Orthobiologics in Foot and Ankle Surgery
Orthobiologics in Foot and Ankle Surgery
The premise that the use of autologous or engineered products have the potential to positively influence bony healing after surgery for complex fractures, fractures in high-risk patients or reconstructive arthrodesis is intriguing to orthopaedic surgeons. The morbidity, especially short and long-term pain, associated with harvesting autologous bone graft is a strong motivating factor supporting this interest.When one adds the dual benefits of avoiding donor site morbidity (pain or infection) and potentially increasing bone healing capacity, the economic potential for these new products are astronomical.
The biggest drawback is in the results. The available evidence on autologous PRP, osteoconductive bioceramics, and allograft (demineralized or bulk) does not support the added cost of care.We must avoid a ''tabloid'' mentality and accept sound scientific evidentiary standards before advocating these products. That is not to say that there is no role for these products. Using the paradigm discussed earlier, a judicious combination of these different families of products may be the next step in the evolution of bone injury surgery.
The use of autologous stem cells or growth factors and the use of recombinant upregulating growth factors may be the next step. Another potential application is a temporal application of these products. There is very little information available on the levels of various growth factors as a function of time after injury or surgical intervention. The next step might well be an intervention at surgery followed by a different intervention at some time in the perioperative period that takes advantage of the properties of one of these agents. It is currently too early to assign the winners in this both scientific and commercial contest of upregulating the orthopaedic genome.
Discussion
The premise that the use of autologous or engineered products have the potential to positively influence bony healing after surgery for complex fractures, fractures in high-risk patients or reconstructive arthrodesis is intriguing to orthopaedic surgeons. The morbidity, especially short and long-term pain, associated with harvesting autologous bone graft is a strong motivating factor supporting this interest.When one adds the dual benefits of avoiding donor site morbidity (pain or infection) and potentially increasing bone healing capacity, the economic potential for these new products are astronomical.
The biggest drawback is in the results. The available evidence on autologous PRP, osteoconductive bioceramics, and allograft (demineralized or bulk) does not support the added cost of care.We must avoid a ''tabloid'' mentality and accept sound scientific evidentiary standards before advocating these products. That is not to say that there is no role for these products. Using the paradigm discussed earlier, a judicious combination of these different families of products may be the next step in the evolution of bone injury surgery.
The use of autologous stem cells or growth factors and the use of recombinant upregulating growth factors may be the next step. Another potential application is a temporal application of these products. There is very little information available on the levels of various growth factors as a function of time after injury or surgical intervention. The next step might well be an intervention at surgery followed by a different intervention at some time in the perioperative period that takes advantage of the properties of one of these agents. It is currently too early to assign the winners in this both scientific and commercial contest of upregulating the orthopaedic genome.
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