Orthopedic surgeon brings cutting-edge technology to Oswego Health. He discusses better ways to perform total joint replacement, treat arthritis and more
By Chris Motola
Q: Tell us a bit about your orthopedic practice.
A: I was trained classically as a general orthopedic surgeon. As the years progressed, I streamlined down to a total joint practice. I was the first person at [Cooperstown-based] Bassett Hospital to utilize the NAVIO robotic-assisted total joint program. So I had the expertise to bring that here. So over the last couple years we’ve been performing robotically assisted total joint arthroplasty at Oswego Health. It’s pretty new in the sense of cutting-edge technology. One of my goals is to bring cutting-edge technology to rural institutions where these advanced techniques aren’t usually available. So we’ve done very well with that. We’re currently upgrading our robot to the CORI robot, which is a little bit faster and more precise. It’ll help us deliver the very latest care when it comes to total joint replacement at Oswego Health, for our population.
Q: You’re also looking into something called platelet rich plasma treatments (PRP). What is that and how would it be used?
A: It’s something I’ve been interested in for more than 30 years. It’s something called a biological agent. If you think about what joint replacement could look like 30 years from now, joint replacement will probably be an obsolete procedure altogether. We’ll be more adept at healing cartilage and taking care of arthritic problems where we can treat them before they really present themselves. So, we use these biological agents, bone marrow concentrate, which has stem cells in them and PRP. I’ve been using PRP for about 10 years now to try and stop the arthritic processes and perhaps even heal or regrow cartilage over time.
Q: What’s that process been like over the last 10 years?
A: I pioneered a program where I came from where I performed a novel surgery to try to help joints preserve their cartilage, which included harvesting bone marrow and isolating the stem cells in it. I had some very nice results. I didn’t publish anything, but I got some good anecdotal results. So I wanted to bring that here. I don’t believe there’s much of that going on here, and that includes in Syracuse. I’m interested in starting a joint preservation and restoration clinic. That’s been my goal for many years and if this appears to be my last stop on my tour of jobs, I’m very interested in doing that. So basically I’m interested in starting a clinic where we can comprehensively treat a patient who has early arthritis or moderate arthritis before they need a joint replacement.
Q: Are these procedures covered by insurance companies?
A: Unfortunately, a lot of these processes are not yet accepted by insurance companies, but I do foresee a time where the PRP injection becomes the new cortisone injection of the future. So, why PRP? If you think about any kind of injury, one of the first components that will come to the area is platelets. And these platelets have all of these growth factors. One of them is TGF-B (transforming growth factor beta), a cell growth and proliferation enzyme or protein that will make cells grow faster and more prolific. You have a blood vessel growth factor. You have a stimulus growth factor and a host of other things that will go ahead and stimulate cells and perhaps repair them. One of the other things it does is reduce catabolic enzymes that come in and degrade things. So if you hurt your knee, there are enzymes that will actually hurt your cartilage. So PRP increases the growth factors and decreases the harmful enzymes.
Q: How new are PRP treatments?
A: Athletes around the world and sports teams around the world are routinely using these for joint injuries, ligament injuries. So it’s nothing new on the market, we’re just looking at utilizing it with newer techniques. I think it could really be used to great extent in some kind of clinical setting. We have a machine in the office that will harvest PRP.
Q: How is PRP harvested?
A: It’s not all that complex, which is nice. So the patient comes to the office, they come to a room, a nurse draws a vial of blood. The blood will be put into a centrifugation system and the PRP will be separated out of the other plasma. And at the end you’ll be left with an injection that can be put into the area of involvement, whether that be a shoulder, ankle, knee, etc. to help the healing process. Unfortunately, since insurances don’t cover it, it costs about $600 to do this, which can be prohibitive for some people, but it’s worth the investment.
Q: I remember stem cells being all the rage a couple decades ago, but a lot of that died off when they didn’t live up to expectations. Are we finally working the kinks out and homing in on the mechanisms?
A: Absolutely, yes, that’s a super question. Years ago everyone was excited about stem cells and were using them for corneal issues and even deafness, because they’re cells that can differentiate into almost anything. I think the question has been “how do you get them to differentiate?” Some of the latest studies out of Japan suggest that we may be able to start pushing the stem cells to differentiate. The real issue over the last 10 years, unfortunately, has been the FDA. Not to harp on the FDA, but the rest of the world is so much farther advanced on this issue. We have such strict criteria on what we can do with what comes out of the body. It has to be done in the same office, on the same day and you cannot manipulate the cells in any way. There was a company out of Utah that was taking stem cells and growing them. They were having some nice results, but the FDA came in and said if you manipulate the cells it becomes a drug. So they were shut down. So we’re pretty far behind. A lot of athletes go to Europe or elsewhere to receive these treatments.
Q: What kind of results have you seen?
A: Back where I used to work, I was able to recover some specimens that did show some cartilage response. But, as far as regrowing the cartilage in the joint, probably not yet. That will be the next great advancement, whether through genetic manipulation or manipulating the stem cells.