Orthobiologics and alternatives to manage joint swelling, pain and cartilage damage.
Platelet Rich Plasma injection therapy (PRP therapy), is a treatment option best known for soft tissue injuries including tendon, muscle and ligaments. It is also used for mild to moderate osteoarthritis.
Platelet rich plasma therapy has been used overseas, particularly in Europe, for many years but only recently has it been used regulalrly in Australia for the treatment of musculoskeletal and orthopaedic conditions.
Some tissues in the body have a poor blood supply or respond poorly to excessive load and ultimately are unable to heal naturally. This reslts in chronic injuries and occurs most often in those who exercise at any level.
The initial treatments for these soft tissue injuries amongst many others are physiotherapy, massage and biomechanical correction.
When these treatments have failed PRP therapy is an option which utilises the healing properties within blood to start and encourage healing in a tissue that is not healing on its own.
Platelets are collected from your blood (plasma). The plasma is spun which separates it into its components and the “platelet rich plasma” layer which also contains white blood cells is collected. This layer is injected into the tissue that is being treated.
Platelets contain special growth factors that when released, allow stem cells within the tissue to switch on and cause new tissue to be synthesised and healing the injured area.
An example is lateral hip pain of gluteal muscle tendinopathy or entheseopathy. If the Gluteal tendon is painful, thickened and not responding to rehabilitation PRP can be injected into the tendon. This will cause tendon cells (tenocytes/fibroblasts) to synthesise new collagen. This strengthens the tendon and promotes healing
Gluteus Medius tendon entheseopathy with progressive partial and full thickness tears (green arrow) .
In this situation progressive pain and loss of function over four years of conservative management. Required surgical tendon repair and PRP injection for pain relief.
Stem cell therapy is when stem cells are injected into damaged tissue in order to treat disease or injury. Many medical scientists and clinicians believe that stem cell treatments have the potential to treat common human diseases and injuries alleviating pain and restoring function.
Stem cells are the building blocks from which all cells that make up an organism come from. Stem cells are “undifferentiated cells” that can differentiate into specialized cells (eg muscle, nerve, cartilage) or divide to produce replicas of themselves.
In the situation of arthritic disease there is progressive damage or loss of the hyaline cartilage lining the hip or knee joint. Stem cell therapy has the potential to replace lost hyaline cartilage by stem cells differentiating in to cartilage.
Stem cell treatment is a new technology. Apart from bone-marow transplantation for blood cancers the mechanism of stem cell action in arthritis both in producing hyaline cartilage and interaction with the arthritic environment leading to long term benefit is not well known and controversial. This is the focus of much International study.
Stem cells most likely act by multiple pathways in a “self tailored response” to the patients unique arthritic environment rather than just potentially replacing damaged cartilage.
One pathway of much interest is the ability of stem cells to decrease inflammation and swelling. Inflammation and swelling is a common first presentation for arthritis it causes pain and loss of function. This is why today those with arthritis are routinely prescriped antinflammatories or NSAIDs.
In orthopeadics mesenchymal stem cells are used. Mesenchymal stem cells are taken from the patients abdominal fat. Mesenchymal stem have already partially differentiated but can divide into a variety of cells which includes cartilage.
Fat (or adipose) mesenchymal cells are similar but not as active as the mesenchymal stem cells which are collected from umbilical cord blood at birth. The umbilical mesenchymal cells are stored incase the newborn baby develops blood cancer during its lifetime and requires a bone-marrow transplant . It is the increased activity of the umbilical stem cells that make them better for treating the blood cancer. As we grow older the adult mesenchymal stem cells become less active.
Coming soon…
The sensation or audible sound of snapping around the hip may be felt during hip movements. There are two types of snapping. “Internal snapping” usually an audible snap, or clunk, when the hip is extended from a flexed position. This is caused by the Psoas (a major hip flexor, in the front of the hip) tendon catching while sliding over the hip joint and then suddenly giving. Typically patients will describe it as their “party trick” until it becomes painful. “External snapping” is often not audible, but is felt by the patient on the side of the hip.
Both forms of snapping may be treated with cortisone injections to try to settle inflammation and swelling, and physiotherapy to try to release tightness in the muscle and tendon. If these treatments are unsuccessful, and the symptoms warrant, then arthroscopic surgery may be performed to lengthen the tendons and prevent further catching. This surgery successfully relieves snapping in the great majority of cases.