A Targeted Response

The body becomes its own best medicine with a fascinating approach to healing bones, joints and connective tissues

WRITTEN BY Lauren B. Johnson

PHOTOGRAPHS BY (Dr. Demarco) Kit MacAvoy; (knee) PopTika

If you’ve ever marveled at the impossibly swift comeback of a pro athlete after being sidelined by serious injury, then you may have witnessed the power of orthobiologics. While the name sounds complex, the process is fairly straightforward. A doctor removes blood, fat or marrow from a patient’s body and spins these substances down into a concentrate of therapeutic cells. This potent serum then gets injected back into the body at the injury site, sending an instant all-call to the body’s healing mechanisms. “If our bodies could switch on these anti-inflammatory factors as fast as they did at age 21, we might be able to mend on our own, but what we put our bodies through outpaces the process of healing. Orthobiologics can kick-start a rapid recovery,” says Dr. Jay Demarco, a Roper St. Francis Healthcare affiliated orthopaedic surgeon who specializes in this emerging field of musculoskeletal medicine. Here, he explains the ins and outs of this low-risk, high-reward therapy:

Dr. Jay Demarco

HOUSE CALLS (HC): What exactly are orthobiologics?
Dr. Jay Demarco (JD):
Broadly, substances from the human body used to prompt healing for musculoskeletal issues like damaged tendons and arthritic joints. There are four main tissues now under investigation and use. Three come from a patient’s own body: blood, bone marrow and fat. There’s still debate over the safety of the fourth option, placental cells from the amniotic sac or umbilical cord after a baby is born.

HC: Can you explain how orthobiologics are used?
Let’s talk about platelet-rich plasma (PRP). We draw blood in the office, then place it in a centrifuge to separate the red blood cells from the buffy coat, a clear layer packed with platelets and anti-inflammatory factors. Using a syringe, we inject that PRP into the tendon or joint. Those concentrated cells then signal other healing cells to focus on that particular location. It’s like pulling the fire alarm in a building—if there’s a fire department nearby, you’ll get a response.

HC: Do orthobiologics actually lead to healing or simply help a patient feel better?
Unlike cortisone injections, orthobiologics stimulate healing in tendons, which we can prove with MRI and ultrasound. The joint is a different entity, though. While patients experience decreased pain and increased motion in degenerative or arthritic joints, it’s due to decreased inflammation in the lining rather than cartilage improvement. Still, this means they can engage in more therapy, stretching and strengthening to delay joint replacements.

HC: Who’s a good candidate?
Almost anyone. In young athletes, the approach can prevent common problems like patellar tendonitis from progressing to a chronic state that requires surgery. For the middle-aged warrior trying to stay in shape but with degeneration in the shoulder or knee, orthobiologics can instigate a nice response. And it can be helpful to older people that don’t want to undergo surgery.

HC: How have patients responded?
We’ve had about an 80 percent success rate with decreasing knee pain over six months using platelet-rich plasma, and about a 60 percent success rate for shoulder pain. Though it has to be drawn in the operating room, bone marrow concentrate improves arthritic joints in 90 percent of patients. As long as the injections keep working, people can get them as often as they need.

HC: Is this the same as stem cell therapy?
The phrase stem cells shouldn’t be used when talking about orthobiologics. There’s a lot of misinformation out there from regenerative medicine shops that promise stem cells that can grow into whatever your body needs to heal. In the 1990s, Dr. Arnold Caplan figured out how to get stem cells to turn into other types of cells in a petri dish but never how to signal them inside the human body. Aggressive research is now being done to determine how to tell cells to do what we want them to do in the body, but we can’t do that yet. That’s the holy grail.