Use your body’s power to heal itself
Learn more about orthobiologic treatments at Ohio State
Learn more
If you have been living with pain from an injury, effects of aging, or another reason, you understand the daily strain this can have on your life. Many individuals living with ongoing pain find themselves using medication that addresses the symptoms but doesn’t provide a solution to the problem. That’s why a growing number of people are turning to orthobiologics.
You may have heard of orthobiologics or one of its most common forms, platelet rich plasma (PRP). With many treatment options available to patients today, it’s important to understand when to consider these treatments, what to expect and the myths and facts you should know.
What is orthobiologic treatment?
Orthobiologics, sometimes called regenerative medicine or cell-based therapy, promotes pain relief and restores broken-down tissue by repairing and regenerating human cells and tissues to enable proper function lost due to aging, disease and damage. Orthobiologics uses your body’s naturally occurring cells to treat problems that don’t heal well on their own. Many people choose these regenerative therapies because they’re looking for a more natural way to heal chronic pain or injury.
What conditions benefit from orthobiologics?
Conditions that often benefit from orthobiologics include common orthopedic conditions such as joint pain/arthritis, such as in the hip or knee, or tendinitis in areas such as the hamstring, Achilles tendon and the elbow.
When is orthobiologics appropriate to use for treatment?
Orthobiologics is considered when a patient’s symptoms aren’t improving with standard-of-care treatments, or when the patient and physician decide the problem would best be treated with a more natural approach. It’s also beneficial for people who are looking to go beyond treatment of the pain alone to strengthen the related tendon or joint, for example. Patients are encouraged to speak to their family doctor initially about their concerns, and if orthobiologics is recommended, ask for a referral to an orthopedic or sports medicine physician.
Common forms of orthobiologic treatment
Platelet rich plasma (PRP) was the first major biologic intervention to help the body recover from injury. During this procedure, blood is drawn from the arm, placed in a centrifuge machine to concentrate platelets, and then injected at the problem area. When these platelets are applied to injured tissue, they release growth factors that stimulate tissue repair. By using PRP injections for problems like arthritis, you’re taking the body’s inherent healing potential and applying it in areas that are historically more difficult to treat.
The major steps of PRP injection:
Step 1
Blood is drawn from the patient.
Step 2
Blood is placed in a machine to concentrate platelets.
Step 3
The plasma-rich platelets are drawn.
Step 4
The plasma-rich platelets are injected back into the patient’s problem area.
Bone marrow concentrate (BMC) is another form of orthobiologics. This process is similar to PRP, but rather than a blood draw, it uses a bone marrow aspiration, which involves a thin needle used to remove a small amount of liquid bone marrow. The bone marrow then goes through the same concentration process as PRP.
Microfragmented adipose tissue fat (MFAT) is the third form of orthobiologics and involves harvesting adipose (fat) through mini-liposuction. The adipose is then rinsed with saline to remove cellular debris and passed through a filter to create an injectable product. MFAT preserves several types of cells found in adipose that may be helpful in tissue healing.
How effective are orthobiologic treatments?
At Ohio State, we consider PRP the gold standard of treatment. PRP has been compared head-to-head against both BMC and MFAT for knee osteoarthritis (OA). BMC and MFAT, which are more invasive, have never been proven superior to PRP. From a single PRP injection, patients can see reduced pain, and increased activity levels, and they’re often able to get back to activities they enjoy at a higher level. Patients often see results within two to six weeks following the procedure, and these results are long-lasting, since your body is actively creating new, healthy cells.
If you’re addressing tendinitis or similar issues, PRP is usually needed only once, with benefits lasting up to one year and sometimes longer. For those treating arthritis symptoms, PRP is generally repeated yearly. In some patients who use PRP over several years, we’ve seen positive changes in bone health.
Dr. Baria explains how platelet rich plasma (PRP) helped a patient recover from a shoulder injury.
What are the potential risks of orthobiologics?
Many clinical trials have proven the safety and efficacy of PRP. PRP has been shown to fight bacteria, which further reduces the risk of problems like infection. Bruising and post-injection discomfort is common but short-lived. BMC and MFAT are more invasive. It’s important to do your research and speak to your family doctor to ensure you’re working with an experienced medical practitioner to receive orthobiologics. When performed by a skilled physician, these are generally safe, but anytime invasiveness is increased, the risk to the patient also increases.
What should patients consider prior to undergoing this type of treatment?
If you’re seeking a natural alternative to standard orthopedic treatments and are looking to improve the health of a joint or tendon in addition to improving symptoms, orthobiologics is a good option. At The Ohio State University Wexner Medical Center, we offer treatments for multiple pain generators/areas of the body and continue to research the outcomes and best uses for orthobiologic treatments.
How much do platelet rich plasma and other orthobiologics treatments cost?
It’s important to note that these procedures are not yet covered by insurance and are always out-of-pocket expenses.
How do orthobiologic treatments differ from stem cell treatments?
There are misconceptions that some forms of orthobiologics involve stem cells. In the United States, the use of stems cells is currently approved only for treating certain cancers and disorders of the blood and immune system. Products to treat pain that claim to contain stems cells are illegal and should be avoided.
Many people refer to BMC and MFAT as stem cell procedures, but this is incorrect. There’s a miniscule amount of residual stem cells in these tissues, but this is very different than a true stem cell procedure. Furthermore, many believe that off-the-shelf amniotic or placental injections are stem cells. This also is false. These injections aren’t permitted in the United States, have resulted in significant patient harm, and should be avoided.
The bottom line
Orthobiologics can be a highly effective treatment option to relieve chronic pain or injury and promote healing in the body. Talking to your doctor first and choosing reputable, trained professionals is your most important step to trying it for yourself.
Michael Baria, MD, MBA, specializes in sports medicine at The Ohio State University Wexner Medical Center. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation with The Ohio State University College of Medicine. He serves as director of Orthobiologics and head team physician for The Ohio State University Wrestling.
Whitney Luke, MD, MBOE, specializes in physical medicine and rehabilitation, pain medicine and addiction medicine and serves as medical director of Oncology Rehabilitation at The Ohio State University Wexner Medical Center. She is a clinical associate professor in the Department of Physical Medicine and Rehabilitation with The Ohio State University College of Medicine.
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