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What are biologics?

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Biologics are substances that enhance or quicken healing in structures, such as bones, ligaments, tendons and muscles. This area of orthopedics involves the use of matrix materials, growth factors, and gene and cell therapies used alone or in conjunction with orthopedic devices.

Matrices are conductive materials used to hold cells needed to facilitate healing. Matrices fill defects and can be man-made or derived from human bone. In autograft cases, bone is culled from the patient – often from the iliac crest – which can cause donor site pain. In allograft procedures, the bone is collected from a donor or cadaver and is then implanted into a patient.

Growth factors are specific proteins found in bone that regulate the healing process and signal stem cells to the site of injury. Synthetic proteins, such as recombinant human bone morphogenetic proteins (rhBMPs) and BMPs, have garnered interest as a mode of accelerating healing and have been studied in the areas of spine and long-bone fractures.

Researchers are also looking to the use of mesenchymal stem cells to spur bone, tissue and cartilage repair. Although these immature cells have the ability to differentiate into a variety of cells, research in rotator cuff repair has indicated that the use of these cells alone may not be enough to enhance healing.

The use of platelet-rich plasma (PRP), or platelet concentrate, has also garnered recent attention as it is thought to multiply the concentration of growth factors. While some researchers have seen promising results using PRP, others researchers have not noted improved bone healing.

Additional information can be found by reading the following website and journal articles:

• Bridwell KH, Anderson PA, Boden SD, Vaccaro AR, et al. What’s new in spine surgery. J Bone Joint Surg Am.2011;93(16):1560-1566.
• Bridwell KH, Anderson PA, Boden SD, Vaccaro AR, et al. What’s new in spine surgery. J Bone Joint Surg Am. 2010;92(10):2017-2028.
• Callaghan JJ, Crowninshield RD, Greenwald AS, Lieberman JR, et al. Symposium: introducing technology into orthopaedic practice. How should it be done? J Bone Joint Surg Am. 2005;87(5):1146-1158.
• http://orthoinfo.aaos.org/topic.cfm?topic=A00525
• Obremskey WT, Marotta JS, Yaszemski MJ, Churchill LR, et al. Symposium. The introduction of biologics in orthopaedics: Issues of cost, commercialism, and ethics. J Bone Joint Surg Am. 2007; 89(7);1641-1649.