What Are Biologics?

Biologics are substances that your surgeon may inject or use during your surgery to help you heal. They contain material or cells that have an effect on other cells in your body. Depending on the contents, they can help stimulate your body to form new bone, build new blood vessels, or limit damaging inflammation.

Where do biologics come from?

Some biologics are harvested directly from you! By taking some of your own bone marrow or fat cells, your surgeon can isolate your own stem cells and growth factors to help you heal. This usually is the best option since there is a lower chance of a poor reaction to other tissues. However, there may be consequences to obtaining the material, limitations of the amount available, or other negative aspects that make this option difficult. Examples of biologics that can be harvested from your own tissue include platelet-rich plasma (PRP), stem cells from abdominal fat, and stem cells from bone marrow aspirate concentrate (BMAC).

Other biologics are harvested from other sources, usually from human donors. These commercially available biologics have many different brand names, which can be confusing. On individual product websites, you can find more information about what the biologics actually contain. However, the following are some examples of the substances found in commercially available biologics:

  • Stem cells and/or bone cells
  • Bone morphogenetic protein (BMP)
  • Platelet-derived growth factor (PDGF)
  • Vascular endothelial growth factor (VEGF)

Treatment

Your foot and ankle orthopaedic surgeon may recommend a biologic to treat conditions like arthritis or tendon degeneration. There is not much evidence that these injections work reliably, but there are some reports of significant benefit. Many patients are interested in treatment like this because the risks are low and it has the potential to delay surgery. At this time, insurance usually does not cover these injections, which can cost thousands of dollars.

Your surgeon also may recommend using biologics during your surgery. Most commonly, they are used to help bone healing. Many foot and ankle surgeries involve fusions, or trying to get two or more separate bones to become one. It can be difficult for bones to join together, and using biologics can help increase the chance of the bones healing properly.

Risks and Complications

The risks of using biologics are extremely low. Commercially-available biologics are tested for disease and are treated to prevent immunologic reactions (in other words, your body shouldn't have a negative reaction to them). The biggest downside is the cost, as many of these products are very expensive.

FAQs

Can biologics help me avoid surgery?
We know that some biologics can help your bones heal together when used during surgery. However, there is debate about how helpful they are for other conditions. At this time there is no solid scientific evidence that show reliable benefit. Unfortunately for patients with arthritis, these injections are not going to regenerate lost cartilage, but they may decrease inflammation and improve the symptoms. 

A Final Note

This is a very exciting field with new products being developed and new studies being reported almost every year. The above is a current summary of this area of medicine, but given the rate of change, it is quite possible to be different in the future as this field develops.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.