Do Orthobiologic Treatments Work?

We’ve seen growing interest in orthobiologic treatments in recent years. In many cases, the chance for relief from joint pain, and even the ‘promise’ of a ‘cure’ for osteoarthritis has led many to explore these injectable remedy routes. But do they work? Jim Newman looks at the latest information.

It’s fair to say there’s a lot of quackery surrounding injectable orthobiologic treatments. For patients in pain, it’s extremely easy to be tempted by glossy web pages that make big promises. Unfortunately, despite the marketing noise and celebrity testimonials, this is an area that currently promises more than the evidence suggests it can deliver – especially in relation to osteoarthritis.

What are injectable orthobiologic treatments?

There are a few types. Let’s focus on one of those – platelet rich plasma (PRP). Your own blood is taken for a spin in a centrifuge, which breaks it down into its component parts. One of these is PRP. Platelets contain lots of anti-inflammatories and chemical messengers. According to some of the more spurious marketing out there, when you inject them back into your knee (or any other joint) you can cure your osteoarthritis.

You can’t. PRP can’t do that.

> Discover more about osteoarthritis, symptoms & treatments

Can PRP be effective?

To be clear, PRP is used to a small degree in the NHS. Of all the numerous orthobiologic treatments, PRP is the one that’s been around longer, so it’s had time to be subjected to some scrutiny. There is some evidence to suggest it may be effective in alleviating pain, although there’s not been enough research yet to clearly understand how well it works or for how long. There does seem to be some potential for it have positive effects in treating, for example, certain forms of tendinitis.

But it can’t cure osteoarthritis.

When you think about, that makes perfect sense. Arthritis is a degenerative, mechanical condition. It’s the wearing away of cartilage to leave bone on bone. PRP can’t regrow cartilage, although it may be able to reduce some of the inflammatory effects and therefore reduce pain.

In a recent statement, the British Orthopaedic Association (BOA) concluded: “Overall, there is no evidence that PRP can restore cartilage or slow progression of OA.”

> Discover more about tendinitis & overuse injuries
> Discover more about osteoarthritis, symptoms & treatments

Are other treatments effective?

If PRP may have some potential benefit in some areas (although not in terms of fixing or slowing osteoarthritis), things are even less clear for other orthobiologic treatments. From Bone Marrow Aspirate Concentrate and Stromal Vascular Fraction to Microfragmented Adipose Tissue, studies are often conflicting, low quality or inconclusive.

You can find more about these in the BOA statement.

In many ways, the uncertainty is hugely frustrating. There’s a large pool of younger patients who are starting to struggle with osteoarthritis for whom knee replacement (and certainly total knee replacement) may not be a viable option for some years. An orthobiologic with the proven ability to reduce pain and inflammation for the long term really would be game changing. But we’re not there yet.

So if you’re suffering from chronic knee pain, don’t trust an unproven injection. See a consultant. Get an MRI scan. And get their specialist opinion. It’ll lead to a better outcome in the long term.

> Find out more about Jim Newman
> Discover more about osteoarthritis, symptoms & treatments
> Discover more about tendinitis & overuse injuries