Management of osteoarthritis - biological approaches: current concepts

Osteoarthritis is a major cause of disability and decreased quality of life in millions of patients and costs billions of dollars annually to treat. The current treatment options for osteoarthritis include weight loss, activity modification, anti-inflammatory medications, steroid intra-articular injections, lubricating hyaluronic acid injections and arthroplasty for end-stage cases. There has been interest in recent decades in identifying biological treatment modalities to slow the progression of the disease and preserve native joints. Biologics including platelet-rich plasma, bone marrow aspirate concentrate and adipose-derived mesenchymal stem cells are among the most commonly investigated treatments. Existing literature demonstrates anti-inflammatory properties of orthobiologics, butno treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse progression of osteoarthritis. What is more clear is that these injection treatments have been shown in the majority of studies to be safe. Research is ongoing to identify optimal indications, preparations, compositions, safety profiles and clinical outcomes of biological therapies. This article will review the current evidence of biologics for treatment of osteoarthritis and recent statements made by orthopaedic subspecialty groups on this important topic.