Orthobiologics

Orthobiologics Therapy

Orthobiologics therapy is a form of regenerative medicine that utilizes the body’s natural healing mechanism to treat various conditions.

Orthobiologics are being used in regenerative medicine to renew and repair diseased or damaged tissues and have shown promising results in treatments of various orthopedic, cardiovascular, neuromuscular and autoimmune conditions.

Orthobiologics are present in all of us acting like a repair system for the body. However, with increased age sometimes the optimum amount of Orthobiologics are not delivered to the injured area. The goal of Orthobiologics therapy is to amplify the natural repair system of the patient’s body.

Types of Orthobiologics

There are two major types of Orthobiologics embryonic Orthobiologics and adult Orthobiologics. Embryonic Orthobiologics (ESCs) are Orthobiologics derived from human embryos. They are pluripotent, which means they have the ability to develop into almost any of the various cell types of the body.

As the embryo develops and forms a baby, Orthobiologics are distributed throughout the body where they reside in specific pockets of each tissue, such as the bone marrow and blood. As we age, these cells function to renew old and worn out tissue cells. These are called adult Orthobiologics or somatic Orthobiologics. Like embryonic Orthobiologics, adult Orthobiologics can also replicate into more than one cell type, but their replication is restricted to a limited number of cell types.

Use of Orthobiologics in Orthopedics

The unique self-regeneration and differentiating ability of embryonic Orthobiologics can be used in regenerative medicine. These Orthobiologics can be derived from eggs collected during IVF procedures with informed consent from the patient. However, many questions have been raised on the ethics of destroying a potential human life for the treatment of another.

Adult Orthobiologics are most commonly obtained from the bone marrow, specifically the mesenchymal Orthobiologics, which have the ability to replicate into cells that form the musculoskeletal system such as tendons, ligaments, and articular cartilage. They can be obtained from the iliac crest of the pelvic bone by inserting a needle and extracting the Orthobiologics from the bone marrow.

Currently, Orthobiologics therapy is used to treat various degenerative conditions of the shoulder, knees, hips, and spine. They are also being used in the treatment of various soft tissue (muscle, ligaments and tendons) as well as bone-related injuries.

Who is a Good Candidate for a Orthobiologics Procedure?

You may be a good candidate for Orthobiologics therapy if you have been suffering from joint pain and want to improve your quality of life while avoiding complications related to invasive surgical procedures.

Preparing for the Procedure

It is important that you stop taking any non-steroidal anti-inflammatory drugs (NSAIDs) at least two weeks before your procedure.
Preparing for a Orthobiologics procedure is relatively easy and your doctor will give you specific instructions depending on your condition.

Orthobiologics procedure

The procedure begins with your doctor extracting Orthobiologics from your own bone marrow. Bone marrow is usually aspirated from your hip region. Your doctor will first clean and numb your hip area. A needle is then introduced into an area of your pelvic bone known as the iliac crest. Bone marrow is then aspirated using a special syringe and the sample obtained is sent to the laboratory. In the laboratory, the aspirate is spun in a machine for 10 to 15 minutes and a concentrated Orthobiologics sample is separated.

Your doctor then cleans and numbs your affected area to be treated and then, under the guidance of special x-rays, injects the Orthobiologics into the diseased region. The whole procedure usually takes less than one hour and you may return home on the same day of the procedure.

Post-Procedure Care

You will most likely be able to return to work the next day following your procedure.
You will need to take it easy and avoid any load bearing activities for at least two weeks following your procedure.
You will need to refrain from taking non-steroidal, anti-inflammatory medications (NSAIDS) for a while as this can affect the healing process of your body.

Advantages & Disadvantages

Orthobiologics therapy is a relatively simple procedure that avoids the complications associated with invasive surgical procedures.
As Orthobiologics therapy uses the cells derived from your own body it reduces the chances of an immune rejection.

Disadvantages

The disadvantage of adult Orthobiologics therapy is lack of data about its long-term effects as it is a newer evolving therapy.

Risks and complications

Orthobiologics therapy is generally considered a safe procedure with minimal complications, however, as with any medical procedure, complications can occur.

Some risks factors related to Orthobiologics therapy include infection as the Orthobiologics may become contaminated with bacteria, viruses or other pathogens that may cause disease during the preparation process.

The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected. Rarely, an immune reaction may occur from injected Orthobiologics.

Cell therapy

Treatment for most orthopedic conditions starts with a noninvasive, conservative treatment plan. This can include simple methods such as rest, medication, applying ice or physical therapy. Only when these methods fail to relieve symptoms will your doctor suggest surgery. With surgery, there are potential risks and complications such as bleeding, clot formation and damage to adjacent tissues. cell therapy is an advanced nonsurgical treatment that has the potential to heal tissue without the need for surgery.

Cell therapy are undifferentiated cells that have the unique ability to differentiate into certain types of tissues and self-renew. cell therapy can be of two types, embryonic cell therapy or adult cell therapy. Embryonic cell therapy can differentiate into any cell of the body and adult cell therapy have the ability to differentiate into specific types of cells. The field of orthopedics utilizes adult cell therapy found in bone marrow, amniotic fluid, or fat, called mesenchymal cell therapy, for treatment of many musculoskeletal diseases that have limited therapeutic options.

The benefits of cell therapy over other surgical options include:

No rejection because the cell therapy are taken from your own body
Promotes natural healing of the damaged tissues.
Effective alternative therapy to surgery.
Treats severe injuries and degeneration that cannot be repaired, such as degenerative disc disease.
Is not associated with the potential risks and complications of surgery.

Indications

cell therapy has found its use in many fields of medicine, with particular advantages in orthopedic injuries. cell therapy are found in various areas of the body and are often harvested from bone marrow, fat, or amniotic fluid.

The use of cell therapy for treatment of disease is often referred to as regenerative medicine. cell therapy are most often used for their ability to become specialized cells that help regenerate and repair diseased or damaged tissues. Mesenchymal cell therapy have the ability to differentiate into bone and cartilage cells and can be used to treat a wide variety of orthopedic conditions. Some examples include:

Tendinitis
Tendon tears
Ligament tears
Cartilage damage
Arthritis

Procedure

cell therapy involves the extraction of cell therapy, typically from the bone marrow, fat, or amniotic fluid, and processing of the cells. Once the cell therapy are harvested and processed, they can be implanted to the site of damage. This procedure can be done by either using your own cell therapy (autologous cell therapy) or using cell therapy that have been extracted and processed from amniotic fluid (allogenic cell therapy).

Amniotic Fluid

Amniotic fluid includes a mixture of cell therapy and growth factors and may also include the amniotic membrane. These cells have the ability to develop into various tissue types including cartilage, tendons, nerves, muscle, and bone. These cells also have the ability to promote healing through the multiplication of reparative cells.

When amniotic fluid is obtained for regenerative medicine purposes, it is sent to a lab where it is then processed and cryopreserved. Cryopreservation is the process of cooling the fluid to a low enough temperature such that the healing properties of the cells are maintained. This fluid is then sent to your healthcare provider’s office where it may be used for injection.

The injection of amniotic fluid is performed as an outpatient procedure, within the clinic office setting. The area of injection is cleansed, and the fluid is injected into the area damaged or diseased tissue. The injection is routinely given under the guidance of ultrasound to ensure that the needle is inserted accurately. You may be recommended one or multiple injections to provide the greatest amount of healing.

Autologous cell therapy

Autologous cell therapy are cell therapy extracted from your own tissue/body. For this procedure, you will be required to go to the hospital for a very brief, outpatient procedure. Local (twilight) anesthesia will be administered in the operating room. The cell therapy are then harvested from bone marrow found in the pelvic bone (iliac crest). A narrow needle is inserted into the iliac crest and a sample of bone marrow is extracted. The bone marrow is then centrifuged, and cell therapy are separated and obtained.

Once the cell therapy have been separated from the other components of the bone marrow, the cells are injected into the diseased or injured region of the body. You will then be awakened from the procedure, and typically discharged home in 1-3 hours.

Potential Effects of cell therapy:

Differentiate into tissue specific cells (i.e. cartilage cells or bone cells)
Encourage tissue regeneration
Decrease inflammation
Produce growth factors to enhance the process of healing

Post-procedure Care

Following the treatment, you may experience irritation and mild pain for 24-48 hours. Typically, a day of rest (avoidance of exercise) and cold application to the injection site is all that is needed to reduce mild pain

Risks and Complications

Orthobiologics injection is usually a safe and non-invasive treatment procedure. However, as with most treatment procedures, Orthobiologics injection is rarely associated with certain complications. The risks and complications that could be associated with these injections include:

Increased pain at the injection site
Infection
Tissue damage
Injury to neighboring nerves

Undergoing the procedure under the hands of a skilled medical provider can greatly minimize these risks.

Regenerative Medicine Basics

Regenerative medicine is a scientific and medical discipline which focuses on reining the power of cell therapy and the regenerative capacity of the body in order to restore the functioning of damaged cells, tissues and organs. The goal of regenerative medicine is to find the path to cure previously untreated injuries and diseases.

Cell therapy are present in all of us acting like a repair system for the body. However, with increased age sometimes we don’t get optimum cell therapy to the injured area. Regenerative medicine functions to amplify the natural repair system of the patient’s body.

To obtain the cell therapy, your doctor administers a local anesthetic to the back of the hip (Posterior superior iliac spine) and takes a small bone marrow sample through a needle. The sampling procedure is called bone marrow aspirate, which is different from bone marrow biopsy and is less painful. Blood is also taken from a vein of the patient’s arm. These sample cells are processed and then re-injected into the area where repair of the damaged tissue is required. Imaging guidance such as real time fluoroscopy or musculoskeletal ultrasound is used along with MRI to plan the location of the injection.

Mesenchymal cell therapy (MSCs) are multipotent cells derived from non-marrow tissues, such as umbilical cord blood, adipose tissue, adult muscle or dental pulp of deciduous baby teeth. The isolated MSCs are also injected on the same day, along with natural growth factors obtained from the blood platelets of the patient. The main objective is to deliver a much greater number of cell therapy to the injured area to restore its function.

Researchers are employing different approaches for creating new pluripotent Orthobiologics lines, such as in vitro fertilization embryos, nuclear transfer, and induced pluripotent stem (iPS). Different government and private organizations are committed to developing new Orthobiologics-based therapies for chronic, debilitating diseases.

Pluripotent cell therapy hold the greatest potential to treat a wide range of diseases but to create new Orthobiologics therapies takes a long time. Before testing pluripotent cell therapy in human disease, researchers must grow the right cell type, ie. differentiation of cell therapy, and then their safety is first tested in animals before moving to human trials.

Regenerative medicine has a great potential to cure injured and impaired tissues. Scientists all over the world are researching ways to rein cell therapy and use them for diagnosing and treating various disease conditions.

Some risks factors are associated with regenerative medicine and include immune reactions from injected cell therapy and also cells may become contaminated with bacteria, viruses or other pathogens that may cause disease. The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected.

In some cases, certain complications such as formation of tumors can be seen as a result of unproven cell therapy.