2019 is a very exciting time to be involved with molecular science, medicine, and orthopedic surgery. Autologous Orthopedic Immunobiologics (AOI) were originally developed for cartilage injuries in veterinary medicine more than three decades ago. Today, AOI has been translated to orthopedic surgical clinical practice based on key orthopedic surgical concepts. In the following paragraphs, I will detail the mechanisms behind arthritis, and outline the subchondroplasty treatment method offered in our clinic.
Arthritis Is An Adaptive Response To Gravity
Arthritis is bone disease rather than cartilage. In actuality, it is not a disease in the traditional sense, but rather an adaptive response to gravity. When the cartilage can no longer support load cycles, the subchondral bone (bone underneath the cartilage) reacts by remodeling into a stiffer construct (harder joint surface). The newly stiff bone then reflects the load to the opposite side of the joint. Arthritis ensues, and worsening catabolic (break-down) conditions result in joint destruction and chronic patient misery. There is evidence that, if addressed in early stages, this catabolic state may be reversible with appropriate biomechanical and biochemical intervention.
Subchondroplasty Encourages Organic Joint Recovery
Addressing the subchondral bone is a simple office procedure done using a Jamshidi® needle under ultrasound or x-ray. This procedure, known as subchondroplasty (SCP), is performed under local anesthesia and takes less than five minutes. For a visual look at the procedure, refer to Figure 1 below. When performed in conjunction with the appropriate biomechanical program (physical therapy), SCP encourages more rapid bone remodeling and prompter organic joint recovery.
Figure 1. A detailed look at the subchondroplasty treatment offered at Regenerative Medicine Clinic in Wilmington, NC.
Less stiff new bone follows a deliberate alteration in a patient’s biomechanics. This result can be achieved with the help of methods including:
- Re-alignment surgery (high tibial osteotomy)
- Fibulectomy (described by Chinese surgeons)
- Unloader bracing
- Custom heel-wedge orthotics
- Gait training
- Physical therapy
All of these methods encourage a less stiff joint compartment that can resist the load more easily, and elaborated cartilage proteins can ultimately become less stiff as well. Remaining cartilage cells can form a more water-retaining (softer) aggrecan scaffold which contributes to diminishing the impact during walking through better cushioning.
Physical therapy is always appropriate, and most active patients with organic joint disease are candidates for the SCP procedure. SCP adds another dimension to autologous orthopedic biologic procedures that promise to be a future mainstay of cell-based therapy. If you are interested in reading more about clinical results, the Arthroscopy Journal details a trial by Zimmer.
To read about our patient experiences, and schedule a consultation, please visit Am I a Candidate? on our website.