Since I see my job as creating a new medical specialty that will transform orthopedics from a surgical to a percutaneous specialty (injection-based), you might imagine that my views on things will sometimes rile up orthopedic surgeons. Some of them see what’s coming down the pike, and a handful are even hard at work trying to adapt and invent their own version of the future. However, for most, it’s like I’m speaking Mandarin. Instead of recognizing what’s happening in that seed change, they instead erroneously believe that Regenexx must be all about the magic-stem-cell pixie dust. You can certainly see why. It seems like most of the vendors of machines, devices, and magic amniotic or cord “stem cells” take the same magic-pixie-dust point of view. So this morning I’d like to set the record straight for all— Regenexx is about inventing interventional orthopedics using orthobiologics as tools. It’s about creative disruption of an entrenched and invasive medical specialty, and, yes, it’s about making a large chunk of existing surgical orthopedics obsolete.
Imagining the Future Is Hard for Some PeopleThis morning Airbus just showed an amazing concept of a future air-transport network. Basically, it’s a pod with seats that can autonomously add a skateboard-type module to become a car or instead have a quadcopter module fly in to attach itself to the roof. In that way you can get from point A to B driving or flying and let the system do the work. However, what they teased and didn’t show is as important as what they did. All the parts of this system have an Airbus logo on them instead of an airline logo. Even more curious is that a jet manufacturer didn’t show this pod being hooked into a jet module. Why? They wanted to both tease the future of autonomous air travel where pilots and crews become obsolete as well as stay away from making the airlines feel threatened. After all, who needs Delta or United when these pods, skateboards, and quadcopter parts all fly around doing their own thing? Certainly not Airbus nor Boeing. However, most people who watch this video will never notice the subtle messaging.
The same is happening right now in orthobiologics, which includes the use of stem cells and platelets but also many other types of substances that can heal. A few smart orthopedic surgeons see the handwriting on the wall. They notice that if we have better and better substances that can heal tissue, the entire concept of a knee replacement or debridement or other surgery can itself become obsolete. They see that if you can heal an ACL ligament with a precise injection using X-ray guidance, then what’s the utility of arthroscopy? In that world, arthroscopy becomes an overly invasive procedure. They see that if you can bring tissue together through a needle to fix something like a retracted tendon, then why is surgery needed? However, most surgeons don’t see it yet. They can’t imagine a world where most of the procedures they perform today are no longer state of the art. They’re just like the airlines in the example above who will never see what the Airbus video really means. Or they’re just like the cardiovascular surgeons in the 1980s who couldn’t imagine a world where most men with angina didn’t get open-heart surgery. That was, until most men with angina got a stent placed through a catheter by a different medical specialty called interventional cardiology.
What Is Interventional Orthopedics?If you haven’t watched the IOF video “What Is Interventional Orthopedics?” this is a great time to get up to speed.
More specifically, the core tenants of this new medical specialty follow:
- Injectates (i.e., what’s injected) that can facilitate healing of bone, tendon, ligament, muscle, or cartilage
- Precise placement of those injectates into damaged structures using imaging guidance
- The eventual development of new tools to facilitate percutaneous tissue manipulation
Notice how what’s injected, like stem cells or platelets, is only one of the three things that make up this new specialty. Just as important is the precise placement of what’s injected and new the tools that will be needed to bring it all to fruition. The orthopedic surgeons don’t really get these two key parts. They believe that stem cells and PRP are magic fairy dust to sprinkle into their existing surgeries or, far worse, a business plan to make some extra cash on the side.
Botox for Orthos
Six or seven years ago, I was speaking to an orthopedic surgeon about stem cells. I told him what we were doing and why. The only way he could grasp it is to put it in the context of cosmetic dermatology. He had seen many of his dermatology friends adding cash procedures to their practices like Botox. These cosmetic procedures weren’t game changing technologies, just something to improve the bottom line. So he blurted out, “Oh, I get it, this is like Botox for orthos.” At that point, I found a way to politely get off the phone.
Hence, orthopedic surgeons still have a hard time figuring out that what we’re doing at Regenexx is very different. While we love to teach doctors how to make the best possible stuff to inject and take pride in the research behind our proprietary platelet and stem cell preps, how we precisely get it to the right place and the future devices that will allow much of orthopedic surgery to be made obsolete is also the focus. In other words, Regenexx is about the creative disruption of orthopedic surgery through the invention of interventional orthopedics. This is why we don’t add just any doctor with a heartbeat and a medical license to our network and why we do require extensive knowledge of image-guided musculoskeletal procedures.
The upshot? My job is to reinvent orthopedics from the ground up as an interventional specialty. I arrive at work every day asking myself what orthopedic surgical procedure can I make obsolete today? In essence, the creative disruption of an entrenched and invasive medical specialty. Patients have been benefiting from the shift from more-invasive to less-invasive procedures since the ’80s, and they will benefit from healthy competition between surgical and interventional orthopedics as well. Will all orthopedic surgeries go away? No. There will always be a place for orthopedic surgery. However, it’s easy to see a future where we do fewer and fewer each year!