AAOS Takes the Lead in Biologic Therapies

Stem cells, BMP, PRP and, recently, DNA are collectively known as ‘biologics’ and, for several decades, they have represented the brave new future of orthopedic medicine.

In terms of allograft tissue forms, biologics are a basic element in the surgeon toolbox.

But what about stem cells or PRP or other living tissue implants—even if sourced autologously?

Enter the American Academy of Orthopaedic Surgeons (AAOS) and their new and very useful position statement—“Use of Emerging Biologic Therapies”—regarding the risks and benefits of stem cell and other biologic treatments for musculoskeletal joint conditions.

According to AAOS, the goal of the position statement is to “…reinforce the role of the orthopaedic surgeons in fully informing patients of the risks and benefits of various treatments, including biologics, and securing patient consent before moving forward with a particular modality…orthopaedic surgeons and their affiliated hospitals and clinics/organizations participate in orthopaedic registries and other data collection systems to provide much-needed data on the efficacy of biologic treatments.”

J. Tracy Watson M.D. chair of the AAOS Biologic Implants Committee, took the time to speak with OTW and he had this to say, “Today’s orthopaedic surgeons need to understand that emerging treatment strategies have progressed from an approach based primarily on biomaterials and ‘hardware,’ to a cell and tissue-based approach that includes a thorough understanding of cell-sourcing and bioactive stimuli.”

“This is especially important as many new treatment modalities for osteoarthritis and soft tissue injuries are being advocated. Available cell-based strategies include targeting local cells with use of scaffolds or bioactive factors, transplantation of autogenous connective tissue progenitor cells derived from bone marrow or other tissues, and the use of autologous growth factors obtained from the patient’s own platelets.”

“As ‘hard tissue’ surgeons, most of our training has been procedure and ‘metal’ oriented. This technology didn’t exist when most current practicing orthopaedic surgeons were in their training. Thus you may be getting your information about these technologies from your local product rep or salesperson.”

“While gaining in popularity (especially in the lay press), and providing relief for some patients, surgeons need to understand that these biologic treatments may lack the demonstrated safety and efficacy of many traditional orthopaedic therapeutics that we perform on a routine basic. There is currently a lack of high-level comparative evidence for use of many of these materials. This highlights the need for comparative data in order to determine the effectiveness of just randomly utilizing these adjuvants.”

“We certainly acknowledge that physicians should be able to apply their best medical judgment in the use of these adjuvants.”

“However, surgeons should understand and be comfortable with the science behind these treatment modalities.”

“At this point they can then enlighten their patients and provide accurate and non-conflicted information such that informed consent can be obtained. The surgeons should ask themselves this simple question: ‘Would I perform this procedure on a member of my own family or myself?’ And as Albert Einstein said, ‘If you can't explain it simply, you don't understand it well enough.’”