Interventional orthopedics is about to change the world of musculoskeletal care forever, and the average American or physician doesn’t yet know it exists. Today is a huge day for that new specialty, as structured stem cell education for that new skill set kicks into high gear this morning with the first level-1 comprehensive knee, hip, and shoulder course being taught by the Interventional Orthopedics Foundation. Why is that a big deal? Let me explain.
While most people in the world of regenerative medicine are focused on the bright, shiny object of stem cells, they’re missing the point. The real magic of regenerative medicine is all of the new techniques and devices that will be developed to deploy those cells. You see, stem cells aren’t magic; they’re tools that can help patients with certain conditions as long as they’re placed in the right way in the right area.
Surgical orthopedics has had study after study this past decade that has shown that, for the most part, things like operating on the meniscus, cleaning out arthritic joints, fusing the spine, and sewing together damaged tissue often doesn’t work better than just doing nothing. While some surgeons are now focusing on using these same invasive techniques and throwing in the magic pixie dust of stem cells, they’re also missing the point. The real opportunity we have before us is reinventing orthopedics from the ground up—making it less invasive, rethinking its often poorly thought-out assumptions, and re educating a generation of physicians.
While many Americans consider arthroscopy to be less invasive than open surgery, it’s still oftentimes like a bull in the proverbial china shop of the musculoskeletal system. Take, for example, the concept of “cleaning up the knee.” We’ve known since the Moseley study in 2002 that this procedure is no better than a fake surgery. The idea of a “clean up” came from the time that the first surgeon poked an arthroscope into an arthritic knee and saw what looked to be a mess, or, as I refer to it, the “dirty room.” It wasn’t long before instruments were developed to “clean up” that dirty room. However, most of the data we have to date suggests that removing cartilage pieces and parts of the meniscus in an attempt to tidy up just makes patients worse.
We now know that orthopedic surgery is based on a number of assumptions that have turned out to be incorrect. First and foremost is the structural model of pain, drilled into our heads since the first time we injured ourselves playing sports. Interventional orthopedics is an opportunity to rethink those poor assumptions.
For example, the structural model of pain is not accurate. This means that what a structure looks like on MRI and whether it functions well are often disconnected, despite armies of radiologists and surgeons who believe otherwise. In this area we need to push the reset button.
To illustrate the point, one of my patients yesterday was an orthopedic surgeon who I had treated with culture-expanded stem cells down at our licensed site in Grand Cayman. We spent more than an hour plowing through before and after MRIs of his knees and shoulders. Despite most of the areas showing good pain and functional improvement, he wanted his films to look great, like they did before his multiple knee surgeries. He was caught up in the poorly thought-out structural model of pain.
So this morning, the idea of orthopedics embarks on its next chapter. The problem with education in this new area of less-invasive injections used to replace more-invasive surgeries is that the educational experiences are all over the map. For-profit regenerative medicine conferences are built around vendors that want to sell their devices, so the education is biased in that direction. On the other side of the fence, nonprofits rarely have any kind of curriculum based on structured learning. Meaning what the physician learns may be any one of five or six different techniques for doing X, depending on which instructor he or she is paired with.
Neither of these models is how medical education should work. Medical-device vendors selling widgets shouldn’t drive the curricula of medical conferences where doctors learn. In addition, physicians need a set of fixed procedures to learn and master in a stepwise fashion—from simplest to most advanced. Once they master the simple stuff, they should move on to the more difficult procedures. As they become a master of the techniques, they can then innovate and make changes to improve those procedures. This is how structured medical education works.
So the reason this morning is a milestone in interventional orthopedics is that this is the first stem cell education course in the this area run by a nonprofit that isn’t selling widgets and speaking slots to the highest bidder and that also has a structured curriculum of set procedures ordered from the easiest to hardest to master. It marks the beginning of the medical specialty, which will be shaped by hundreds of people over the next decade.
The upshot? I congratulate the Interventional Orthopedics Foundation on reaching this milestone. It will be holding many such structured learning events over the next year. Today I’m honored to be one of the instructors, but we’ll also be educating a team of stem cell education instructors to go out and educate physicians. Today is the beginning—the day when the reset button gets pushed on a whole medical specialty, birthing something new and better. Surgical orthopedics will always have a place, but 20 years from now, we’ll all look back and say this was the day and the spot where interventional orthopedics began!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…