General Management
Several factors play an important role in the health of your musculoskeletal system, including your joints, cartilage, ligaments, tendons, and muscle. These include:
- Genetics
- Age
- Weight
- Injury (either from one severe injury to a body part or repetitive abuse)
- Alignment
- Nutritional status (including adequate vitamin D intake)
- Smoking
- 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 play a key role in tissue repair and regeneration. These reparative cells have the ability to influence healing by releasing signaling molecules that reduce inflammation, support cell survival, and promote the repair of damaged tissues. Many of these factors are also found in platelet-rich plasma (PRP). In our clinic, we obtain these reparative cells primarily from the patient’s own adipose tissue (fat) using the Lipogems® procedure. This in-office treatment involves a minimally invasive fat harvesting procedure (liposuction), gentle processing of the tissue into microfragmented adipose clusters, and targeted injection into the treatment area. The microfragmented fat is thought to act as a natural source of reparative signals—sometimes described as "cellular factories"—that support healing in joints, tendons, and other soft tissues. Although the exact mechanisms of how these adipose-derived cells and tissues contribute to orthopedic recovery are still being studied, clinical research has shown promising results in improving pain and function. It’s important to note that this technique is more costly than other treatments and is not covered by insurance providers.
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.