Previous advances in orthopedic surgery have centered largely on surgical technique and surgical implants. I should know having dedicated almost 40 years of my orthopedic career to developing the cement-less prosthesis and refining the minimally invasive knee and hip surgical approach. The cement-less movement was the result of a clinical trial in which I was a co-investigator from 1979 to 2004 and the MIS approach was something I popularized in conjunction with a partial knee replacement (See News Releases-Rush University Medical Center April 28, 2000). I still am involved with the Prospective Multicenter Post Approval Study of the LPS-Flex Mobile Bearing Knee. Yet it is my new world, biologics-including platelet-rich-plasma (PRP) and bone marrow aspirate concentrate (stem cells) that is emerging in orthopedic surgery due to their regenerative properties.
From a sports medicine standpoint, biologics are playing an increasing role in treating rotator cuff, meniscal, and cartilage injuries. For example, PRP is a growth factor therapy that is increasingly being used to augment healing after a partial tear of a tendon. My particular clinical practice and integrated clinical research is directed to helping patients with osteoarthritis of large joints manage symptoms, increase motion, and restore functional capacity both in the aging athlete or for those experiencing limitations in activities of daily living.
Stem Cells-cells that are harvested from bone marrow when aspirated and concentrated, have multiple capacities that make them unique. They can reproduce. They can differentiate into different types of cells such as cartilage and bone. They can release growth factors and other cell signaling molecules. As readers of this Blog are aware, I have implemented PRP and Bone Marrow derived stem cells into my clinical practice in the setting of osteoarthritis and I continue to collect data confirming positive results. The anti-inflammatory effect and pain reduction with increase in range of motion and functional capacity are no longer based on anecdote but rather statistically significant numbers. In the next several months, those who underwent stem cell intervention 18 months ago will be asked to complete quantitative MRI evaluation; and I will confirm in addition to all the benefits of stem cells as to how stem cells influence cartilage regeneration in my patients. It will be several years to confirm as to whether the Bone Marrow Concentrate will alter the natural history of the arthritic joint by bio-immune modulation as believed; and I will continue to monitor patients so as to assist an arthritic patient in possibly postponing or avoiding a joint replacement. Of particular interest is the feedback from several patients concerning the fact that their previous orthopedic surgeons are now undergoing training in how to become stem cell providers.