Biologic therapy Gilbert means care made from your blood, marrow, or fat

Blood, marrow, and fat make different treatments

PRP is blood taken from your arm and spun in a machine. The spin keeps a part with more small blood pieces called platelets. It's placed near the sore joint, hoping to ease soreness. Concentrated PRP has still more platelets, but that doesn't ensure more relief.

BMAC uses pelvic marrow, which is taken and spun before use. A fat-based choice starts with fat taken from your body. Both require more than the arm draw used for PRP. Ask what they'll take, how they'll prepare it, and where it'll go.

A harder treatment isn't always a better treatment

Taking marrow or fat may bring more soreness and recovery time. Studies haven't shown that these harder procedures always help more than PRP. Some people notice little change after any of these treatments. A clinic can't know beforehand how much relief you'll feel.

Ask, “Will you take blood, marrow, or fat from me?” Then ask where that material will be placed. You'll need the full cost and expected return visits too. Those answers let you compare the actual treatments.

Easier days may settle a tired joint

For a few days, ease back from the movement that set off soreness. Gentle movement may feel better than sitting still all day. Heat or ice can help when either feels comfortable. Don't change medicine without asking your doctor.

Notice which movement brings the ache back. Check whether rest lowers swelling and helps normal movement return. A few notes are enough. They'll make a later exam easier.

Returning soreness is worth an exam

A visit makes sense when soreness keeps changing your usual day. Bring any old X-ray and your medicine list. The clinician will check the joint, then explain the likely cause. There's no need to choose a treatment during that talk.

Ask what the treatment uses, what it may cost, and who gives it. Ask how many visits and recovery days may follow. QC Kinetix has medical providers, meaning clinicians who'll examine you, and offers non-surgical regenerative treatments such as PRP made from your spun blood at the Chandler clinic.

Sources

1. The largest head-to-head trial of cell-based orthobiologics to date randomised 480 patients with KL II-IV knee OA across four arms: autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, allogeneic umbilical cord tissue-derived MSCs, and a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another or to the corticosteroid control on either co-primary endpoint (VAS pain, KOOS pain), and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events were reported.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nature Medicine, 2023. DOI: 10.1038/s41591-023-02632-w.

2. A meta-analysis of 27 Level I studies (1,042 PRP, 226 BMAC, 1,128 HA patients) found significantly better post-injection WOMAC, VAS and subjective IKDC scores for BOTH PRP and BMAC compared with hyaluronic acid - and NO significant difference between PRP and BMAC on any outcome score. This is the clearest published statement that the two most-marketed orthobiologics perform the same as each other in the knee.

   Belk JW, et al. — Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis.. Arthroscopy, 2023. DOI: 10.1016/j.arthro.2023.03.001.

3. A randomized trial allocated 175 patients with KL II-IV knee OA to BMAC (n=111), PRP (n=34) or hyaluronic acid (n=30) and followed them for 12 months. All three produced significant improvement from baseline in WOMAC, KOOS and IKDC with no serious side effects; BMAC showed significantly better clinical improvement than PRP and HA on most scores, and PRP scored higher than HA without reaching statistical significance. Note the unequal, non-blinded design - this is the strongest direct BMAC-versus-PRP randomized comparison available, and it is not a strong design.

   Dulic O, et al. — Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis.. Medicina (Kaunas), 2021. DOI: 10.3390/medicina57111193.

4. In a within-patient placebo-controlled trial, 25 people with BILATERAL knee osteoarthritis received bone marrow aspirate concentrate in one knee and saline in the other, acting as their own controls. Pain scores fell significantly from baseline in BOTH knees at 1 week, 3 months and 6 months, and the relief - described by the authors as dramatic - did not differ significantly between the BMAC knee and the saline knee.

   Shapiro SA, et al. — A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis.. American Journal of Sports Medicine, 2017. DOI: 10.1177/0363546516662455.

5. FDA's July 2020 final guidance 'Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use' is the document that decides whether a given orthobiologic can be used without a licence: an HCT/P may be regulated solely under section 361 only if it is minimally manipulated AND intended for homologous use, among other criteria; otherwise it is a drug or biological product requiring an approved licence or an active investigational new drug application.

   U.S. Food and Drug Administration — Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use - Guidance for Industry and Food and Drug Administration Staff. FDA Guidance Document, 2020.