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Orthobiologics and Joint Preservation
The biologic treatment of Musculoskeletal injuries and diseases is a relatively new and exciting area of orthopedics.
Musculoskeletal injuries and diseases are affected and regulated by your body’s natural healing processes. There is
a complex “dance” of cellular and chemical activity that occurs in your body to promote healing and repair of damaged
tissues, including muscles, tendons, ligaments, bone, and cartilage. When tissues are damaged or become aged, their
reparative mechanisms are often no longer as effective.
There are naturally occurring cells in your body that have the capability to differentiate and promote the repair and
regeneration of a variety of damaged tissues. These cells produce a variety of chemicals (growth factors and cytokines)
that signal other cells to repair, decrease infammation, and inhibit the breakdown of tissues. These cells are in high
concentration in certain parts of your body including adipose (fat) tissue and bone marrow.

Alternative Treatment Options
Most diseases and injuries can be treated by a variety of methods depending on the individual circumstances of the
patient. For example, arthritis of the knee might be treated first with modification of activities, weight loss, over the
counter anti-inflammatory medications, physical therapy, bracing, corticosteroid injections, and hyalouronic (lubricant)
injections. In some cases, knee arthroscopy may be helpful and in the most advanced stage of knee arthritis, total
knee replacement is the most reliable method for decreasing pain and improving function. It’s important to weigh
the pros and cons of your various treatment options before deciding which approach is best for you.

Precautions and Risks
The risks related to restorative therapy as practiced in this facility and by our medical professional are very low. There
may be some mild discomfort associated with any procedure. However, there is a very small risk of infection whenever
aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are
exceedingly rare. As orthopedic subspecialists, we use our detailed knowledge of normal anatomy as well as imaging
techniques to assure your procedure is done as safely and effectively as possible. You will be given some important pre-procedure and post-procedure instructions that help reduce the risk of complications. Patients with a history of bone
marrow disease, cancers of the blood system (leukemia, lymphoma, etc.), and active infections are not normally candidates
for this type of cell therapy. Patients with bleeding disorders and other chronic medical problems may not be suitable candidates.

Goals and Success Rate
The goal of restorative therapy is to reduce pain and improve function without the need for surgery. In some cases, the
condition being treated is too severe to achieve these goals and other treatments may be necessary. Studies in humans
have indicated that the treatments are very safe and low risk. Studies regarding the effectiveness therapy compared to
"no treatment" or other accepted treatments are still in the early phases and are complicated by the fact that it is difficult
to design good controlled and randomized studies in humans. Furthermore, different investigators often use different
techniques and have different definitions of success. Nevertheless, many independent investigators have shown evidence
of effectiveness in treating orthopedic injuries and diseases by reducing pain and improving quality of life. Some studies
have shown MRI evidence of healing and even regeneration of tissue (including cartilage) that would not have been expected
without the treatment. Reported success rates are as high as 70- 90% in some studies. When treatment is successful, pain
relief and improvement in function typically begin to occur about 5-6 weeks after treatment. The exact mechanism by
which restorative cell therapy may decrease pain and improve function is still in the process of being understood. In this
center, we are committed to following the results of our patients using an "outcomes" system that monitors the success
rate of the treatments.

PRP, AMNIO, and FAT
There are numerous past and current studies for applications of PRP, AMNIO, and Fat.

PRP
A commonly used “orthobiologic” is Platelet Rich Plasma (PRP). This material is usually isolated after a routine blood draw. A
centrifuge is used to isolate the portion of your blood that contains a variety of chemicals (growth factors, enzyme inhibitors,
and cytokines) that assist the healing processes. It can be used alone, or along with other restorative treatment procedures,
to supplement and stimulate healing of damaged or diseased tissues. PRP preparation systems have been designed to produce
a plasma solution rich in platelets and proteins. Processes used to concentrate platelets may result in different recovery level
of platelets from whole blood, depletion levels of red blood cells, amounts of leukocytes (white blood cells), and different
viability and potency platelets.
Platelets (Thrombocytes) are the main component of PRPs and play a central role in hemostasis and tissue healing. Platelets
are the architects of tissue healing as their presence to an injury site initiates and guides the healing process. When activated,
platelets change shape and exhibit stickiness, while increasing their surface area to attach and spread over the injury site. Clot
formation then occurs, providing a fibrin-based bioscaffold which sustains a healing environment. During the clot formation
process, platelets degranulate and release growth factors which participate in and enhance the healing process. In addition
to releasing growth factors, platelet degranulation also produces a multitude of bioadhesive proteins and of bioactive factors,
such as fibrinogen, fibronectin and vitronectin, which are all critical to the healing process and the recruitment of cells.
Plasma contains biological factors and proteins involved in healing, including growth factors. Leukocytes (white blood cells)
are responsible primarily for defending the body against infection, but also serve other functions during tissue healing. These
cells, when present in suitable concentration, are key players during the initial inflammation phase of tissue healing, protect
the body against infection, remove undesired organisms produce antibodies, and/or are involved in allergic response.
Leukocytes are nucleated cells and therefore can release growth factors which in turn may be beneficial to the healing process.

PRP can be taken safely and rapidly from a small sample of blood at the patient’s point of care.
Procedure
Step 1
Collect the patient’s own blood.
• Less than two ounces (between 8 to 16 milliliters) are required for the procedure. The collection is virtually identical to
giving blood for a blood test, with a collection needle inserted into a vein in the arm and the blood captured in a small vial.
Step 2
Centrifuge the blood.
• A centrifuge is a device that spins at high speeds. This action physically separates the solid and liquid parts of the blood -
red blood cells (erythrocytes), white blood cells (leukocytes), platelets (thrombocytes), and plasma (liquid).
Step 3
Process and collect the platelets.
• Regular blood contains about 200,000 platelets per milliliter, while platelet-rich plasma contains as much as five times
that amount. The resulting three to seven milliliters of platelet-rich plasma will be collected in a syringe, to be administered
immediately.
Step 4
Inject the PRP into the desired site.
• The final syringe of platelet-rich plasma will contain approximately 1-2 teaspoons of fluid. With the guidance of an
ultrasound probe, the PRP will be guided into the proper location, based on the nature of the injury being treated.

Expected Results
Initial improvement may be seen within a few hours of the PRP injection. However, healing is unique to your
injury and your body’s recovery. The complete reparative process can take up to 12 weeks.

Lipogems
Microfragmented adipose tissue processed by the LIPOGEMS System is used to provide cushion and support to
help the natural healing process by supporting the repair, replacement, reconstruction of damaged or injured
tissue. The LIPOGEMS minimally invasive procedure is performed in a physician’s office or a surgical setting and
can be completed in less than an hour. The fat is first harvested. It’s then gently processed and/or cleaned with
the LIPOGEMS device and then delivered into areas in the body to promote healing.
LIPOGEMS is ideal for patients who would prefer an alternative to a major, invasive surgery; or would like to use it
in addition to your surgery to promote faster healing.

Advantages of Lipogems
• FAT is minimally invasive to harvest
• Most people have a lot of extra FAT
• FAT is the highest quality tissue
• FAT has 100-500 times more reparative cells
than other similar tissue
• FAT provides cushion and support
• For patients that suffer from orthopaedic
conditions in multiple areas of their body,
Fat cells can be delivered to multiple areas
in just one visit
• Research has shown that as a person ages,
their FAT maintains its reparative properties
unlike other similar tissue, such as bone marrow,
which may lose healing capacity with age
• FAT contains many supportive and reparative
cells that help to promote a healing environment
throughout the body

Amniotic Fluid Injections
If you have stubborn pain or a non-healing injury, Amniotic fluid may be right for you and may be used in the first line of
treatment, or in conjunction with other treatments such as PRP injections. Amniotic fluid is a “orthobiologic” that surrounds
a developing baby inside the mother’s womb. It plays a vital role in the fetal development and contains an abundant source
of proteins, cytokines, and growth factors. The fluid is obtained from donations made by mothers during full-term, healthy
caesarean deliveries. Amniotic fluid’s inherent cushioning surrounds and protects your injury, allowing your body time and
space to engage in active healing. Because it is also considered immune privileged, amniotic fluid treatments are unlikely
to produce an inflammatory response, making it a safer alternative than other modalities. Research has also been shown to
illustrate possible secondary benefits of treatment from amniotic fluid.
An amniotic fluid injection can be administered during a standard office visit and requires no preparation or down time.
Amniotic fluid donations are thoroughly tested for potential pathogens through comprehensive laboratory testing and
extensive medical history analysis. Once deemed safe, donated amniotic fluid is aseptically processed and terminally sterilized,
ensuring a clean and safe product for clinical delivery.
Amniotic fluid injections enhance and enable your body to repair itself by recruiting your own cells to do the work. Amniotic
fluid is noted for its abundance of constructive collagens, cytokines and elastins. The injection substance is derived from live
willing donors and does not involve any fetal tissue. In addition, the amniotic fluid material is FDA regulated and processed
in an ISO certified lab, so all major diseases are ruled out.
Human amniotic membrane is derived of the same nutrients and growth factors that facilitate fetal growth, and when injected
AF injections provide a non-steroidal mechanism to alleviate pain by helping repair your tissues and reducing inflammation.
This promotes healing while completely removing cellular material that may cause pain and localize swelling from immune
response.

Benefits of Amniotic Fluid Injections
• Pain-free, nonsurgical
• Easy, convenient procedure that takes less than 10 minutes
• Full of potent nutrients and over 200 different growth factors
• All natural and Drug Free

Expected Results
Initial improvement may be seen within a few hours of the amniotic fluid injection. However, healing is unique to your
injury and your body’s recovery. The complete reparative process can take up to 12 weeks.

Wharton’s Jelly
GeneXStem is a minimally manipulated tissue based product derived from Wharton’s Jelly of the umbilical cord for
homologous use. Wharton’s Jelly has a greater amount of essential regenerative components than other tissue-types,
making it more effective for treatment. Wharton’s Jelly contains an abundance of Cytokines, Growth Factors, High
Molecular weight, Hyaluronic Acid, and Extracellular Matrix.

Advantages of Wharton’s Jelly
• Less invasive when compared to platelet rich plasma (PRP) procedures, and bone marrow aspiration
• Cryopreserved without DSMO, digestive enzymes, or the use of preservative agents
• The immunologically privileged status of Wharton’s Jelly provides the ability to modulate the immunological
responses in the allogenic settings
• Wharton’s Jelly is processed from donated non-embryonic human tissue from full term, c-section deliveries in
accordance with the FDA
• Wharton’s Jelly is processed by using the highest safety measures, which exceed those required by the AATB and FDA

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