Orthobiologics – Spectrum Health's Alternative To Invasive Surgery
Body aches and pains are something that most of us have to deal with at some point in our lives. These ‘aches’, unfortunately, are not just about joints and bones – we’re dealing with a huge system of muscles, tendons, and cartilage as well, that undergo strain on a day-to-day basis. Long term overuse, or just the aging process, can cause degeneration, which is responsible for all the aches.
Surgery has long been considered the only option for long-lasting relief. Recently, however, the use of orthobiologics, which is a new, exciting area of regenerative medicine, aims at improving your pain and quality of life. The term ‘orthobiologics’ refers to substances that are capable of regrowing and repairing parts of your body’s musculoskeletal system, including bone, cartilage, muscles and tendons. Orthobiologics harnesses your body’s natural tendency to heal, and speeds up the process.
What Type Of Substances Are Used In Orthobiologic Therapy?
Basically, any substance that has proven its efficacy to hasten the healing capacity of your musculoskeletal system can be considered an orthobiologic.
This was one of the first orthobiologics to be used. Hyaluronic acid is an important part of the body’s ‘ground substance’, the matrix that surrounds your cells. In your joints, it plays an important role as a lubricant, and has an anti-inflammatory effect as well. While it’s great at relieving your pain, and is definitely a superior option to taking painkillers, its effects are not long-term.
Platelet Rich Plasma (PRP)
This is a component of blood that is rich in cells called platelets. Platelets are a rich source of various growth factors that have multitasking abilities. These include clearing dead tissue, inducing cellular proliferation, new blood vessel formation, and extracellular matrix formation. PRP also contains a component called fibrinogen, which forms a physical scaffold covering the defect. This serves as a framework for the repairing cells to do their job.
PRP is prepared from your own blood. A nurse or technician at Spectrum Health will draw your blood, similar to a blood test. The blood undergoes processing in our laboratory centrifuge, where the platelet component is separated, concentrated and extracted.
Stem cells are also known as 'medicinal signaling cells' which direct many other cells to auto repair and reduce inflammation that leads to chronic degeneration. These cells are present in several areas of the body, including blood, bone marrow, dental pulp, and body fat. Unfortunately, these cells cannot always travel fast enough to the damaged area – that’s where orthobiologics helps. By isolating and concentrating them from their sources, then re-introducing them into the damaged area, we help the body optimize the ‘auto-repair’ mechanism. At present, there are two major sources of stem cells that are being tapped – the bone marrow cells and fat cells.
Bone Marrow Concentrate
Bone marrow concentrate is the best source of adult mesenchymal stem cells in the body. Although it can technically be taken from any bone, we prefer to harvest it from the back of your hip bone.
Adipose derived Mesenchymal Stem Cells
Body fat, or adipose stem cells, are obviously easier to procure than bone marrow. It does have a higher quantity of stem cells as compared to bone marrow, but fewer clinical trials exist than bone marrow. That being said, there is lots of evidence emerging that this type of stem cell is very unique and valuable in the repair of musculoskeletal tissue. Recently due to an FDA ruling, it is advised for physicians to not use this type of stem cell for orthopedic issues as it is seen as a drug and needs more rigorous clinical research to show safety.
Chondrocytes are essentially cartilage forming cells. When the cartilage of your joint gets damaged, as happens in several degenerative diseases, an attempt to repair it is made by the existing chondrocytes. The end result is, however, cartilage of inferior quality. Attempts have been made to isolate chondrocytes from healthy, uninvolved tissue, expand them outside the body, and re-introduce them into damage areas. This produces better quality cartilage that has a longer life.
Cytokines are chemical substances that control the inflammatory process in the body. While some actually induce inflammation, there are several chemicals that can suppress inflammation and promote healing. One such cytokine is alpha-2 macroglobulin, which specifically targets inflammatory mediators involved in osteoarthritis. It has been tried along with other agents in degenerative joint diseases to promote healing. Clinical trials analyzing its efficacy are still underway, and more evidence is required before we begin to use this.
Why Is Orthobiologics Better Than Surgery?
Orthobiologics have a ‘natural’ mechanism of action. They do not remove old, damaged tissues, but attempt to repair these. On the other hand, modern orthopedic surgery attempts to either remove damaged tissues, or replace them with artificial structures.
Modern orthobiologics halt disease progression. This stops the degeneration of your joint, which is otherwise an ongoing process. This is a result that cannot be achieved by surgery.
The recovery and rehabilitation after orthopedic surgery can be quite long, and requires months of physical therapy. Orthobiologic treatment allows you to return to an active lifestyle almost immediately after the procedure
Orthobiologics have no serious documented adverse effects. Most adverse reactions, such as pain and swelling, are minor and last for only a few days. Orthopedic surgery comes with the risk of serious adverse effects, including increased risk of heart attacks, and thromboembolic disease.
Surgery is a prolonged procedure – you have to go through an extensive workup prior to the procedure, and it requires lengthy hospital admissions after the procedure. Not only does this need a lot of your time, it also adds to the cost of the entire treatment. Orthobiologics mostly require only single outpatient visits, which last for a few hours only.
Does Orthobiologic Therapy Actually Work?
The evidence says it does! Studies performed in pre-clinical models have shown the growth of actual tissue when these substances are used. Human studies have also had good results. Orthobiologics have been used in several joints of the body, including the knee joint, hip joint, shoulder and back, with excellent clinical outcomes. A few examples illustrating these points are given below.
- A systematic review of fifty-nine articles (Filardo et al., 2013) assessed the effectiveness of platelet rich plasma in joint injections.1 Preclinical studies included in this review showed that PRP injections created an environment that favoured joint healing. Clinical trials included in this review showed that patients showed improvement in their clinical symptoms.
- Taylor et al. (2011) reviewed 15 articles that analyzed the use of PRP in sports injuries alone. All studies showed an improvement in pain and functional scores.2 The authors stated that the use of PRP had several advantages, including faster recovery, less recurrence of pain, and no adverse effects.
- A critical evaluation of all available literature evidence (Cotter et al., 2018) was done to analyze the efficacy of bone marrow stem cells in repairing cartilage defects.3 The authors found that bone marrow concentrate stimulated the formation of more robust cartilage, which was also reflected in better clinical outcomes.
- The efficacy of adipose derived stem cells in cartilage regeneration has also been established, in a systematic review of ten studies (Pak et al., 2018).4 The authors stated that the mesenchymal stem cells are capable of attaching themselves to the defect sites and then regenerate cartilage.
- One clinical study in 15 patients with osteoarthritis (Shaw et al., 2018) analyzed the effect of four sequential bone marrow concentrate injections.5 The pain scores improved with each subsequent injection, until it reached insignificant levels.
- Another clinical study (Spasovski et al., 2018) evaluated the injection of adipose derived stem cells in nine patients who had osteoarthritis.6 They found that all patients experienced significant improvement in pain scores, range of motion and quality of life.
How Do I Know If I'm A Candidate For Orthobiologic Treatment?
At Spectrum Health, we’re here to help you find the answer to that question! If you’ve had chronic pain that has lasted for more than three months or if you find yourself needing those over the counter painkillers often, you should consider coming in for an evaluation, so that we can tell you what’s causing your pain. Orthobiologics are the answer to most musculoskeletal problems, ranging from sports injuries, to age-related wear and tear. Setting-up an appointment with Dr. Joseph Locke will help you decide which form of regenerative treatment would suit you the best. This may well be your key to a healthier, pain-free life ahead!
- Filardo G, Kon E, Roffi A, Di Matteo B, Merli ML, Marcacci M. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2013;23(9):2459-74.
- Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med. 2011 Jul;21(4):344-52. doi: 10.1097/JSM.0b013e31821d0f65
- Cotter EJ, Wang KC, Yanke AB, Chubinskaya S. Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence. Cartilage. 2017;9(2):161-170.
- Pak J, Lee JH, Pak N, et al. Cartilage Regeneration in Humans with Adipose Tissue-Derived Stem Cells and Adipose Stromal Vascular Fraction Cells: Updated Status. Int J Mol Sci. 2018;19(7):2146. Published 2018 Jul 23. doi:10.3390/ijms19072146
- Shaw B, Darrow M, Derian A. Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544118781080. Published 2018 Jun 18. doi:10.1177/1179544118781080
- Spasovski D, Spasovski V, Baščarević Z, Stojiljković M, Vreća M, Anđelković M, Pavlović S. Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis. J Gene Med. 2018 Jan;20(1). doi: 10.1002/jgm.3002. Epub 2018 Jan 22.