What's next for the 'alphabet soup' of biologics in orthopedics?

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Partnerships will be important to helping push regenerative medicine further in orthopedics, Thomas Graham, MD, said.

Dr. Graham, physician in chief at Allentown, Pa.-based Lehigh Valley Orthopedic Institute, spoke with Becker's about his perspective on orthobiologics and how it can grow in the specialty.

Note: This conversation was lightly edited for clarity.

Question: What orthobiologic technologies excite you the most?

Dr. Thomas Graham: Orthobiologics are really one of the tools that we use to treat our patients optimally. There's a list of the biologic adjuvants, and some of them are becoming more tried and true as evidence-based such as PRP. We obviously have a long history in our highly technical specialty of utilizing material, chemical and structural things to enhance bone healing and advance motion recovery. All those things are critically important. They reside right along there with the traditional fixation mechanisms. But things that stimulate bone growth have always been important — both the osteoconductive and osteoinductive. 

The things that I think right now are creating a little bit more of a buzz on the biologic side reside in and around things derived from stem cell lines such as bone marrow aspirates, bone marrow concentrates, the utilization of bone morphogenic protein, mesenchymal cells and anything that has that pluripotential opportunity to accelerate healing. We're all looking for the holy grail of orthopedics, which is some form of articular cartilage replacement.

We take care of the widest possible age range of patients. So all those things in biologics have a role, whether it's bone marrow derived or whether it's fat derived. The good news is we as orthopedists don't walk around with saws and hammers in our hands. We have a lot of people right now that are really advancing some of the most important breakthroughs in some of these more chemically and biologically related fields. Obviously, we have two winners of Nobel Prizes who are orthopedists, and one of them for stem cell work. We should be proud of that. Orthobiologics is an alphabet soup — PRP, Bmcc, VMA, ECM, whatever it is, these biologic adjuvants definitely will have a role. We are committed as a specialty, and also as a very large institute practice to be part of understanding them and dispensing them in a logical, systematic, safe manner.

Q: What does the future of regenerative medicine look like in your specialty? What do you think will push it forward sooner?

TG: I think rigorous science will open our minds to these things. We have a tradition in our specialty of being very tied to metallurgy and polymer science and the mechanics and physics that surround this structural integrity. Whereas biologic adjuvants and some of the orthobiologics have that opportunity to advance us because they would be complementary or supplementary to the good work we do, as long as we don't rely on them too heavily. That's why we need to be scrupulous in our academic rigor with this. But this is a new set of partnerships for us. We're used to talking to the folks who make shiny metal objects. We have to get a facility within our specialty to create those bonds with the folks who were doing basic bench level work and who are working in a completely new set of things. 

I like the term regenerative medicine because if we can find a way to balance our lifespan and our health span, which for us means our active lifestyle. That would be something to which we all should aspire. We can't become complacent because of our success in joint replacement. We should be talking about joint preservation. So those are the kind of mindset changes that those of us who are large and are kind of at the vanguard of things are speaking about. We're not just talking about our joint replacement. We are thinking about prevention of joint injury, preservation of joints and reconstruction of joints, not just replacement.

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