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Orthopedics 2.0

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What is Orthopedics 2.0?  In particular, orthopedic s 2.0 doesn’t refer to the discipline of Orthopedic Surgery.  While Orthopedic surgery may well be used as a part of Orthopedics 2.0, Ortho 2.0 has a bigger focus beyond just fixing one part of the musculoskeletal system (bone, joints, muscles, tendon, and ligaments).  Ortho 2.0 represents the shifts from joint replacement or debridement to repair.  When the focus shifts to repair, the amount one needs to know about the joint increases exponentially.  The pyramid above outlines what we use to evaluate a joint, outside of or as part of the Regenexx procedure.  It’s not as simple as injecting magic stem cells as allot goes into deciding which procedures to apply.  If stem cells are a good tool (and sometimes they are not the best tool for the job), then where should they be applied?  Multiple studies have shown that just injecting stem cells into a joint blindly is not that effective.  When stem cells aren’t the best option, what other tools need to be applied?

The problem of musculoskeletal repair is very complex.  Think about your car.  You know that there are critical components to keep it running.  The wheels have to be aligned or the car won’t go straight and the tires will wear unevenly.  The connections between the wheels, the axel, the driveshaft, and the engine have to be flexible and allow fluid movement.  The engine as it turns the drive shaft has to be well oiled.  As the engine cranks up to ever faster speeds, the connections had better be stable, or the whole thing will fly apart.  Finally, your engine now has miles of wiring and small computers on board to monitor the whole thing and to regulate the activity of the engine, tell you what’s wrong, and keep the car in tip top shape.

Now think about your body and it’s joints, muscles, tendons, and ligaments.  The same principles of alignment, good joint connections, stability of those joints, and the wiring (nerves and minicomputers that impact everything from the timing of muscle firing to the information about joint position) applies. Regrettably, our orthopedic surgical approach to date has too often just focused on bringing the car into the shop to replace a few worn parts, but not considering how the parts got that way.  Let’s look at that analogy now as it applies to a person.  If a 40 something that runs every day suddenly is diagnosed with his right (and not left) knee with significant arthritis, shouldn’t we ask ourselves why only the right knee?  Could it be that for years his right knee was getting worn down due to more forces on the right due to poor alignment?  We’d all accept that at face value that a misaligned front wheel and axel could cause the right front tire to wear faster than the left.  Yet for some reason, our medical care system often ignores why one joint wore out faster.  The reason?  if we’re going to replace the joint, who cares?  What if we wanted to save the joint?  Would it matter more?  Absolutely.  Hence the tenants of Ortho 2.0.  When the shift is moved from replacement to repair, it matters how the joint got that way, if the joint is stable, if the surrounding muscles are firing correctly to protect the joint, whether the alignment is correct to support a healthy joint, and if the wiring is in order.

My goal for the Ortho 2.0 series is to look at all of these issues as they pertain to joints.  While stem cells are a great advance and represent a cutting edge tools, their use without considering all of these other things doesn’t get patients where they want to be, which is a joint they can count on for many years to come.  We’ll look at all of the parts of Ortho 2.0 listed above, or as my partner coined the term, SANA.  This is Stability, Alignment, Neurologic, and Articulation.

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