Glenohumeral Osteoarthritis: The Role for Orthobiologic Therapies: Platelet-Rich Plasma and Cell Therapies

Abstract

The glenohumeral (GH) joint ranks third on the list of the large joints that are most commonly affected by osteoarthritis, after the knee and the hip. General nonsurgical modalities, including changes in daily activities, physical therapy, pharmacotherapy, and corticosteroid injections, constitute the mainstay of treatment. Most of these options, however, have shown moderate and short-term effectiveness. Arthroplasty techniques have proven to be successful for elderly patients. Nevertheless, replacement options are not optimal for younger patients because their functional demands are higher and prostheses have a finite life span. This has led to the search for new nonoperative treatment options to target this subgroup of patients. It has been suggested that orthobiologic therapies, including platelet-rich plasma (PRP) and cell therapies, present great promise and opportunity for the treatment of GH osteoarthritis. Despite the promising results that have been shown by cell therapies and PRP for treating degenerative joint conditions, additional studies are needed to provide more definitive conclusions.

Fig. 1

Conceptual representation of current human cell and cell-derived products for orthopaedic use. *GCFS = granulocyte colony-stimulating factor. **Limited access worldwide, although some options are available in countries with little/no regulation. &&Practice in the United States requires adherence to minimal manipulation, not more than rinsing, sizing, and shaping, as outlined in the U.S. FDA Same Surgical Procedure Exception (SSPE). ***Multiple devices are available that utilize enzymatic digestion of SVF cells from adipocytes. Considered by the FDA to be more than minimal manipulation and thus outside the scope of SSPE; would require FDA IND or BLA to comply with current U.S. regulatory framework. BMAC = bone marrow aspirate concentrate, FDA = U.S. Food and Drug Administration, MSCs = mesenchymal stem cells, IND = Investigational New Drug, and cGMP = current good manufacturing process.