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OAZ Biologics Program

What are Orthobiologics or Biologic treatments?

This includes cells, blood components, growth factors, human donor tissue, and other naturally occurring substances that promote the body’s essential ability to heal and decrease inflammation

Are Biologic treatments safe?

Yes, additionally this is an area with heavy research interest in continuing to expand and provide effective treatment options for patients who qualify for biologic treatments

Dr. Dempsey and Dr. Brautigan only recommend the safest and most effective biologic treatments based on the patient’s unique history and clinical condition

Biologic treatments available at our office

At OAZ Dr. Dempsey and Dr. Brautigan offer biologic treatments to include platelet rich plasma (PRP) and cartilage transplantation for qualified patients

These biologic treatments can be used as a single treatment, to enhance surgical procedures, or as surgical procedures themselves in certain scenarios.

Who is a candidate?

PRP injections:
  • Current research suggests that the best patients to undergo PRP injections fit into three broad categories
    1. Patients with early stage osteoarthritis
    2. Patients with persistent tendon injuries
    3. Patients undergoing surgery related to either early stage osteoarthritis or persistent tendon injuries to enhance the healing process
  • Additionally, they have exhausted all other non-operative treatment strategies including activity modification, physical therapy, corticosteroid injections, bracing but have not fit the criteria for joint replacement or other surgeries
  • PRP injections are not typically recommended for patients with endstage or “bone on bone” arthritis
Cartilage transplantation:
  • Current research suggests that the best candidates are patients less than 45 years of age with limited or focal cartilage damage in an otherwise healthy joint
  • These patients should not have a severely elevated BMI and do not have severe co-morbidities like rheumatoid arthritis or other autoimmune arthritic conditions

What are specific conditions that we recommend biologic treatments for?

After a thorough evaluation by Dr. Dempsey or Dr. Brautigan we typically recommend biologic treatment for:

  • Early stage osteoarthritis or cartilage damage of the knee, hip, shoulder, elbow, or ankle joint
  • Focal or diffuse articular cartilage damage
  • Tendon injuries to include:
    1. Shoulder: Rotator cuff
    2. Elbow: Tennis elbow
    3. Hip: Gluteus medius/minimus tears, proximal or midbody hamstring tears
    4. Knee: Quadriceps tendon, patellar tendon
    5. Lower leg: Achilles tendon, plantar fasciitis
  • Ligament injuries

Biologic injections available at our office

Platelet Rich Plasma (PRP): A patient’s blood is drawn and then placed in a special device called a centrifuge to separate the platelets and growth factors essential for healing the damaged area. These isolated platelets and growth factors are then injected into the damaged area. In certain situations, PRP can be injected into the surgical site to aid in the healing process

Cartilage Transplantation surgical procedures available at our office

These procedures are typically reserved for the knee but there are isolated applications of these surgical procedures in other joints like the shoulder and elbow

Osteochondral Autograft transplantation: This surgery is reserved for patients with relatively small area of cartilage loss. A small area of a patient’s own healthy cartilage and bone is harvested in a non-weightbearing region and transplanted to the area of cartilage loss recreating the cartilage and bone surface

Osteochondral Allograft transplantation: This surgery is reserved for patients with relatively large areas of cartilage loss. Donor cartilage is shaped to fit perfectly into the patient’s area of cartilage loss recreating the cartilage and bone surface

Matrix-Induced Autologous Chondrocyte Implantation: This is a two-stage procedure that requires a diagnostic arthroscopy in the first stage to harvest cartilage from the patient’s knee. These cartilage cells are then grown in a lab where they are later implanted during the second stage surgery.

Meniscus Transplantation: This surgery is reserved for patients who previously had their meniscus removed surgically due to injury and now have persistent knee pain and swelling. A donor size-matched meniscus is arthroscopically sewn in place acting as the new meniscus.

Insurance considerations

Some of these procedures are still considered investigational (experimental) by insurance carriers and may be a self-pay service only.

Non-Operative Management of Osteoarthritis

What is Osteoarthritis (OA)?

Gradual breakdown of articular cartilage within a joint. OA is typically caused by wear and tear and worsens over time. It most often occurs in individuals over the age of 50 but can be present in younger patients. Individuals with OA may experience pain, swelling, stiffness and/or limited range of motion.

How can it be treated non-operatively?

Physical therapy/activity

  • Exercise can increase range of motion and increase muscle strength around the joint potentially decreasing symptoms and providing stability.

Ice

  • Ice can reduce inflammation and swelling of joint while also reducing pain.

Neuromuscular Electric Stimulation (NMES)

  • NMES has been shown to help patients overcome muscle activation deficits
  • Early data suggests relief of pain due to knee osteoarthritis

Bracing

  • The use of a brace can increase stability and increase activity levels.

Oral non-steroidal anti-inflammatory drugs (NSAIDs)

  • Over-the-counter or prescription anti-inflammatory medications can decrease pain, inflammation, and stiffness.     Examples include Advil (Ibuprofen), Aleve (Naproxen), Mobic (Meloxicam), Voltaren (Diclofenac), Celebrex (Celecoxib), etc.

Glucosamine and Chondroitin Sulfate oral supplements

  • Recommended dose: 1500 mg glucosamine, 1200 mg chondroitin sulfate
  • Natural anti-inflammatory for overall joint health, helps reduce catabolic activity
  • Recommend taking if for a short period of time consistently then stopping to see if there is a difference in pain, stiffness, and swelling

Turmeric oral supplement

  • Curcumin is the key ingredient, may reduce pain and stiffness caused by inflammation as an alternative to oral NSAIDs
  • Select brands contain black pepper extract to aid in absorption

Injections

  • Cortisone injection
  • An anti-inflammatory steroid that when injected into the joint provides pain relief and decreases inflammation.
  • Hyaluronic Acid (HA) Injection
  • In joints, synovial fluid fills the space to allow bones to glide smoothly and to provide further shock absorption and protection. A main component of synovial fluid is HA.
  • Often in OA, there is breakdown of HA in the joint.
  • Thus, a supplement in HA increases the lubrication, strength, and protection of synovial fluid which may reduce the symptoms of OA.
  • Platelet-rich plasma (PRP) Injection
  • In a PRP injection, blood containing a high platelet concentration is drawn from the patient and injected into the affected joint. The PRP stimulates healing and reduces pain and stiffness. Insurance may not cover PRP.
  • Stem Cell Treatment
  • Stem cells are obtained through different means, either from the hip, adipose fat or donor cells. Through simple processing, the stem cells are introduced into the affected joint to decrease inflammation, potentially slow cartilage degeneration, and decrease pain.
  • It does not regrow cartilage cells
  • Insurance may not cover stem cells.

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Patient Resources


Platelets Matter - A Patient's Guide to PRP

A medical professional will perform a simple blood draw and transfer it into a platelet concentration system device. A short, simple spin efficiently captures a majority of the platelets into a highly concentrated formula. With this technology, your doctor now has access to the hundreds of thousands of platelets and the growth factors they contain in a very small, rich volume.

Learn More

VISCO-3 Sodium Hyaluronate

What other treatments are available? If you have osteoarthritis, there are several things that you can do that do not involve VISCO-3 Sodium Hyaluronate injections.

Learn More

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Meet Our Team

Dr Ian Dempsey Orthopaedic Associates Sports Medicine Zanesville Ohio

Ian J. Dempsey, M.D.


Arthroscopic Shoulder, ACL Reconstruction, Sports Injuries, Arthroscopic Elbow Procedures, Total Joint Replacements of the Shoulder and Knee and Fracture Care.