Biological therapies are treatments using the patient’s own cells for regenerative purposes. We currently use two types of cells:
- Mesenchymal cells; they are undifferentiated cells of embryonic origin, capable of regenerating tissues depending on the place where they settle, i.e. if we put them in muscle, they regenerate muscle, and if we put them in bone, they regenerate bone. They are especially indicated in anoxic environments, i.e. where there is no oxygen, since even in these circumstances they can act. This type of cells are obtained by bone marrow aspirate, normally performed in the iliac crest.
- Platelet-rich plasma; consists of obtaining platelets in the blood by venipuncture, exactly as if we were performing a blood test for any other reason. A variable amount of blood is extracted depending on the need for platelets, normally between 20 and 60 c.c. Once the blood has been obtained, the platelets are separated and concentrated by centrifugation in an airtight vat. This process is carried out at all times avoiding contact of the blood with the ambient air, so that the extraction syringe is transferred from the extraction syringe to the airtight vial, and from there to the infiltration syringe. The concentrations achieved are between 7 and 8.5 times the original number of platelets in the blood. Contrary to what happens with stem or mesenchymal cells, platelets need oxygen to act correctly, so they should not be used in poorly oxygenated environments.
In the case of mesenchymal cells, the process must be performed in the operating room under sedation. Cell extraction is performed by trocar aspiration of the bone marrow from the iliac crest, proceeding immediately to its processing to obtain an adequate concentration of mesenchymal cells. Immediately after collection, the cells are applied to the processes proposed in the surgery, thus avoiding external contamination.
In the case of platelet-rich plasma (P.R.P.), the collection is performed by venipuncture, like any other blood test, and the whole process is performed on an outpatient basis in the office, with a total duration of the process of approximately 40 minutes, due to the time used in the processing of the cells.
Applications of biological therapies
The fundamental applications of both cells are regenerative.
In the case of their use in tissues other than articular cartilage, the therapeutic intention is regenerative, both from the point of view of the formation of new tissue and in the treatment of inflammatory phenomena that occur due to the effect of these cells in modifying the normal histology of the inflamed tissues. Thus, in pure inflammatory problems or associated with partial ruptures, such as shoulder pathology, trochanteritis, fasciitis, etc, they have an absolute indication.
As a palliative treatment they have a clear indication in osteoarthritis. Articular cartilage cannot regenerate, but the use of PRP makes the remaining cartilage remain in better condition and is destroyed more slowly. It also improves the functional characteristics of all other tissues, achieving better lubrication and better nutrition of the treated joints. The cadence of infiltrations in this palliative aspect is at least annual.
In the case of mesenchymal cells, their maximum indication is bone necrosis and pseudoarthrosis or fracture consolidation defects.
Biological therapy with PRP carries no risk, since there can be no reaction or rejection as the cells are from the same organism.
In the case of mesenchymal cells, the only risk they present is that inherent to a sedation or bone puncture, with the possibility of infection – frankly infrequent.