Orthobiologics & Its Benefits for Foot & Ankle Surgery

Orthobiologics utilises biological substances made from naturally occurring materials in the body to help the body heal more quickly. It can be used in orthopaedics to stimulate healing for broken bones, injured muscles, tendons and ligaments. 

Biologics in an orthopaedic context refers to substances that are naturally derived and can heal tissues and is different from its usage in rheumatology where it often refers to prescription drugs that contain a component of a living organism. Orthobiologics may also be referred to as regenerative medicine, stem cell therapy or cell-based therapy.

Categories of orthobiologics

Common orthobiologics include platelet-rich plasma, bone marrow concentrate, some fat grafts and birth tissues. There are two main categories that orthobiologics can be broken down into — autologous and allogeneic.

Autologous means the orthobiologic comes from the same person it’s used on. For example, an orthopaedic surgeon may take blood to make platelet-rich plasma and inject it back into an injured tissue of the same patient. 

Allogeneic refers to when the orthobiologic comes from another person, for example, a product derived from birth tissues and used in an adult. Substances such as amniotic fluid or membrane that are rich in hyaluronic acid and unique cells from a healthy donor source can be injected into a patient’s injured tissue to reduce inflammation and promote healing.

Orthobiologics can be segmented into 4 major tissue categories:

1. Blood derived

Platelet-rich plasma made from a patient’s own blood. Concentrated platelets from the blood produce growth factors that can promote healing. Blood derived orthobiologics can also include serums and plasmas that may help muscles heal and inhibit cartilage breakdown. 

2. Stem cell containing products

Stem cell containing biologics work through their stem cell content. Bone marrow aspirate is taken from the back of a patient’s pelvis and used to produce bone marrow aspirate concentrate. This contains growth factors and anti-inflammatory proteins and can promote bone and soft tissue healing.

3. Extra-cellular matrix

Extra-cellular matrix can fill voids in torn tissue so cells can grow on it and repair the damaged area. Examples include fat grafts and birth tissues derived from amniotic or umbilical cords. 

4. Conditioned media

Also known as exosomes, this is a stem cell derived conditioned product that may have the ability to be produced as pharmaceuticals for regenerative medicine and can potentially have their own tissue repair effects. It is not legally or widely available currently. 

Examples of orthobiologics

Orthobiologics is an exciting emergence in orthopaedic surgery and the rise of it is changing orthopaedic treatments for the better.

Let’s take a look at some ways orthologics can be harnessed in daily orthopaedic medical practice in Singapore:

• Bioabsorbable implants can be used to treat hip or knee fractures or joint replacements. 
• Bone grafts can be used in fracture healing.
• Platelet-rich plasma can be injected into rotator cuff tears for it to heal.
• Bone marrow aspirate concentrate can be injected into injured joints to assist in the healing of the cartilage.

Benefits of orthobiologics for foot and ankle surgery

Orthobiologics can be used for their healing effects on skeletal and soft tissue injuries. Foot and ankle surgeons have a number of orthobiologic products available now, such as bone allografts, bone substitutes, growth factors and chondral scaffolds. 

Bone loss can be a challenging aspect of foot and ankle surgery even for an experienced doctor. With new orthobiologic developments in grafting, there is promising evidence for improved pathways. Orthobiologics can also be used in foot and ankle fractures that are taking longer to heal. Instead of opting for surgery, orthobiologics can be used to enhance and accelerate bone injury repair. Since orthobiologics can help the body heal faster, they can be used in sports medicine to treat foot and ankle injuries instead of surgery which can be more invasive with longer recovery times.

As orthobiologics advancements are made, there is a promising future outlook to see invasive surgeries move to less invasive injections since these orthobiologic substances can heal damaged tissue. There are more options available now to help the musculoskeletal system heal with the goal of pain reduction and improved quality of life in patients.

The future of orthopaedic surgery

Dr Gowreeson Thevandran has a keen passion for changing the future of orthopaedic surgery in Singapore. As an experienced orthopaedic surgeon and lower limb specialist for foot and ankle, knee and hip, he is poised to partake in the growth of orthobiologics. 

He has researched the role of orthobiologics in foot and ankle surgery. With an interest in cartilage regeneration and bio-absorbable implants, he also has dedicated an ample amount of time towards biomaterials research into absorbable implant technology in orthopaedic surgery and has originated the use of Magnezix bio-absorbable screws in Singapore and the Asia Pacific region.

Book a consultation to speak with Dr Gowreeson on how his pioneering efforts in orthobiologics may be able to help in your orthopaedic treatments.