Desert Orthopaedic Center surgeons and physicians are leaders in the use of cutting-edge orthobiologic treatment. Two types of regenerative treatments frequently used include platelet-rich plasma (PRP) and stem cells derived from bone marrow aspirate concentrate (BMAC).
Platelet-Rich Plasma (PRP)
PRP therapy involves using chemicals and growth factors from your own blood to help stimulate the healing process. It has become a nice option in conservative care before committing to a surgical procedure. We typically perform PRP treatments in the office during a normal office visit. A small amount of blood is drawn from the arm and then spun in a centrifuge. We use a special kit that has all the materials necessary for this process. The process of spinning the blood isolates the platelets and plasma, which contain natural growth factors and healing proteins. After isolating the PRP, we inject the area of concern. This process may lead to healing of cartilage, tendons, and ligaments, given the high concentration of healing factors delivered to the area of injury.
We are currently using PRP to help with the healing of degenerative problems throughout the body. It has been useful in treating tendinitis, arthritis, and other orthopaedic conditions. We typically recommend treatment with PRP when other more traditional modalities have failed to produce a satisfactory improvement and a patient is contemplating surgery. This means physical therapy, stretching, strengthening, activity modification, shoe wear modification, and the use of anti-inflammatories have all failed. This can be offered as a step prior to surgery.
Studies continue to be done using PRP as a treatment agent versus placebo to judge the effectiveness in various conditions. There have been a number of published studies stating that PRP works better than placebo in the treatment of plantar fasciitis, for example. However, insurance companies still consider the use of PRP experimental, and therefore, they will not provide coverage for its use. Thus, in most centers, PRP is a cash service.
Feel free to discuss the appropriate use of PRP with us at your next visit.
Stem cells are immature cells that are currently not specialized and retain the ability to divide. Stem cells in orthopaedics are most commonly found in your bone marrow; although, they can also be derived from adipose tissue (fat). A stem cell maintains the ability to change into a more specialized cell, such as a muscle cell, a bone cell, or a cartilage cell, and thus, it is being heavily studied in orthopaedic research today. Stem cells are felt to contribute to the body’s ability to renew and repair its tissues. For this reason, stem cells are now being harvested from the bone marrow and then injected into the injured area to regenerate the tissue. If we then take this bone marrow aspirate and spin it in a centrifuge, we can concentrate the number of stem cells, greatly increasing the number of cells injected over a simple aspiration. We refer to this process as bone marrow aspirate concentrate (BMAC). Outside the U.S., centers can then take these stem cells and manipulate them by a process that greatly amplifies these stem cells even further to create a “super” concentrate. The FDA, as of 2018, has not allowed for this type of manipulation in the U.S., so we are using BMAC currently if you reside in the U.S.
PRP injections bring growth factors into the region, but stem cells actually bring in new cells that are capable of becoming the injured type of cell and, in this way, may be forming new healthy tissue. Uses in the foot and ankle are many. Most popular is as an adjunct to healing bone in fractures as well as fusion surgery. We have used it to help heal osteochondral defects of the talus where there is a missing piece of cartilage.
The cost of stem cells can be higher and sometimes requires sedation.
It should be noted that further studies are necessary for all biologics, and no guarantee can be made concerning outcomes with these modalities.
There are many studies that show excellent results with the above treatments. Here are a few examples.