Orthobiologics

Orthobiologics are an evolving field in musculoskeletal care, as well as aesthetics. Leaders in the field hope it transforms orthopedic interventions to being less invasive with a shorter recovery time. The field stems around using autologous products (derived from your own body) to promote healing. 

I’ve found that the more a patient moves after a procedure, the better outcome they have. This is why physical therapy, a reasonable training program, or even walking are imperative to having a good outcome after an intervention.

What are orthobiologics? These are classically called “stem cells.” The common thought was that we could transfer undifferentiated cells into an area of our body and regrow material. This is not consistent with the current literature. Now the thought is that we are loading growth factors or cytokines into an area to activate the local stem cells to differentiate and stimulate healing. The most common procedures performed are called platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Both PRP and BMAC are considered experimental, meaning they do not have large randomized controlled studies supporting their use and thus are often not covered by insurance. 

For PRP you get a blood draw. The blood is then spun down in a centrifuge and concentrated. The PRP concentrate is then injected into an area of pathology (injuried area). Ideally, this would be performed under some form of imaging guidance. For BMAC, bone marrow aspirate is drawn from your pelvis and then concentrated similar to PRP. The material is then injected into the area of pathology. Unlikely steroid injections which are anti-inflammatory, PRP and BMAC cause inflammation which is a normal part of the healing process. It is common to be more sore for a couple of days to a couple of weeks following the procedure. 

The healthier the patient is, the better the treatment outcome. This is because healthier people tend to have higher cell counts and thus higher amounts of growth factors. 

Will this intervention replace all surgeries? No. Surgical interventions are still necessary for significant injuries or severe degenerative joint disease. Not every patient is a good candidate for this procedure. It’s a promising treatment option for musculoskeletal conditions that will hopefully improve patient outcomes. Are steroid injections always bad? No. Corticosteroid injections are sometimes necessary if the body causes too much inflammation. They are a useful tool to reduce pain, improve range of motion, and allow for the patient to perform a reasonable rehabilitation program. Like life, all medical interventions have trade offs. 

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