Description

Orthobiologic Treatments at Orthopedic ONE

Orthobiologic therapies, also known as regenerative cellular therapies, are rapidly expanding the treatment options for arthritis and chronic tendon injuries and muscle tears. Orthobiologics are substances found in the human body that are often concentrated or filtered to obtain a small quantity for injection into the site of injury. The growth factors contained within or secreted by these substances facilitate tissue healing; improve pain and aid in restoring function. These treatments are useful in mild to moderate arthritic joints but not severely arthritic joints. They also can be effective in small tendon tears as well as stubborn soft tissue sports injuries.

These treatment options are currently considered to be experimental and therefore are not first line therapies but can be considered when conventional treatments have failed. Discuss this with your treating physician to determine if you would be a candidate for these therapies. Many insurance companies do not currently cover these treatment options.

Cell based therapies, such as platelet rich plasma (PRP) injections, can accelerate healing of these common injuries

• 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 and lateral epicondylitis (tennis elbow)
• Back pain related to degenerative disc and facet joint

Orthobiologic treatments include platelet rich plasma (PRP), alpha 2 macroglobulin (A2M), and stem cell injections. The following are performed at Orthopedic ONE:

Platelet Rich Plasma (PRP)

PRP is the most studied of the Orthobiologic therapies. Many, but not all, of these studies have shown benefit in reducing pain and improving function in patients with arthritis or chronic tendinopathies. Platelets contain powerful transforming growth factors that stimulate tissue healing and also can stimulate and signal local stem cells. PRP is obtained from the patient’s own blood and processed in the office. This takes approximately 45 minutes. A small quantity is then injected into the site of injury. The patient can return to normal function afterward but many take it easy the rest of the day. The main restriction afterward is the avoidance of anti-inflammatory medications, which can reduce the effectiveness of this treatment. Studies have shown that often 2-3 injections are needed for arthritis and 1-2 injections for a tendinopathy. Costs for injections vary depending on the type of injury and site of injection. PRP injections at Orthopedic ONE start at $400 and can range up to $900. That cost is inclusive of the office visit with your physician as well.

Alpha 2 Macroglobulin (A2M)

A2M is a protein within the blood that inhibits cartilage degradation by neutralizing harmful enzymes within a degenerative joint and is a treatment option for swollen arthritic joints. To determine if you are a candidate for A2M a FACT test can be performed to determine if a degenerative process is ongoing within the joint that would be responsive to an A2M injection. A2M is obtained from blood drawn in the office and then processed. This takes approximately 45 minutes. The A2M is then injected into the joint. This can be followed later by 1-2 PRP injections to stimulate the cartilage cells within the joint. The cost of an A2M injection at Orthopedic ONE is $1,500.

Bone Marrow Aspirate Concentrate (BMAC)

Autologous (our own) bone marrow contains stem and progenitor cells, which under the right conditions will divide and form precursor cells that have the capacity to generate new tissues. This includes blood, bone, cartilage, fat and blood vessels. These cells are necessary to maintain the health of the tissues over time, and to respond to injury.

Bone marrow is aspirated with a needle from the hip or pelvis. The majority of cells in bone marrow are blood-forming cells. However, a small number of cells in bone marrow are referred to as “connective tissue progenitors” (CTPs). CTPs can make bone, cartilage, fat and other fibrous tissues that are important for joint function.

CTPs and other cells in bone marrow can be concentrated by several methods and then injected into sites of diseased or damaged tissue. When injected, CTPs may contribute to new tissue formation. They may also release proteins known as growth factors or cytokines. These growth factors may also act on cells that are already in the diseased or damaged tissue to improve their function.

The method of aspiration can be done in the clinic but is most often done in tandem with a surgical procedure in the operating room. Pricing varies based on the site of service and can range up to $4,000 per injection.

Click here to find a physician who performs orthobiologic injections.

Other Orthobiologic Treatments to Understand – The following are not offered by Orthopedic ONE

Amniotic Fluid, Placental Tissue, and Umbilical Cord Tissue

A growing number of products are now sold that are composed of amniotic fluid, placental matrix tissue, and umbilical cord blood and tissue injections. The interest for these products stems from the high concentrations of growth factors and cytokines they contain and the belief that they may be helpful in tissue repair or regeneration.

As human babies form in the uterus of their mothers, they are surrounded by tissue that is grown by the fetus, called the amniotic membrane. This membrane has two layers, the amnion and the chorion. Each layer is very thin and contains cells, growth factors and cytokines.

Several companies are now collecting and processing the amniotic fluid or amnion, chorion tissues, and umbilical cord tissue, with approval of the parents. These are then processed using sterile methods to preserve the cells, proteins, growth factors, collagen and hyaluronic acid elements that might have a therapeutic effect.

These materials thus far appear to be safe. However, the viability of cells or the ability to provide predictable and lasting improvement in the treatment of common causes of joint pain has not yet been definitively established. Nor has the best method for processing or delivery of these materials been determined. For these reasons, Orthopedic ONE does not offer these types of products or injections.

Questions about stem cells, PRP and other Orthobiologics for treatment of OA?  Click here to read what the AAHKS has published on the topic of PRP for the Management of Osteoarthritis of the Hip and Knee.