Orthobiologics in the treatment of hip disorders

Orthobiologics are biological materials that are intended for the regeneration or healing of bone,cartilage and soft tissues.In this review we discuss the use of orthobiologics for hip disorders providing an update.The orthobiologics included in this article are hyaluronic acid,platelet rich plasma,bone marrow,adipose tissue and expanded mesenchymal stem cells.We explain the concepts and definitions of each orthobiological product,and the literature regarding its use in the hip joint.The paucity of guidelines for the production and characterization of the biological products leads to uneven results across the literature.Each biologic therapy has indications and benefits;however,noteworthy are the characterization of the orthobiologics,the application method and outcome analysis for further improvement of each technique.

Bone marrow-derived products: A classification proposal – bone marrow aspirate, bone marrow aspirate concentrate or hybrid?

Degenerative musculoskeletal disorders are one of the top causes of pain and disability in the adult population.Current available alternatives to mitigate symptoms include conservative treatments such as the administration of pharmacological agents and an educative approach towards lifestyle modification.The use of certain analgesics,such as opiates and corticosteroids,delivers short term results but do not address the etiological source of pain and disability.Also,prolonged use of such medications may cause additional complications.Therefore,the demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as“orthobiologics”.This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair.Bone marrow(BM)aspirate(BMA)and concentrate are well-known orthobiologics used to treat musculoskeletal conditions.Orthobiologics derived from the BM have been discussed in the literature;however,the lack of standardization regarding collection and processing protocols presents a challenge for generalization of study outcomes and determination of efficacy.Since BM-derived orthobiologics have not yet been classified,to our knowledge,this manuscript proposes the ACH classification system,which speaks to BMA(A),BMA and concentrate(C)and hybrid(H),which combines A and C.This classification proposes and describes 8 parameters that are relevant for the quality of biological products.The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used.The ACH classification envisages a necessary contribution to the comprehension of both clinical procedures and research outcomes,ultimately ushering in a standardization of best practice.

Photobiomodulation therapy for osteoarthritis: Mechanisms of action

Photobiomodulation(PBM)is a non-invasive therapeutic modality with demonstrated effects in many fields related to regenerative medicine.In the field of orthopedics,in particular,PBM at various wavelengths has demonstrated the capacity to trigger multiple biological effects associated with protective mechanisms in musculoskeletal tissues.The articles cited in this review show that devices operating close to or within the near infrared range at low intensities can provoke responses which favor the shift in the predominant catabolic microenvironment typically seen in degenerative joint diseases,especially osteoarthritis(OA).These responses include proliferation,differentiation and expression of proteins associated with stable cell cycles.Additionally,PBM can also modulate oxidative stress,inflammation and pain by exerting regulatory effects on immune cells and blocking the transmission of pain through sensory neuron fibers,without adverse events.Collectively,these effects are essential in order to control the progression of OA,which is in part attributed to exacerbated inflammation and degradative enzymatic reactions which gradually contribute to the destruction of joint tissues.PBM may offer medical experts ease of application,financial viability,efficacy and lack of serious adverse events.Therefore,it may prove to be a suitable ally in the management of mild to moderate degrees of OA.This review explores and discusses the principal biological mechanisms of PBM and how the produced effects may contribute to the amelioration of osteoarthritic progression.Literature was reviewed using PubMed and Google Scholar in order to find studies describing the mechanisms of PBM.The investigation included a combination of nomenclature such as:“photobiomodulation”,“phototherapy”,“laser therapy”,“PBM”,“osteoarthritis”,low level light therapy”,“inflammation”and“cartilage”.We considered only articles written in English,with access to the full text.