Orthobiologics belong to a relatively new branch of medicine called Regenerative Medicine. They are therapies developed from natural (biologic) substances, including cells and tissues, nucleic acids, proteins and sugars.
Orthobiologics are promoted as a way to relieve pain and promote healing, either after an injury or post-surgery. However, while the concept is a good one and we understand why people are attracted to the idea of Regenerative Medicine, there is currently a lack of solid scientific evidence for the claims made about this form of treatment. Neither NICE nor medical insurance companies currently support the concept of using orthobiologics in orthopaedics, so patients who wish to go this route often need to self-fund their treatment.
Our advice is to avoid spending money on orthobiologic treatments until there is an evidence base to show that they provide clear benefits over longer established treatment.
What are orthobiologic/steroid alternative treatments and how are they marketed?
Biologics are taken from human and animal sources along with micro-organisms. Treatments that are marketed for use in orthopaedics are referred to as “orthobiologics”. Examples of orthobiologic treatments for conditions like arthritis and tendinitis include:
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Platelet-rich plasma – This treatment uses an injection of plasma containing a high concentration of platelets derived from a sample of the patient’s own blood. Platelets contain proteins called growth factors which play an important role in healing. Sadly, although this does not seem to be a harmful treatment, rigorous scientific and clinical evidence for the effectiveness of PRP treatments is patchy.
- Stem cell treatments – Stem cells are the building blocks of all cells, able to transform into whatever cells your body needs and reproduce indefinitely. The idea of stem cell treatment is that it could be used to regenerate damaged tissues, such as joint cartilage (for example, in osteoarthritis). Stem cells may be taken from human embryos (although this poses many ethical questions), adult stem cells (which are present in small numbers in adult tissues) and lab-grown adult stem cells called mesenchymal stem cells.
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Viscosupplementation – This is marketed as a treatment for knee osteoarthritis. It involves injecting hyaluronic acid into the knee joint. Hyaluronic acid is a naturally occurring component of synovial fluid which lubricates your joints. The idea behind viscosupplementation is that it will relieve pain and support better movement of the knee. Sadly, however, recent research does not support these claims and only some people who receive this treatment report any benefits. Because it has not been shown to be better than other more established treatments, and some patients experience a significant reaction to the hyaluronic acid substance, NICE does not recommend their use.
Why it’s important to be cautious
When you are experiencing pain and loss of function, it is natural to want to try any type of treatment that might help. However, the lack of solid scientific evidence for orthobiologics coupled with the fact that patients have to fund these treatments themselves as they are not approved by NICE, means it is important to be cautious. In the case of stem cell treatment, for example, there is almost no evidence that an injected stem cell can survive long enough to multiply and create healthy new tissue in the body. Instead, it may signal to the body’s own stem cells to create new tissue so it is these cells that are actually doing the work. Despite many decades of research, we have yet to see definitive and consistent evidence that stem cells are an effective treatment for orthopaedic conditions. It is important to bear this in mind, and to carefully weigh up any risks, before embarking on this type of treatment.
Proven treatments for tendinitis and arthritis
If you are experiencing joint pain or loss of function, our advice is to contact a reputable specialist clinician who can advise on the range of proven treatments available. Very often, understanding your diagnosis and what can aggravate your condition, giving enough time for natural resolution, and working with a physiotherapist will be the best option. For some, depending on your particular condition and its severity, other options include injections of steroids into the affected joint, nerve decompression surgery, keyhole shoulder surgery or joint replacement.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
