Regenerative Medicine in Orthopaedics
By MELANIE KILGORE-HILL
Experts Weigh in on Stem Cells, PRP as Game Changers
Few areas show more promise of completely revolutionizing healthcare than regenerative medicine, the process of creating living, functional tissues to repair or replace damaged tissue or organ function. There's no shortage of expertise in Middle Tennessee's orthopaedic and sports medicine sector where a number of surgeons and researchers are utilizing the technology and moving the science forward.
Orthopaedic surgeon Gregg Motz, MD, of Hughston Clinic Orthopaedics located at TriStar Hendersonville, treats patients with stem cells and platelet rich plasma injections - the two most common forms of regenerative medicine.
Most injections given at the practice are for arthritic knees, acute sprains or tendonitis, and are often given in conjunction with surgery. While the therapy is proving successful, its estimated cost of $800-$5,000 per injection isn't covered by insurance, leaving both patient and surgeon to weigh the pros and cons.
"Most patients are trying the traditional orthopaedic treatments of steroid injection, arthroscopy and/or physical therapy first due to insurance coverage of those issues and the expense of stem cells," Motz said. "If those treatments don't alleviate the problem, patients are frequently choosing stem cell treatment prior to considering knee replacement. We are also looking at using stem cells along with surgery in certain cases in order to try to improve outcomes."
On average, patients who undergo stem cell injections report a 90 percent improvement in pain symptoms. But there's still a bit of mystery into exactly how injections work. "We speculate to some degree as to what occurs," Motz said. "What stem cells are most likely doing are communicating with your cells in the joint and activating them to heal the surrounding area themselves."
Dr. Ethan Kellum
Today, stem cells are derived from multiple sources including bone marrow or fat from the patient. Amniotic, placental and umbilical tissues from live births are also common sources, as are tissue banks. Orthopaedic surgeon Ethan Kellum, MD, of Nashville Regenerative Orthopedics, has injected thousands of patients in his four years post-fellowship.
For most of Kellum's patients, the protocol is a series of injections that happen over a week. These injections include a pre-injection, the same-day stem cell extraction and reinjection procedure, followed by a post-injection of multiple proprietary platelet mixes a few days later. "When I got out of fellowship, I saw how often this therapy kept patients out of the OR," said Kellum, former assistant team physician with the NBA's Boston Celtics.
Today, his Franklin practice is 90 percent regenerative medicine, sometimes in combination with surgery. The two main categories within regenerative medicine are stem cells and growth factors, which include platelet rich plasma. While he uses both, Kellum prefers stem cells for patients with soft tissue, joint or arthritis damage. "Everyone's different, and you really have to evaluate the patient and understand what's going on and what their goals are," said Kellum, who finds that stem cells yield similar results as PRP but produce longer lasting effects.
Patients at Nashville Regenerative Orthopedics typically receive stem cells from their own bone marrow, proven to be more effective than fat cells. Kellum urges patients to ask questions and really understand the product they're receiving. "Sometimes patients think they're getting stem cells but are really getting a growth factor or amniotic product off the shelf, and some providers think they're giving stem cells when they're really giving growth factors," he said. "There's a lot of misinformation out there among patients and providers."
Dr. Christian Anderson
Christian Anderson, MD, a sports medicine surgeon with Tennessee Orthopaedic Alliance, said PRP is more affordable than stem cell injections and more effective long-term than traditional steroid injections, which have a rapid onset but equally rapid offset. Platelet rich plasma is a protein derived from a patient's own blood. Platelets contain special substances called growth factors that play a critical role in the body's natural healing processes, stimulating the repair and replacement of damaged tissues with new, healthy tissue. Because PRP comes from an individual's own blood, there's not a risk of rejection or allergic reaction.
While outcomes speak for themselves, Anderson said the relative newness of regenerative medicine, or orthobiologics, is still causing trouble. "There's no consensus on terminology or the definition of stem cells, and they tend to the lumped into the same category as PRP," he explained. "In reality, most 'stem cell' treatments are better defined as 'cell concentrates,' which unfortunately only contain small fractions of actual stem cells."
To that end, the American Academy of Orthopaedic Surgeons has assembled a task force to better define terminology used in regenerative medicine. Regardless of their findings, all three surgeons agree that the field is completely changing the trajectory of orthopaedics. "Regenerative medicine has opened up a whole area of medicine totally unavailable before and has so much potential to cure diseases like arthritis," Anderson said. "Researches spend billions a year looking for cures, and hopefully regenerative medicine can move us closer to that goal."