Biologic therapy includes innovative treatments that enhance the body’s natural capacity to heal. It is a type of regenerative medicine that uses various technologies to harvest the natural healing resources of the body such as stem cells, platelets and growth factors and targets their activity towards areas that need healing. These regenerative substances are present in various tissues and are usually obtained from the bone marrow, blood and fat. Biologic therapy is used to treat various medical and orthopedic ailments. It enhances the body’s ability to heal injuries including broken bones, and injured muscle, tendon, and ligaments. It can slow down degeneration, reduce pain, improve movement and delay the need for surgery.
Biologic therapy is an emerging field with a tremendous potential for growth and new applications.
In order for joints to move smoothly they must contain an adequate amount of synovial fluid, which acts as a lubricant and shock absorber. Osteoarthritis causes synovial fluid to lose its properties by depletion of a component called hyaluronan. This leads to loss of cartilage and painful rubbing of the bones in the joints. A gel-like form of hyaluronan called hyaluronates or hyaluronic acid may be prepared and injected into the joints to increase their lubricating and shock-absorbing properties. Hyaluronate injections can relieve pain, improve mobility and delay the need for surgery.
Hyaluronate injections are usually performed after other non-surgical treatments for osteoarthritis such as medications, physical therapy and steroid injections have failed.
The procedure, also called Viscosupplementation, first involves removal of any excess joint fluid with a syringe. Hyaluronates are then injected into the joint. Immediately following the injection, you may experience pain, swelling and warmth, which can be eased by ice applications. Avoid weight-bearing or strenuous activity involving the joint for the next 48 hours. The pain and swelling from osteoarthritis is gradually relieved with effects lasting for several months. A single dose or a total of 3 separate doses over several weeks may be required for optimum benefits.
Complications are rare but occasionally an allergic reaction may develop, intensifying symptoms.
Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.
PRP is a relatively new method of treatment for several orthopedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.
Your doctor will first draw about 10 cc of blood from the large vein in your elbow. The blood is then spun in a centrifuge machine for about 10 to 15 minutes to separate the platelets from the remaining blood components.
The injured part of your body is then anesthetized with a local anesthetic. The platelet-rich portion of your blood is then injected into your affected area. In some cases, your doctor may use ultrasound guidance for proper needle placement.
- It is normal to feel some discomfort at the injection site for a few days after your procedure.
- You will be prescribed pain medications by your doctor.
- You may use cold compresses to alleviate your symptoms.
- You will be instructed to stop any anti-inflammatory medications.
- You may resume your normal activities but should avoid any strenuous activities such as heavy lifting or exercises.
Risks and complications
There are very minimal risks associated with PRP injections. Some of the potential risks include
- Increased pain at the injection site
- Damage to adjacent nerves or tissues
- Formation of scar tissue
- Calcification at the injection site
Stem Cell Therapy
Stem cell therapy is a form of regenerative medicine that utilizes the body’s natural healing mechanism to treat various conditions.
Stem cells 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.
Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes the necessary amounts of stem cells are not present at the injured area. The goal of stem cell therapy is to amplify the natural repair system of the patient’s body by increasing the numbers of stem cells at injury sites.
Types of Stem Cells
There are two major types of stem cells: embryonic stem cells and adult stem cells. Embryonic stem cells (ESCs) are stem cells derived from human embryos. They are pluripotent, which means they can develop into almost any of the various cell types of the body.
As the embryo develops and forms a baby, stem cells 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 and cells. These are called adult stem cells or somatic stem cells. Like embryonic stem cells, adult stem cells can also turn into more than one cell type, but their differentiation is restricted to a limited number of cell types.
Use of Stem Cells in Orthopedics
The unique self-regeneration and differentiating ability of embryonic stem cells can be used in regenerative medicine. These stem cells 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 stem cells can be harvested from many areas in the body. These include adipose tissue (fat), bone marrow and peripheral blood. The mesenchymal stem cell is the most commonly harvested. These can turn into cells that form the musculoskeletal system such as tendons, ligaments, and articular cartilage. To obtain stem cells from the bone marrow, a needle is inserted into the iliac crest of the pelvic bone to extract the stem cells.
Currently, stem cell therapy is used to treat various degenerative conditions of the shoulder, knees, hips, and spine. Stem cells 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 Stem Cell Procedure?
You may be a good candidate for stem cell 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 stem cell procedure is relatively easy and your doctor will give you specific instructions depending on your condition.
Stem Cell procedure
The procedure begins with your doctor extracting stem cells 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 stem cell 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 stem cells 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.
- 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.
- Stem cell therapy is a relatively simple procedure that avoids the complications associated with invasive surgical procedures.
- As stem cell therapy uses the cells derived from your own body it reduces the chances of an immune rejection.
- There is a general lack of data about the long-term effects of stem cell therapy as it is a newer procedure and represents a newer form of treatment.
Risks and complications
Stem cell therapy is generally considered a safe procedure with minimal complications, however, as with any medical procedure, complications can occur. Some risks factors related to stem cell therapy include infection as bacteria, viruses or other pathogens that can cause disease may be introduced 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 stem cells.