Orthobiologics and Joint Preservation Basics
The biologic treatment of musculoskeletal diseases is a relatively new and exciting area of orthopedics. Musculoskeletal injuries and diseases are affected and regulated by your body’s natural healing processes. There is a complex dance of cellular and chemical activity that occurs in your body to promote healing and repair of damaged tissues, including muscles, tendons, ligaments, bone, and cartilage. When tissues are damaged or become aged, their reparative mechanisms are often no longer as effective. Stem cells are naturally occurring cells in your body that have the capability to differentiate (turn into a specific type of cell). They also have the capability to promote the repair and regenerate a variety of damaged tissues. Mesenchymal stem cells are a particular category of cells that can produce bone, cartilage, ligament, and tendon tissues. These cells produce a variety of chemicals (growth factors and cytokines) that signal other cells to repair, decrease inflammation, and inhibit the breakdown of tissues. These cells are in high concentration in certain parts of your body, including your adipose tissue (fat).
A variety of techniques for using biologic agents and stem cells have been utilized in various centers around the world. The treatments performed in this center are all autologous—meaning that the biologic material and stem cells all come from your own body and not from a donor pool. The advantage of using autologous biologics/stem cells is that there is no concern of disease transmission or rejection. The primary source of stem cells used in our clinic comes from your own bone marrow.
Orthopedic Diseases Treated With Reparative Tissues and Stem Cells
A variety of disease and injuries can be treated with reparative cell therapy. Orthopedic conditions that have been treated and studies using stem cells include acute and chronic injuries of muscle, tendon, ligaments, bone, and cartilage. Some specific conditions that can be treated with stem cell therapy include:
- Mild to moderate osteoarthritis/degenerative arthritis of joints, especially the hip and knee
- Tendon injuries, including partial tears of the rotator cuff of the shoulder
- Back pain related to degenerative disc and facet joint
Goals and Success Rates
The goal of reparative medicine is to reduce pain and improve function without the need for surgery. In some cases, the condition being treated is too severe for these techniques, and surgery may be necessary. Studies in humans have indicated that the treatments are very safe and low-risk. Studies regarding the effectiveness of reparative medicine techniques compared to no treatment or other accepted treatments are still in the early phases and are complicated by the fact that it is difficult to design good controlled and randomized studies in humans. Furthermore, different investigators often use different techniques and have different definitions of success. Nevertheless, many independent investigators have shown evidence of effectiveness in treating orthopedic injuries and disease by reducing pain and improving quality of life. Some studies have shown MRI evidence of healing and even regeneration of tissue (including cartilage) that would not have been expected without reparative medicine. Reported success rates are as high as 70 – 90% in some studies. When treatment is successful, pain relief and improvement in function typically begin to occur about six to eight weeks after treatment. The exact mechanism by which reparative medicine decreases pain and improves function is still in the process of being understood.
Alternative Treatment Options
Most diseases and injuries can be treated by a variety of methods, depending on the individual circumstances of the patient. For example, arthritis of the knee might be treated first with modification of activities, weight loss, over-the-counter anti-inflammatory medication, physical therapy, bracing, corticosteroid injections, and hyaluronic (lubricant) injections. In some cases, knee arthroscopy may be helpful, and in the most advanced stage of knee arthritis, total knee replacement is the most reliable method for decreasing pain and improving function. It’s important to weigh the pros and cons of your various treatment options before deciding which approach is best for you. We will help guide you through that process. Currently, reparative medicine techniques and stem cell therapy are rarely the first line of therapy, but that may change in the future.
Precautions and Risks
The risks related to reparative medicine as practiced at SPOC are very low. There is, of course, some mild discomfort associated with the procedure. There is a very small risk of infection whenever aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are exceedingly rare. As orthopedic subspecialists, we use our detailed knowledge of normal anatomy as well as imaging techniques to assure your procedure is done as safely and effectively as possible. You will be given some important pre-procedure and post-procedure instructions that help reduce the risk of complications. Patients with a history of bone marrow disease, cancers of the blood system (leukemia, lymphoma, etc.), autoimmune diseases, and active infections are not normally candidates for this type of stem cell therapy. Patients with bleeding disorders and other chronic medical problems may not be suitable candidates.
Pre-Procedure Protocols/Preparation
Before a decision is made to proceed with reparative medicine procedures such as Lipogems®, you will have an orthopedic evaluation that will help determine if you are a candidate for this treatment. This often includes obtaining X-rays and sometimes an MRI scan. If you are otherwise healthy, then you will not normally need any other special laboratory testing.
You will be contacted by our schedulers to begin the scheduling process. Although we may attempt to obtain preauthorization from your insurance for this treatment, it is routinely denied by all carriers. You can expect that the cost of this procedure will be an out-of-pocket expense. The scheduler will inform you of the charge for the procedure that is due on the day of the procedure. We currently accept cash, all major credit cards, and health savings (HSA) cards.
One week prior to your procedure, you should stop all NSAIDs (anti-inflammatory medications) such as Advil (ibuprofen) and Aleve (naproxen). You should stop taking any aspirin or other medications/supplements (e.g., fish oil) that are known to thin the blood. If you are taking medications to prevent blood clots, then make sure we have given you specific instructions as to when to stop and when to resume those medications.
Financial Policy
Although reparative medicine procedures have been used for years and there are studies that have demonstrated effectiveness, their application in orthopedic conditions is relatively new. Therefore, insurance companies rarely ever include this type of treatment in your benefits. You are responsible for covering the cost of treatment.
The cost of the treatment varies, depending upon the exact procedure. For a cost estimate of the entire procedure/process, please discuss with the scheduler by calling Dr. Eric Hanson's office at (559) 435-9020 or Dr. Steven Thaxter's office at (559) 446-0777.
We currently accept cash, all major credit cards, and health savings (HSA) cards. An alternative payment option may be available in some circumstances.
Educational Resources
Application of Biologics in the Treatment of the Rotator Cuff, Meniscus, Cartilage, and Osteoarthritis, Anz, et al. J Am Acad Orthop Surg. 2014; 22:68-79. https://journals.lww.com/jaaos/Abstract/2014/02000/Application_of_Biologics_in_the_Treatment_of_the.2.aspx and https://www.ncbi.nlm.nih.gov/pubmed/24113698
Current Concepts: The Role of Mesenchymal Stem Cells in the Management of Knee Osteoarthritis. Wolfstadt JI, et al. Sports Health. 2015; Jan7(1):38-44. https://www.ncbi.nlm.nih.gov/pubmed/25553211