Orthopedic Update

By Phillip Steele, MD RMSK CAQ Sports Medicine
Performance Injury Care & Sports Medicine

I was recently asked to speak at an Orthopedic UpDate Medical Conference near Pittsburg, home Steeler’s football. Some interesting trends are emerging in biologics to treat osteoarthritis as well as surgical management. I thought I would share some of what I learned and pass on to you changes for the future.

Biologic & Regenerative therapy is continuing to benefit from many studies and better understanding of the reparative process, but the following was emphasized for improving outcomes from so called “stem cell” type procedures. The major factor is optimizing your potential for recovery by nutritional support focusing on real food. I spoke with the author of a great presentation about her recommendations and I hope we will have a quality outline for foods to both focus on and avoid to maximize your healing potential in the near future. A brief summary is low sugar diet as sugar does cause inflammation to the joints and tissues. You should also focus on a low anti-inflammatory diet. Omega 3, Vitamin D and zinc were also highly recommended.

In terms of Regenerative therapy or what is marketed as Stem cell therapy, a lot of discussion was around the importance of the other cells needed to make everything work. Simply put, stem cells need scaffolding (structural support/matrix) to work with. If you inject just stem cell into a joint without scaffolding cells you will not get the results you need. The best example of this is using umbilical cord stem cell (UCB) injection that many so called stem cell clinics offer. First of all, UCB is processed and the structural cells are for the most part removed. Although, you will have some mesenchymal stem cells and growth factors in UCB, the structural elements must be added back to help create a scaffolding matrix for new growth to occur. By adding platelet rich plasma or adipose tissue grafting you can create the optimal environment for regeneration of tissue. Simply, just injecting stem cells into a tissue may not guarantee a good result.

From a surgical prospective many new procedures are using growth factors, platelets and bone marrow to help improve surgical success. Robotic joint replacement is the wave of the future with better results and less complications. A recent study showed that without computer assisted positioning 50% of joint replacement failed to make proper alignment. Picking your surgeon carefully is therefore important as most hospitals in Montana cannot afford the investment in this newer technology. With lower and lower reimbursement for joint replacement surgery by Medicare this technology may not show up anytime soon.

Now the meniscus surgery update. More and more evidence is being presented that we are over utilizing surgery for degenerative meniscus tears. Micro fracture technique for osteochondral tears is not effective and tends to break down only after one year. Recommendations are moving towards biological treatments that have superior results. A newer procedure, they grind up (like a fancy coffee grinder) the torn tissue and re-implant it with a fibrin glue allowing the tissue to grow back.

Finally the key to the “core strength” may lie through the foot. In the setting of chronic joint pain of the shoulder and hip, a strong core is required. More and more evidence is showing that to resolve shoulder and hip pain you have to have a strong core. And with other studies showing a strong core requires a strong foot. Somehow the old song “the knee bone is connected to the …. foot bone’ is in reality connected to the shoulder bone. The kicker (no pun intended) is that if you have medial arch collapse of your foot (pronation) then you will weaken your core and increase knee, hip and shoulder issues.

So consider buying stability or anti-pronation shoes and a high quality off the shelf orthotics. Most studies have shown that custom foot orthotics are not any better than the good over-the-counter orthotics available today. You can stop by our clinic and check out what we believe is the best over the counter orthotic support on the market.