Integrative Medicine as an Adjunct to Orthopaedic Surgery

James R. Ficke, MD; Nathan M. Moroski, MD; Steven D. Ross, MD; Ranjan Gupta, MD


J Am Acad Orthop Surg. 2018;26(2):58-65. 

In This Article

Natural Products

Sales of herbal dietary supplements increased by 7.9% in 2013.[26] The top-selling herbal supplement in 2013 was horehound (Marrubium vulgare;Table 3). It is used for the treatment of asthma and nonproductive cough and is thought to possess hypoglycemic, vasorelaxant, antihypertensive, analgesic, anti-inflammatory, and antioxidant properties. Horehound has traditionally been used as an expectorant and continues to be found in cough lozenges and cold preparations. This supplement is currently used as flavoring in liqueurs and cough drops. In a double-blind clinical trial, M vulgare was given to patients with type 2 diabetes who were nonresponsive to conventional medicine.[27] Subjects receiving M vulgare along with conventional medicine were found to have reduced blood glucose as well as reduced cholesterol and triglycerides. In an animal study, hypertensive rats were given either M vulgare or amlodipine.[13] Both treatments resulted in a similar decrease in systolic blood pressure. A limited number of human clinical trials have examined the efficacy and safety of M vulgare. Potential side effects are thought to be hypoglycemia, hypotension, and arrhythmia.

Turmeric was another top-selling herbal dietary supplement in 2013.[26] The principal curcuminoid of turmeric is curcumin (Curcuma longa). Turmeric spice is a member of the ginger family, is orange-yellow in color, and is often used in curry powder. It has long been used in alternative medicine as a treatment of inflammatory conditions and other ailments. Investigators at MD Anderson Cancer Center have studied this compound and its anticarcinogenic properties and have suggested that turmeric has an effect on melanoma, breast, lung, and pancreatic cancers.[28,29] The anti-inflammatory and free radical–scavenging properties of curcumin have been well documented. Curcumin was first shown to exhibit antibacterial properties in 1949.[28,30] Since then, this polyphenol has been shown to possess anti-inflammatory, hypoglycemic, antioxidant, wound-healing, and antimicrobial activities.[30] Curcumin has been shown to have anti-inflammatory properties by its suppression activation of nuclear factor kappa-light-chain-enhancer of activated B cells, which is induced in various inflammatory stimuli. Belcaro et al[14] reported on the use of curcumin to treat osteoarthritis (OA) in humans. Compared with control subjects, those receiving treatment showed a substantial decrease in Western Ontario and McMaster Universities Osteoarthritis Index score as well as a decrease in the levels of serum markers of inflammation (interleukin [IL]-1β, IL-6, and erythrocyte sedimentation rate).

Turmeric is safe for most adults. High doses or long-term use can cause indigestion, nausea, or diarrhea. In animal studies, turmeric has been shown to cause potential liver problems at high doses; however, this has not been shown in human trials.[28,29] Patients with gallbladder disease should avoid using turmeric because it can worsen the condition.[14]