Today, Pietropaoli is an orthopedic physician, founder of Victory In Motion, and author of Repair Not Replace, a book advocating for joint restoration over automatic replacement surgery. His work focuses on identifying root causes of joint pain and using regenerative and non-surgical approaches whenever possible.

Another major influence on his philosophy was his training under Dr. James Andrews of Birmingham, Alabama, one of the world’s most respected sports medicine physicians.

Pietropaoli spent a year working with Andrews, treating elite athletes and everyday patients alike.

“He taught me to treat everyone like an elite athlete and to try everything possible before surgery,” Pietropaoli said. “Surgery should be the last resort, not the first.”

Andrews later wrote the foreword to Pietropaoli’s book, endorsing the principle that preservation should come before replacement.

Pietropaoli was also influenced by the work of French orthopedic surgeon Dr. Philippe Hernigou, whose long-term study compared knee replacement with stem cell treatment in patients with severe arthritis in both knees. The study found that more than 80 percent of knees treated with stem cells did not require replacement even after 10 to 20 years.

To Pietropaoli, the findings confirmed what he had long believed. “The body still has the ability to heal itself, even later in life,” he said.

In his practice, Pietropaoli emphasizes comprehensive evaluation, often looking beyond the joint itself to determine whether pain originates in surrounding structures such as the spine or hips. He also promotes prevention through hydration, nutrition, sleep, and early intervention.

He says that trust is central to healing.

“Hope is important, but trust is even more important,” Pietropaoli said. “When patients trust the process and stay committed, their outcomes improve.”

Looking ahead, Pietropaoli has an ambitious goal.

“Our mission is to reduce and eventually eliminate the need for routine joint replacements by 2043,” he said. “We need to focus more on prevention and early treatment, not just late-stage solutions.”

For Pietropaoli, the path that led him there can be traced back to a single question asked in an operating room decades ago.

“It wasn’t popular at the time,” he said. “But it became the foundation of everything I do.”

What began as an unwelcome question has since become a guiding principle in a career built on challenging convention and rethinking how medicine approaches joint pain.