Monday Medical: Biologic supplementation is tool for treating orthopaedic issues
July 4, 2015
While the recreational activities of Steamboat residents keep cardiovascular systems strong, muscles toned and waists slim, there is an associated and accelerated orthopaedic impact seen in greater numbers than other communities.
Steamboat Springs orthopaedic surgeon Andreas Sauerbrey describes these accelerated degenerative processes, which include pain, damage and arthritis in the joints, as a unique concern.
"We are trying to manage younger and younger patients with worn out issues." Sauerbrey said. "There are 50-year-olds here that have the same degenerative process as someone in their seventies would have in a less active community."
Initial steps in managing degenerative processes include weight control, activity changes and nonsteroidal anti-inflammatory drugs. Physical therapy, massage, stretching and cortisone injections are also among early treatments. Many patients however, itching to get back to an active lifestyle without surgery, are seeking more progressive, though less established, options. Among these options is biologic supplementation, or techniques which utilize or mimic the body's own biological healing processes.
"We need alternatives. Some patients are not getting better with cortisone," Sauerbrey said. "There is a push in orthopaedics to manage pain and conditions more naturally — less with cortisone and more with something delivering a biological response."
For orthopaedic surgeons like Sauerbrey, balance is sought in providing cutting-edge treatments, with which many patients find success, while ensuring these costly treatments are both effective and appropriate for the patient.
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Viscosupplementation is one of the most commonly used biologic supplementations and is most often used with osteoarthritis of the knee. Viscosupplementation involves injecting hyaluronic acid, a naturally occurring joint lubricant that helps improve movement. Viscosupplementation injections can be done in just a few minutes, and many patients report reduction in pain. The procedure is often covered by insurance, making it a viable option for many.
Another type of biologic supplementation is platelet rich plasma therapy, or PRP. PRP involves manipulating blood to separate the platelet rich plasma and then administering a concentrated injection using ultrasound guidance.
"Platelets have multiple enzymes and molecules that are released when the platelets are activated to promote a healing response," said Sauerbrey, who has performed hundreds of PRP injenctions since 2007. "They are essentially a turbo charger. They trick the body into thinking that an injury has happened, and healing should occur."
Unlike viscosupplementation, which duplicates naturally occurring biological material in a lab, PRP utilizes a patient's own processed blood. PRP therapy is not covered by insurance and costs approximately $500 per injection. Yet it can also be done in just a few minutes, and many patients report a reduction in pain.
Most recently entering the biologics discussion has been the use of stem cell injections. Stem cells can be extracted from one's own blood or fat, donated from someone else or gathered from amnion (from a placenta). Stem cells are pluripotent, or precursor cells, to many different kinds of cells.
"The concept is that if you take a young cell or a cell that's not reached its final maturation stage that it can mature into a cell that you need, so a tendon cell, a cartilage cell, a ligament cell or a bone cell," Sauerbrey said.
When new cells are created in existing healthy tissue, the thought is they may help repair damaged or injured tissue. Stem cells can be collected and processed in different ways, and these options must be considered when evaluating the effectiveness of the procedure. There is discussion whether 70-year-old stem cells are as potent as 20-year-old stem cells or as potent as the 40-week-old stem cells from amnion. Additionally, some methods of collecting and processing stem cells are regulated differently, both on the state level and between countries. Stem cell injections are not covered by insurance and can cost thousands of dollars.
Overall, Sauerbrey describes biologic supplementation as another tool in the arsenal for patients struggling to find success with traditional methods and encourages discussion with a physician.
"The goal is to continue to open up the biologics industry to Steamboat," he said. "I want people to ask the question, 'what's out there, and what's right for me?' We want to grow the availability of it, but try to do so in a responsible way. There are places that want eight grand and are selling you a miracle. It could be snake oil for all you know. We have to make good decisions about who's going to benefit and who's not."
Information from the American Academy of Orthopaedic Surgeons was used in this article.
Nick Esares is a marketing and communications specialist with Yampa Valley Medical Center