Orthobiologics in Osteoarthritis

Introduction

The development of osteoarthritis (OA) precipitates an irreversible cascade of degenerative changes affecting the hyaline articular cartilage. It is projected to affect more than 20% of adults in North America and Europe by 2020. The burden of disease of OA on the affected patient population ranges from pain to severe functional limitation. With the increased prevalence of OA in the aging population, more than one-third of adults older than 60 years have radiographic evidence of knee OA. Currently, nonsurgical treatments such as topical or oral nonsteroidal antiinflammatory drugs (NSAIDs), intraarticular steroid injection, or hyaluronic acid (HA) have produced mixed results in pain reduction and functional improvement. These pharmacologic treatments target the catabolic cytokines and inflammatory mediators that are integral to OA’s pathophysiologic process of degrading cartilage, synovium, and bone. Although these treatment modalities have proven to be effective in short-term symptom relief, they have not been shown to stop, prevent, or reverse disease progression. A thorough evaluation of the current literature surrounding the role of biologics in OA will be discussed in the following section, which is included to help the treating physician understand how to appropriately utilize this new treatment option.

The Clinical Challenge

The articular hyaline cartilage is composed of chondrocytes and the extracellar matrix (ECM), which mainly includes type II collagen, proteoglycan, and water. The irreversible loss of type II collagen observed during OA progression is attributed to the absence of vasculature and innervation to its microstructure. There is a need to transcend the current symptom relief treatment modalities and provide opportunities to stop and possibly reverse the OA process. Novel biologic treatment modalities have emerged to provide alternative process in decreasing inflammation and cytokines and possibly reverse the collagen and cell population lost. These new biologic treatment options include platelet-rich plasma (PRP) and stem cells and express potential regenerative properties and antiinflammatory modulating effects.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here