Adam Rivadeneyra, MD, a sports medicine specialist with Irvine, Calif.-based Hoag Orthopedic Institute, spoke to Becker's Spine Review about his predictions for the field of biologics.
Note: Responses were lightly edited for style and clarity.
Question: Which advancements in biologics are the most promising for spine and orthopedics?
Dr. Adam Rivadeneyra: Biologic therapies — and especially "orthobiologics" — are very promising in theory, and becoming more promising in practice/research as well. Platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC or "bone marrow stem cells"), [and] adipose (fat) concentrate "stem cells" have been shown to reduce inflammation and pain for many orthopedic conditions.
Q: Where do you think the field of biologics is headed? What applications do you predict will emerge?
AR: We're all hopeful for ongoing, research-based benefits from orthobiologics. Certain problems like chronic tendon pain, joint pain and cartilage injuries are showing great promise. The ultimate goal is to find a way to actually reverse arthritis and cartilage loss. So far, no research has been able to demonstrate reversal of arthritis. Ideally, being able to re-grow areas of cartilage loss would really benefit the most people. Even better, to potentially prevent cartilage loss and post-traumatic arthritis after surgery would go a long way to help people stay more active, and prevent a lot of knee and hip replacement surgeries.
Q: How receptive are patients to biologics? (I.e., do you get patient requests for biologic treatments? Are there concerns surgeons have to address?)
AR: Patients are interested in learning about it for sure. Our "standard" treatments with steroids and anesthetics can be very harmful to the body and tissues, so we're starting to move away from that a decent amount. Orthobiologic treatments are much less harmful overall. But there's a lot of bad information out there. Patients are being taken advantage of financially and being promised more than can be delivered. Most importantly, patients should have an honest consultation with a physician who has experience in image-guided (ultrasound or fluoroscopy) orthobiologic treatment prior to committing and paying for a procedure. One area to be very careful is with frozen products being marketed as "stem cells" from amniotic fluid, umbilical cord blood, birth membranes, etc. — there are no cells in them! They are all sterile, and they have to be sterile to be sold in the United States. Cost is a big issue as well because most insurance companies don't pay for the procedures. Setting proper expectations is very important for patients and physicians.
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