The TOBI meeting was held June 12 and 13. Annually, it is the largest gathering of physicians who dedicate their practices to Regenerative Medicine. I have been contributing yearly to the scientific program almost since its inception; and I did so again this year. The evidence I present is based on my having pioneered the integration of clinical practice with outcomes documentation. This year, I focused on the results of an initiative I started four years ago by combining the placement of Bone Marrow Derived Stem Cells and Biologics both into the joint and into the bone adjacent to the joint. In so doing, our team had statistically documented improved outcomes when contrasted to placement of the biologics into the joint alone.
Orthobiologic Options for Patients
Not every patient with arthritis is a candidate for the approach described in the above paragraph. There are inclusion and exclusion criteria and those can only be assessed at the time of an office visit. For those who are not able to undergo the harvest of either bone marrow derived stem cells or adipose derived stem cells, we have several excellent alternatives to help control the discomfort of osteoarthritis and improve functional capacity. I will devote the remainder of this Blog to explaining two of the alternatives.
The term PRP (Platelet Rich Plasma) has become familiar to the public; but patient beware. The generic product has less than a 50% success rate and only after repeated administration. My proprietary approach, not much more costly than the usual and customary fee schedule for the generic PRP, provides a much greater concentration of biologics including growth factors in addition to six times the concentration of the generic PRP option. It is the intervention that I have personally undergone, and I still consider myself a senior athlete.
The second option is that of a growth factor and anti-inflammatory option; that in many cases, will be covered by Medicare and private indemnification. While our proprietary Platelet Rich Plasma is autologous, that it is prepared from your circulating blood but is available on a self-pay basis; the growth factor/anti-inflammatory option is provided by donors. The processing of the acellular product eliminated the risk of disease transfer and it is an excellent starting point for the use of biologics in the treatment of an arthritic joint.
Help for Patients in Pain
Yesterday, I assessed a 56-year old woman for biologic treatment of her left knee arthritic generated pain and altered functional capacity. Four years ago, she had undergone a right Total Knee Replacement followed 18 months thereafter by a revision procedure. That was followed in a year by yet a third surgical attempt to make the right knee pain free and functional and it is still problematic. The history of a failed knee prosthesis is three surgeries in four years. The natural history of a patient with an arthritic joint who undergoes a biologic intervention is a repeat injection in 18 to 36 months should pain recur.
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