It is a new medical specialty that utilizes the unlimited potential of orthobiologic products, such as Bone Marrow Concentrate and Platelet Rich Plasma (PRP), that are injected under x-ray and/or ultrasound guidance for the management common conditions in patients. These procedures show promise although more research is needed!
Interventional orthopedic medicine is a game-changing area of medicine with the potential to heal damaged tissues, offering solutions and hope for patients who have conditions that were beyond hope of repair. These modern cutting edge management techniques may also help you avoid surgery.
In our office we use Interventional Orthopedics, which involves delivering specific orthobiologic products such as Bone Marrow Concentrate (BMC) or Platelet Rich Plasma (PRP) to the area to be treated. Additionally, we also use other techniques using proliferant solutions to treat diseased tissues. These proliferant solutions when injected into precise location called the entheses, help to improve the patient condition. We also use, when indicated, non-controlled medications such as anti-inflammatories and other medications.
These modalities are used to treat tissues, such as cartilage, ligaments, bones, muscle and so on. Orthobiologics are a key component of Interventional Orthopedics, and they open the door to new clinical applications.
“Orthobiologics”, refers to the use of biological substances with the aim of healing musculoskeletal injuries and conditions quicker. They are used to improve the healing of fractured bones and injured muscles, tendons and ligaments and are derived from substances that are naturally found in your own body.
With its many healing functions Orthobiologic therapy has proven to be a viable treatment alternative for many orthopedic related problems. For the uninitiated, the term orthobiologics refers to all treatments that utilize the most advance natural substance to aid in the healing and reparative process of a musculoskeletal injury or chronic orthopaedic condition.
In Saint Augustine Florida, it was Dr. Dieguez who introduced these non-surgical modalities using orthobiologics, and he has used them for close to eight years in the treatment of musculoskeletal conditions, spine conditions, sport injuries and orthopedic conditions. The success rate varies and this success rate increases if you pick the patients correctly and use the latest techniques. We do not make false claim about the procedures we perform and yes they do not work for everyone and there are failures. Additionally, even in the successful patients, the procedure may have to be repeated years later just like at times you have to have revision of a knee replacement because it is not working right or because the prosthesis is worn out. Nothing last forever! There are failures in treatment even in the best hands. Additionally, not all patients are good candidates for these procedures. That is why it is so important to pick the patients correctly. You want to give them the best chance of success.
Depending on the case, our treatments may include conventional precision-guided injections in any of its forms. We mostly use the EmCyte corporation protocols but from time to time we may use X-Cell Medica protocols. It can also be conventional steroids injection using minimal nanogram dose always to avoid the damage steroids can cause.
In this ever-changing field, we always strive to stay within FDA and Florida Board of Medicine regulations at all times. We want to bring you the latest treatments not frowned upon by the FDA and the Board of Medicine. We do not manipulate any of the products we use in any way shape or form since that would constitute the creation of a drug and this is a highly regulated process. All procedures are performed in our procedure room under the strictest aseptic techniques. We do not make false claim about the procedures we perform and yes they do not work for everyone and there are failures. The failure rate varies. Additionally we do not use any amniotic fluid product or cord blood or placental products or exosomes. We mainly use autologous Bone Marrow Concentrate (BMC) harvested from your own bone marrow with minimal manipulation and nothing added to them and Platelet Rich Plasma also obtain from your own blood. When doing proliferative therapy we use Hypertonic dextrose solutions. All procedures are done in about an hour in our fully equipped procedure room using aseptic technique.
One of the most promising new fields of science and medicine is the area of orthobiologics and their use in interventional orthopedic medicine. These new technologies, most of which are in early stages of development, hold significant promise for transformative and potentially curative treatments for some of humanity’s most troubling and intractable maladies. The prospect of clinical tissue repair strategies is a tangible reality.
However, with all of the medical potential, also comes novelty and uncertainty as this field matures. There are a small number of unscrupulous actors who have seized on the clinical promise of these procedures, while exploiting the uncertainty, in order to make deceptive, and sometimes corrupt, assurances to patients based on unproven and, in some cases, dangerously dubious products. These dishonest actors exploit the sincere reports of the significant clinical potential of properly developed products as a way of deceiving patients and preying on the optimism of patients facing bad illnesses. This puts the entire field of of orthobiologic medicine at risk. Products that are reliably and carefully developed will be harder to advance if bad actors are able to make hollow claims and market unsafe science.
At the same time, it is incumbent upon the FDA to separate with bright lines new treatments that are: 1) medical products subject to the FDA’s regulation and 2) therapies that are individualized by surgeons/physicians in such a way that they are not subject to FDA regulation. This is the key between what is legal and what is not.
This is why we do not use any umbilical cord products or amniotic fluid product being sold out there. They are not FDA approved because there are no live and functional cells in those umbilical cord blood products or amniotic fluid products that are being sold. This is something that Dr. Chris Centeno from Regenex in Denver Colorado has confirmed and now Lisa Fortier's lab at Cornell has also confirmed. Marketing and using these products is basically fraudulent.
The therapies that we use are individualized, and are not subject to FDA regulation. This applies to orthobiologics when they are taken from and given back to the same individual or when they do not undergo significant manufacturing, are intended to perform the same basic functions, and are not combined with another drug or device and their benefits and risks are well understood. In these circumstances, the products may not require premarket review under current law.
For that reason we do not manipulate the orthobiologics, in any way shape or form. That would constitute the “creation of a drug” according to the law and this is a highly regulated process by the FDA and other agencies. All procedures are done under local anesthesia. Dr. Dieguez himself, performs all the procedures in our procedure room under the strictest aseptic techniques. You walk in and out in about one hour.
Having worked for the Florida Department of Health as an expert witness for the prosecution services unit reviewing cases and being very aware of the addiction problem we have in our country, Dr. Dieguez rarely if ever prescribes narcotics and other controlled addictive medications. If he ever does, it is only if absolutely necessary after a minor surgical procedure and never for longer than 3 to 5 days.
We exclusively do minor surgical interventional procedures using orthobiologics and other joints and spine injection. With that been said, if what you are looking for are narcotics or other controlled substances, don’t expect to get them in this office. Don't waste my time or yours. Or your money for that matter! This is not a pain clinic! Here you will go out empty handed. And remember, we will not hesitate in reporting drug seekers to the authorities. Also we do not prescribe Marijuana or any of its derivatives either at this time!