Several factors play an important role in the health of your musculoskeletal system, including your joints, cartilage, ligaments, tendons, and muscle. These include:
- Injury (either from one severe injury to a body part or repetitive abuse)
- Nutritional status (including adequate vitamin D intake)
- Other chronic health conditions (e.g., diabetes, gout)
Whenever possible, please consider optimizing these factions before or during any other treatments. In some cases, your orthopedic problem might best be managed by a combination of options, such as modification of activities, physical therapy, bracing, oral medications, injections (including corticosteroids, hyaluronic acid, platelet-rich plasma, stem cells), and surgery.
Orthobiologics and Reparative Medicine Options
The biologic treatment of musculoskeletal diseases is a relatively new and exciting area of orthopedics. Below is a brief summary of some treatments that are offered in our practice. Your medical providers can provide more information and answer questions for you.
- Corticosteroids (aka cortisone) – Corticosteroids have been used in orthopedics for nearly 100 years. In orthopedics, they are often used with the primary purpose of providing fast-acting, but usually short-term, relief of inflammatory conditions of joints, bursae, and certain tendons. In some conditions, these injections of corticosteroids can break a vicious cycle of inflammation and may cure the condition. Commonly used for a flare or aggravation of shoulder, hip, or knee arthritis, they are also used for bursitis of the shoulder, elbow, hip, and knee. These injections are typically covered by insurance.
- Hyaluronic Acid (aka viscosupplement or joint lubricant) – This material is very similar to the normal lubricant that is made in a healthy joint. The material is made either synthetically or isolated from an avian animal source. It is commonly used for management of knee arthritis as a series of injections (three to five, depending upon the condition and the brand). Studies have generally shown effectiveness for most patients with moderate arthritis for approximately six months. Injections are often, but not always, covered by insurance carriers for the knee. Not covered by insurance for other joints, such as shoulder or hip.
- Platelet-Rich Plasma (aka PRP or ACP) – This material is isolated from your own blood and contains natural healing factors, including growth factors and cytokines (chemical messengers). Your blood is drawn and processed in a special syringe and centrifuge to obtain the PRP. The PRP is then injected into the treatment site. Often used to promote quicker healing of injured soft tissues such as ligaments and tendons, it is also used to reduce pain in arthritic joints. Some studies have shown they can reduce pain in an arthritic joint for much longer than six months. PRP is usually given as one injection per treatment episode, but occasionally in a series of two to three. Insurance rarely covers PRP injections.
- Lipogems® – Fat contains a network of important reparative cells, including pericytes, which are a type of stem cell. Stem cells are a universal type of cell that can differentiate into (turn into) a specific type of cell. Mesenchymal stem cells have the capability to replicate and differentiate into muscle, bone, fat, or cartilage-producing cells. Additionally, these cells can produce factors (some of which are also found in PRP) that help reduce inflammation and fight cell death. Autologous stem cells are those that are taken from the patient being treated (not from another person, animal, or lab). In our clinic, we obtain autologous stem cells primarily from the patient’s adipose tissues (fat) using the Lipogems® procedure. This is an in-office procedure that includes a minimally invasive fat harvesting procedure (liposuction), a gentle processing of your fat into microframgented adipose clusters, and then injection of the Lipogems® into the treatment site. The microfragmented fat clusters (including stem cells) are then thought to act as factories of PRP (and other factors) that promote healing of damaged tissues. There is much controversy about the exact mechanisms by which stem cells help various orthopedic conditions, but many studies have shown evidence of improved pain relief and improved function after stem cell therapy. The technique of harvesting and processing reparative tissues and stem cells is more expensive than other treatment options and is not covered by insurance carriers.
If you are interested in any of these treatment options for your orthopedic condition, please contact our office. An appointment can be made, and an estimate for the costs of the various treatments can be provided.