Biologic Therapies for Hip Pain

Biologic Therapies for Hip Pain

Whether due to degenerative arthritis or injury, the Agency for Healthcare Research and Quality reports that more than 450,000 total hip replacements are performed in the United States every year.[i]

Even though this is major surgery and requires hospitalization and lengthy rehab, many patients who suffer from chronic hip pain believe they have no other options.

Thanks to the advances in the field of regenerative medicine, they do.

Why Do My Hips Hurt?

Hip degeneration or tissue damage can result in pain, tenderness, “clicking” and reduced range of motion. Pain can be localized in the front, side, or back of the hip.

Hip pain can have many causes, including:

  • Degenerative osteoarthritis. Occurs when the cartilage between the bones of the hip joint begins to break down, usually with age.
  • Tendon tears and tendinosis. Overuse may result in a tear or degeneration of the tendons, the thick bands of tissue that attach the hip bones to neighboring muscles.  
  • Muscle or tendon strains. Often the result of repetitive motions that stretch the muscles, tendons, and ligaments that support the hips.
  • Hip labral tear. The labrum is a ring of cartilage that covers the outside rim of the hip socket. It cushions the joint and helps hold the femur (thighbone) ball within your hip socket. Anyone who makes repetitive twisting movements of the hip joint can develop labral tears.
  • Obesity. Carrying extra weight puts tremendous pressure on the hips and can significantly hasten joint degeneration.
  • In some cases, congenital abnormalities may also cause hip pain, as can previous surgery or trauma.

Using the Body’s Natural Healing Abilities to Treat Hip Pain

For those suffering from chronic hip pain, regenerative biologic therapies are providing new hope for pain relief without major surgery.

Regenerative medicine specialists use the natural healing properties in the patient’s own cells to stimulate healing of damaged tissues, reduce inflammation, and in some cases, promote the growth of new cells.

There are two types of regenerative biologic therapies used in clinical practice to treat orthopedic conditions, including hip pain.

  • Platelet Rich Plasma (PRP): A concentrated solution of platelets derived from the patient’s own blood which contains a significant amount of growth factors and proteins that promote tissue regeneration, decrease inflammation, and encourage blood vessel formation. 
  • Cell-Based Therapies: Cells taken from the patient’s own fat tissue (Microfragmented Adipose Tissue) or bone marrow (Bone Marrow Aspiration Concentrate) which contain adult stem cells that have the unique ability to renew themselves and develop into other cell types which promote tissue healing. These cells control pain, decrease inflammation, and fight infection.

How are these Biologic Therapies Performed?

Biologic therapies are injection procedures. Blood, bone marrow, or fat tissue is collected and processed, and then injected into the injured tissue on the same day. These procedures are performed on an out-patient basis and recovery begins at home within hours of the treatment. There are no large incisions, no lengthy hospitalizations, or rehab stays involved.

Most hip tendon injuries and osteoarthritis respond well to these orthobiologic treatments. Factors such as the degree of injury or degeneration, as well as the patient’s overall health, can impact the final outcomes, but for patients weighing invasive surgery, orthobiologics can provide an option for pain relief and healing without surgery.

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[i] https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/

Dr. Ambach lectures to Physicians and Orthopedic Surgeons on Practical Spine Orthobiologics

Dr. Ambach lectures to Physicians and Orthopedic Surgeons on Practical Spine Orthobiologics

Dr. Mary Ambach lectures to physicians, orthopedic surgeons and other orthopedic practitioners on the use of Platelet Rich Plasma and Stem Cell Therapies for the Spine.

Dr. Ambach is one of the esteemed instructors in this Orthobiologic seminar who taught physicians on how to perform regenerative injections and diagnostic musculoskeletal ultrasound scans.

Dr. Ambach has served as faculty and speaker at regenerative conferences in and outside of the country. She has mentored many doctors all over the world in innovative procedures using cell therapies from our own bodies to heal our own orthopedic injuries.

How can Bone Marrow-derived Cells Treat Disc Disease     

How can Bone Marrow-derived Cells Treat Disc Disease     

The bones of the spine called vertebrae are separated by shock-absorbing discs that act as a cushion. These discs have a strong cartilaginous outer portion and a gel-like inner core. When these discs begin to break down from either age or injury, they can result in disc bulging or what is also known as disc herniation.  The discs can also tear, decrease in height or dry out. These changes in the discs can cause pain and pressure on nearby nerves ( radiculopathy). They can also cause degeneration of nearby facet joints and narrowing of the canal (spinal stenosis).

Degenerative disc disease often occurs as part of the aging process. By age 40, it is estimated that 40 percent of the population will have some degree of degenerative disc disease and by age 80, that percentage doubles.[1]

Symptoms from degenerative disc include neck pain, back pain, muscle spasms or radiating pain to the arms or legs. Pain is typically worse with bending forward or prolonged sitting. 

The current standard treatment for degenerative or herniated discs includes physical therapy, medications, injection therapy, and surgery. These aim to provide symptomatic relief of the pain but most do not improve the pathology or reverse the degenerative process. 

Treatment with Bone marrow-derived cells has introduced a unique approach to alleviate pain and improve function by restoring and repairing tissue injury.

What is Bone Marrow Aspirate Concentrate (BMAC)?

The body’s bone marrow possesses unique properties that help the body heal itself naturally. It contains important therapeutic cells, growth factors and proteins that stimulate the body’s natural ability to improve circulation, decrease inflammation and heal injured tissues. 

It also contains adult stem cells called Mesenchymal stem cells. These stem cells have the special ability to renew themselves and differentiate into bone, tendon, cartilage and muscle cells. These make them an ideal therapy for treating orthopedic injuries such as tendon tears, worn cartilage, and degenerated disc disease. 

Bone marrow-derived cells have been shown to stimulate disc cell proliferation, increase disc support tissue, increase disc hydration, decrease inflammation, and support tissue healing. 

How Effective is BMAC?

A study published by International Orthopedics reported the results of 26 patients suffering from degenerative disc disease and were candidates for major surgery such as spinal fusion or total disc replacement who underwent BMAC therapy to their discs. Three years later, 73% of these patients showed improvement in pain, 70% showed improvement in function, and 75% avoided surgery.[2] 

A systematic review of seven clinical trials with a total of 97 patients and up to 72 months follow-up concluded that treatment with Bone Marrow-derived cells intradiscally showed significant improvement in pain and function with low re-injection or complication rates.

BMAC therapy is a minimally invasive, non-surgical procedure that does not require hospitalization or lengthy rehabilitation. Patients are generally able to begin physical therapy and gradual resumption of their daily activities within a week.

For patients who suffer from chronic low back pain from degenerative disc disease and failed standard conservative therapy, BMAC therapy performed by an experienced regenerative medicine specialist can provide an innovative, non-surgical treatment solution. Schedule a consultation with our renowned regenerative medicine physicians to see if you are a candidate for these therapies before considering spinal surgery. 

Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated hundreds of patients with BMAC and other cell-based treatments for more than three decades. They have published authors and stem cell researchers. Their FDA-compliant facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same-day treatments with the highest level of safety and efficacy.

 [1] https://pubmed.ncbi.nlm.nih.gov/23074480/[1]

[2] https://pubmed.ncbi.nlm.nih.gov/28748380/

[3] https://www.cureus.com/articles/36347-systematic-review-is-intradiscal-injection-of-bone-marrow-concentrate-for-lumbar-disc-degeneration-effective 

Stem Cell Therapy Lecture

Stem Cell Therapy Lecture

Dr. Christopher Rogers was honored to speak at the April 2021 La Jolla Golden Triangle Rotary Club meeting. Topics of the lecture included a history of stem cell therapy in San Diego and an update on FDA-approved clinical trials for knee osteoarthritis.  To see a copy of the lecture, visit the San Diego Orthobiologics Medical Group YouTube channel or view the video linked below!

What is the Master Protease Inhibitor?

What is the Master Protease Inhibitor?

The researchers and scientists of the International Human Genome Project first mapped our full genetic blueprint 18 years ago.[i] Their breakthrough efforts enable numerous advances in how we treat and prevent various diseases and orthopedic conditions.

The Human Genome roadmap allows us to better understand the genes that are associated with certain diseases and how these genes can predispose a person to develop these diseases. It can also help in understanding how genes can be altered to improve disease processes.

In the field of orthopedics, a group of scientists at Stanford University discovered a biological indicator of cartilage degeneration and inflammation in patients with arthritis, disc degeneration, and sciatica.  This molecular complex is called the Fibronectin-Aggrecan Complex or FAC. 

Alpha-2-Macroglobulin (A2M) is a Master Protease Inhibitor

Having identified the FAC molecular complex, the Stanford team recognized how this biomarker could be used in conjunction with a naturally-occurring blood protein called Alpha-2 Macroglobulin or A2M to improve the effectiveness of treatments for degenerative disc disease and joint arthritis. The FAC can be measured to predict which patients will have the best results with A2M therapy. 

A2M inhibits the breakdown of collagen in cartilage and has been scientifically proven to stop the progression of joint cartilage and disc degeneration. It is known as a Master Protease Inhibitor. It inhibits proteases, which are enzymes that breaks down proteins in cartilage.  Much like a levee along a rising river, it “holds back” and prevents damage to tissues.

How A2M therapy Works

A2M therapy is a non-invasive treatment performed on an outpatient basis. After conducting a complete examination, your physician will determine if you are a good candidate for this treatment.  Further imaging studies such as x-ray, ultrasound, or MRI may be necessary to determine the cause of your pain.

The A2M procedure starts with a simple blood draw from the arm. The treatment is autologous, which means the A2M is derived from the patient’s own body. There are no donor products used. The blood is concentrated using an FDA-approved device in our lab.  After numbing the treatment area, the concentrated A2M is injected on the same day.  Digital x-ray or ultrasound guidance will be used to make the treatment comfortable, safe and precise.

Currently, this breakthrough treatment is only being offered by a select number of physicians across the country.  By screening patients for these treatments, regenerative medicine specialists are able to offer targeted A2M treatment to appropriate patients. This gives patients new hope for relief of pain and inflammation due to common orthopedic conditions.

Drs. Christopher Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group are two of just a handful of physicians in San Diego who offer A2M therapy for their patients.  They have found this and other new regenerative medicine therapies valuable for the treatment of pain and inflammation associated with arthritic joints and disc degeneration. 

 

Sources:  

[i] https://www.genome.gov/human-genome-project#:~:text=Beginning%20on%20October%201%2C%201990,is%20the%20Human%20Genome%20Project%3F

https://cytonics.com/

https://sdomg.com/master-protease-inhibitor-a2m/

 

What are Mesenchymal Stem Cells (MSC)?

What are Mesenchymal Stem Cells (MSC)?

Regenerative medicine uses the natural healing capabilities of stem cells to help repair injured tissues. One of the biggest challenges facing practitioners of this exciting new medical subspecialty is helping patients understand that not all stem cells are the same.

The ABC’s of Stem Cells

Stem cells are unique because they have the ability to renew themselves and become different kinds of cells that are needed by the body. In fact, they are the only cells in the body that are capable of generating new cell types.[i] To better understand what kind of stem cells are used for orthopedic conditions, it is helpful to know that there are several different types.

Embryonic stem cells are derived from an embryo that develops from fertilized human eggs in the laboratory. They are used for research purposes only.  There are no FDA approved treatments that use embryonic stem cells.

Stem cells derived from birth tissue products such as umbilical cord blood are approved for use in blood cancers and other blood disorders like sickle cell disease.  However, the stem cells from umbilical cord blood and amniotic fluid are not approved by the US Food and Drug Administration (FDA) for any orthopedic indication. The safety and efficacy of these products have not been tested in orthopedic conditions and the FDA does not permit their use.

Mesenchymal stem cells (MSCs) are a specific type of adult stem cell that have the ability to differentiate into bone, cartilage and muscle cells.[ii]  These stem cells are found in all tissues of our body in limited quantities, but they tend to exist in higher amounts in the bone marrow and adipose tissue (fat).  For orthopedic applications, your physician may obtain these cells from your own (autologous) bone marrow or adipose tissue (fat).  These tissues not only contain mesenchymal stem cells, they also contain other cells that are anti-inflammatory and regenerative. Once these cells are injected, they release hundreds of molecules that decrease inflammation, fight infection and repair injured tissues.

The Body: A Constant Work in Progress

There are more than 37 trillion cells in our body which are constantly dying and being replaced. There are more than 200 types of cells in our body and they each have different lifespans. Platelets live for a week, red blood cells live for about four months, bone and muscle cells live about 25 years, while brain cells can live a lifetime.  

An injury or disease can hasten the death of cells. But often, the wear-and-tear of the natural aging process cause tissues to become damaged.  Stem cell treatments enable regenerative medicine specialists to boost the body’s own natural healing abilities by bringing concentrated doses of these powerful building blocks directly to the site of injured or degenerated joint, cartilage or tissue.

Although regenerative medicine is a relatively new specialty within the field of orthopedics, cell-based treatments have been shown to be an effective non-surgical option for patients who have failed standard treatments or want to avoid surgery. 

By combining the body’s own powerful healing capabilities with the latest in scientific and medical technology, orthopedic stem cell therapies provide lasting pain relief and help patients live their life fully.

Drs. Christopher Rogers and Mary A. Ambach have been providing cellular treatments for orthopedic conditions for more than three decades. Their clinical outcome data reveals that the majority of their patients are satisfied and successfully respond to these orthobiologic therapies which also demonstrate excellent safety.

[i] https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117

[ii] https://www.mayo.edu/research/labs/bone-injury-repair/research/mesenchymal-stem-cell-biology

 

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