How to Manage the Active Patient with Osteoarthritis:: Biological Approaches

Abstract More than 30 million people are estimated to be suffering from osteoarthritis (OA) making OA one of the greatest causes of disability in the United States. Many nonoperative and operative treatment options have been described with varying levels of success. For mild to moderate OA, there is growing interest in identifying biological treatment modalities in an attempt to alter or slow the symptoms and possible progression of the disease. Numerous biologics, including platelet-rich plasma, bone marrow aspirate concentrate and adipose-derived mesenchymal stem cells, have been described as injection options for treatment of OA. To date, few Level I or II studies exist that clearly demonstrate joint preservation properties and the ability to alter the disease course of biologics. In the majority of human studies, biologics have been reported to be safe. Areas that need further research within biologics include optimal indications, preparations, compositions, safety profiles and clinical outcomes of biological therapies. In this chapter we review the evidence of biologics for treatment of osteoarthritis specifically as it pertains to platelet-rich plasma, bone marrow aspirate concentrate and adipose-derived mesenchymal stem cells. We also review statements made by orthopaedic subspecialty groups regarding the use of biologics for OA.