 Orthobiologics and Joint Preservation The biologic treatment of Musculoskeletal injuries and diseases is a relatively new and exciting area of orthopedics. Musculoskeletal injuries and diseases are affected and regulated by your body’s natural healing processes. There is a complex “dance” of cellular and chemical activity that occurs in your body to promote healing and repair of damaged tissues, including muscles, tendons, ligaments, bone, and cartilage. When tissues are damaged or become aged, their reparative mechanisms are often no longer as effective. There are naturally occurring cells in your body that have the capability to differentiate and promote the repair and regeneration of a variety of damaged tissues. These cells produce a variety of chemicals (growth factors and cytokines) that signal other cells to repair, decrease inflammation, and inhibit the breakdown of tissues. These cells are in high concentration in certain parts of your body including adipose (fat) tissue and bone marrow. 
Alternative Treatment Options Most diseases and injuries can be treated by a variety of methods depending on the individual circumstances of the patient. For example, arthritis of the knee might be treated first with modification of activities, weight loss, over the counter anti-inflammatory medications, physical therapy, bracing, corticosteroid injections, and hyalouronic (lubricant) injections. In some cases, knee arthroscopy may be helpful and in the most advanced stage of knee arthritis, total knee replacement is the most reliable method for decreasing pain and improving function. It’s important to weigh the pros and cons of your various treatment options before deciding which approach is best for you. Precautions and Risks The risks related to restorative therapy as practiced in this facility and by our medical professional are very low. There may be some mild discomfort associated with any procedure. However, there is a very small risk of infection whenever aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are exceedingly rare. As orthopedic subspecialists, we use our detailed knowledge of normal anatomy as well as imaging techniques to assure your procedure is done as safely and effectively as possible. You will be given some important pre-procedure and post-procedure instructions that help reduce the risk of complications. Patients with a history of bone marrow disease, cancers of the blood system (leukemia, lymphoma, etc.), and active infections are not normally candidates for this type of cell therapy. Patients with bleeding disorders and other chronic medical problems may not be suitable candidates. Orthopedic Diseases Treated with PRP or FAT A variety of diseases and injuries can be treated with orthobiologic therapy. Orthopedic conditions that have been treated and studied using PRP, AMNIO, and FAT include acute and chronic injuries of muscle, tendon, ligaments, bone, and cartilage. Some specific conditions that can be treated include: Mild to severe osteoarthritis/degenerative arthritis of joints, especially the hip and knee 
Tendon injuries, including partial tears of the rotator cuff of the shoulder 
Back pain related to degenerative disc and facet joint 
PRP A commonly used "orthobiologic" is Platelet Rich Plasma (PRP). This material is usually isolated after a routine blood draw. A centrifuge is used to isolate the portion of your blood that contains a variety of chemicals (growth factors, enzyme inhibitors, and cytokines) that assist the healing processes. It can be used alone, or along with other restorative treatment procedures, to supplement and stimulate healing of damaged or diseased tissues. PRP preparation systems have been designed to produce a plasma solution rich in platelets and proteins. Processes used to concentrate platelets may result in different recovery level of platelets from whole blood, depletion levels of red blood cells, amounts of leukocytes (white blood cells), and different viability and potency platelets. Platelets (Thrombocytes) are the main component of PRPs and play a central role in hemostasis and tissue healing. Platelets are the architects of tissue healing as their presence to an injury site initiates and guides the healing process. When activated, platelets change shape and exhibit stickiness, while increasing their surface area to attach and spread over the injury site. Clot formation then occurs, providing fibrin-based bioscaffold which sustains a healing environment. During the clot formation process, platelets degranulate and release growth factors which participate in and enhance the healing process. In addition to releasing growth factors, platelet degranulation also produces a multitude of bioadhesive proteins and of bioactive factors, such as fibrinogen, fibronectin and vitronectin, which are all critical to the healing process and the recruitment of cells. Plasma contains biological factors and proteins involved in healing, including growth factors. Leukocytes (white blood cells) are responsible primarily for defending the body against infection, but also serve other functions during tissue healing. These cells, when present in suitable concentration, are key players during the initial inflammation phase of tissue healing, protect the body against infection, remove undesired organisms produce antibodies, and/or are involved in allergic response. Leukocytes are nucleated cells and therefore can release growth factors which in turn may be beneficial to the healing process. PRP can be taken safely and rapidly from a small sample of blood at the patient’s point of care. PRP can be used for injured tendons, ligaments, muscles, and joints. Repairs and Relieves Pain from the Following Injuries:
Step 1 Collect the patient's own blood.
Centrifuge the blood. A centrifuge is a device that spins at high speeds. This action physically separates the solid and liquid parts of the blood - red blood cells (erythrocytes), white blood cells (leukocytes), platelets (thrombocytes), and plasma (liquid). Step 3 Process and collect the platelets. Regular blood contains about 200,000 platelets per milliliter, while platelet-rich plasma contains as much as five times that amount. The resulting three to seven milliliters of platelet-rich plasma will be collected in a syringe, to be administered immediately. Step 4 Inject the PRP into the desired site. The final syringe of platelet-rich plasma will contain approximately 1-2 teaspoons of fluid. With the guidance of an ultrasound probe, the PRP will be guided into the proper location, based on the nature of the injury being treated. Expected Results Initial improvement may be seen within a few hours of the PRP injection. However, healing is unique to your injury and your body's recovery. The complete reparative process can take up to 12 weeks. PRP can be used for injured tendons, ligaments, muscles, and joints. Lipogems Microfragmented adipose tissue processed by the LIPOGEMS System is used to provide cushion and support to help the natural healing process by supporting the repair, replacement, reconstruction of damaged or injured tissue. The LIPOGEMS minimally invasive procedure is performed in a physician's office or a surgical setting and can be completed in less than an hour. The fat is first harvested. It's then gently processed and/or cleaned with the LIPOGEMS device and then delivered into areas in the body to promote healing. LIPOGEMS is ideal for patients that have an orthopaedic condition and would like an alternative to a major, invasive surgery; or would like to use it in addition to your surgery to promote faster healing.  Advantages of Lipogems
The goal of restorative therapy is to reduce pain and improve function without the need for surgery. In some cases, the condition being treated is too severe to achieve these goals and other treatments may be necessary. Studies in humans have indicated that the treatments are very safe and low risk. Studies regarding the effectiveness therapy compared to "no treatment" or other accepted treatments are still in the early phases and are complicated by the fact that it is difficult to design good controlled and randomized studies in humans. Furthermore, different investigators often use different techniques and have different definitions of success. Nevertheless, many independent investigators have shown evidence of effectiveness in treating orthopedic injuries and diseases by reducing pain and improving quality of life. Some studies have shown MRI evidence of healing and even regeneration of tissue (including cartilage) that would not have been expected without the treatment. Reported success rates are as high as 70- 90% in some studies. When treatment is successful, pain relief and improvement in function typically begin to occur about 6-12 weeks after treatment. The exact mechanism by which restorative cell therapy may decrease pain and improve function is still in the process of being understood. In this center, we are committed to following the results of our patients using an "outcomes" system that monitors the success rate of the treatments. Pre-Procedure and Protocols/Preparation
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