The Apollo Joint Preservation Programme comes at a time when millions of young adults are today grappling with joint issues. The programme incorporates tailoring treatment plans to the individual needs of each patient. Dr Pradeep Kocheeppan, DNB - Orthopedics/Orthopedic Surgeon, Apollo Hospitals discuss on how the programme can be a game changer in joint health.

The launch of the Joint preservation programme at Apollo comes at a time when millions of young adults are today grappling with joint issues. Can you shed some light on how this programme will help this segment of the population who often shy away from taking proactive steps towards care for joint health?

The Apollo Joint Preservation Programme is a timely initiative aimed at addressing the growing concern of joint health among young adults. As millions grapple with joint issues, this programme is designed to encourage proactive engagement in joint care, particularly among those who may typically avoid seeking treatment until conditions become severe.

The programme’s primary focus is to raise awareness and provide education on the importance of joint health. Many young adults are often unaware of the treatment options available or may be reluctant to seek help due to misconceptions about joint issues being solely an elderly concern. By offering comprehensive assessments and personalised treatment plans, the programme aims to instill confidence in patients, encouraging them to take proactive steps toward managing their joint health.

By offering comprehensive assessments and personalised treatment plans, the programme aims to instill confidence in patients, encouraging them to take proactive steps toward managing their joint health.
Through early intervention strategies, such as lifestyle modifications and tailored exercise regimens, the programme seeks to mitigate the progression of joint degeneration. This proactive approach not only aims to alleviate current discomfort but also to prevent future complications that could arise from untreated joint issues.

Personalised medicine has gained traction in recent times offering a structured approach towards addressing patient’s needs. How will this revolutionary approach towards joint preservation include the personalisation element?

Personalised medicine has gained significant traction in recent years, particularly in its application within orthopaedic care. The Apollo Joint Preservation Programme incorporates this paradigm by tailoring treatment plans to the individual needs of each patient. There are few key elements of personalisation
include:

Comprehensive Assessments: Initial evaluations utilise advanced imaging and diagnostic techniques to ascertain the specific nature and extent of joint issues.

Customised Treatment Plans: Based on assessment outcomes, treatment strategies may include a combination of regenerative therapies, physiotherapy, nutritional counselling, and lifestyle adjustments tailored to the patient’s unique circumstances.

Continuous Monitoring: Regular follow-ups allow for adjustments in treatment plans based on patient progress and feedback, ensuring that care remains responsive to individual needs.

This personalised approach not only enhances patient engagement but also optimises outcomes by addressing the specific factors contributing to each patient’s condition.

The Apollo Joint Preservation Programme incorporates this paradigm by tailoring treatment plans to the individual needs of each patient.

What offerings and services can one expect from this programme?
The Apollo Joint Preservation Programme takes a holistic approach to maintaining long-term joint health, offering a range of services designed to address both preventive and therapeutic needs: Regenerative Therapies: Non-invasive treatments such as Platelet-Rich Plasma

Early Diagnosis: Advanced imaging technologies are employed to detect joint conditions at their earliest stages, ensuring timely intervention. (PRP) therapy and stem cell injections are utilised to promote healing and restore joint function, reducing the need for surgery.

Alternative Therapies: Complementary practices, including yoga and mindfulness, are integrated into the program to support overall well-being and enhance quality of life. This comprehensive, patient-centered
approach ensures that individuals receive personalised care aimed at preserving joint function and improving their overall health.

Deteriorating joint health due to trauma, injury or other conditions could present itself as pain, swelling and inflammation. Will such cases also warrant the use of orthobiologic therapies or will pain management solutions like physiotherapy help?

In cases where patients experience symptoms such as pain, swelling, or inflammation due to trauma or other conditions, both orthobiologic therapies and traditional pain management solutions like physiotherapy are considered essential components of care.

Orthobiologic therapies utilise biological substances derived from the patient’s own body to facilitate healing. These treatments can significantly aid in reducing inflammation and promoting tissue repair without the need for invasive surgery. Physiotherapy complements these interventions by focusing on pain relief through targeted exercises and rehabilitation techniques aimed at restoring function.

The integration of both modalities allows for a comprehensive management strategy that addresses
immediate symptoms while promoting long-term recovery.

What are orthobiologic therapies and how do they help in healing damaged tissues and reducing
inflammation without the need for undergoing an invasive surgery?

Orthobiologic therapies represent a transformative advancement in orthopaedic medicine, utilising
biological substances to promote tissue healing and reduce inflammation without the need for invasive surgery. These therapies harness the body’s natural regenerative mechanisms, stimulating repair and accelerating recovery.

By using materials derived from the patient’s own body or compatible biological sources, orthobiologics offer a less invasive alternative to traditional surgical interventions.

Platelet-Rich Plasma (PRP)

Therapy PRP therapy involves drawing a small sample of the patient’s blood, concentrating the platelets using a centrifuge, and injecting the platelet-rich plasma into the site of injury.

Platelets contain growth factors that promote tissue repair, improve circulation, and reduce inflammation. PRP is particularly effective for conditions like tendon strains, ligament tears, and joint inflammation. As
a minimally invasive outpatient procedure, PRP leverages the body’s own healing properties, making it both a safe and effective treatment option for many musculoskeletal injuries.

Stem Cell Therapy

Stem cell therapy takes orthobiologic treatment a step further by using stem cells to regenerate damaged tissues, including cartilage, tendons, and bone. These cells can be harvested in two ways: autologous (from the patient) or allogeneic (from a donor). Autologous stem cells are typically extracted from
bone marrow or adipose (fat) tissue and can be directly applied during treatment without manipulation, ensuring immediate availability. In India, however, the use of autologous stem cells beyond immediate applications is regulated under clinical trial protocols.

For cartilage repair, India has approved a government-regulated therapy that involves cultivating autologous chondrocytes (cartilage cells) in a lab, which are then re-implanted to restore damaged joint surfaces. Stem cells help by differentiating into the specific cell types needed at the injury site, while also releasing anti-inflammatory agents and growth factors that reduce inflammation and promote tissue regeneration.

Benefits without Invasive Surgery
Both PRP and stem cell therapies bypass the risks, costs, and recovery time typically associated with surgical interventions. PRP accelerates healing by delivering bioactive molecules to the injury site, reducing inflammation and promoting tissue repair. Stem cells go further by regenerating complex tissues, such as cartilage, that the body struggles to repair on its own. Together, these therapies offer effective, minimally invasive options for treating conditions like osteoarthritis, tendonitis, and ligament injuries, providing pain relief and functional restoration with minimal downtime.

Orthobiologic therapies represent an innovative, patient-centric approach to healing, enabling the body to repair itself more efficiently and reducing the need for invasive surgical procedures.

Will Orthobiologic therapies salvage joints and repair them in which the extent of damage is severe?
If not what other surgical modalities will be considered in severe cases?

While orthobiologic therapies can be effective for many conditions, they may not suffice for patients with severe joint damage. In such cases, alternative surgical modalities may be necessary:

Joint-Preserving Surgeries: Procedures such as osteotomies or ligament reconstructions aim to realign or stabilise joints while preserving natural structures. Total Joint Replacement: For advanced degenerative conditions where conservative measures fail, total joint replacement may be indicated. This procedure is considered only when absolutely necessary due to significant loss of function or quality of life. The programme emphasises a careful evaluation process to determine the most appropriate intervention based on each patient’s specific condition and needs.

Stem cell therapies like Orthobiologics are a promising and emerging treatment alternative to surgery. However regenerative therapies can have a longer turnaround time, how do you address these grey areas and some of the other limitations?

Stem cell therapies, including orthobiologics, present promising non-surgical alternatives for tissue
regeneration and repair. However, it is important to address certain limitations associated with these treatments:
1.Turnaround Time: Regenerative therapies often require a longer recovery period as they rely on the body’s natural biological processes, which take time to produce observable results. Patients should be made aware that the healing and regeneration phases are gradual, and improvements may take weeks to months to fully manifest.
2.Regulatory Challenges: In India, stem cell therapies are subject to stringent regulatory oversight, which can delay their availability for widespread clinical use. The journey from laboratory research to clinical application involves comprehensive documentation, ethical reviews, and rigorous clinical trials
before these therapies can be made accessible to patients outside controlled settings.
These factors highlight the importance of setting realistic expectations with patients regarding the pace of recovery and the regulatory hurdles that need to be cleared for broader use of stem cell therapies. While promising, these therapies are still evolving, and ongoing advancements aim to mitigate these challenges over time.

Stem cell therapies while being recognised as having immense potential to cure a spectrum of diseases is yet to gain momentum in India, given the long and arduous regulatory approvals for human clinical
trials. Could you shed some light on the process involved right from lab research to documentation and approvals?
Stem cell therapies have significant potential for treating various musculoskeletal conditions, but their
widespread use in India is hindered by complex and stringent regulatory processes, which delay their broader application. The approval process for stem cell therapies involves several stages: laboratory research, extensive documentation, regulatory reviews, and clinical trials, all under the oversight of
the Drugs Controller General of India (DCGI). Currently, stem cells are not approved for commercial use outside clinical trials and can only be applied in controlled medical settings.

Approved Uses of Stem Cell-Based Products

There are exceptions where stem cell-based products are allowed, particularly in orthobiological treatments. These are classified into:

Non-Manipulated Stem Cells:
These are derived directly from a patient’s own tissue (typically adipose or bone marrow) without
complex processing. Products like Stromal Vascular Fraction (SVF), SAHAJ, and Lipogems, sourced
from adipose tissue, and bone marrow-derived stem cells, are approved for clinical use in India.

These therapies help manage joint-related conditions by promoting healing and reducing inflammation.

Manipulated Stem Cells: These involve more complex processing, such as culturing the cells outside
the body. In India, only one manipulated stem cell product, STEM-1, is approved for use, combined with an SCO supplement. Outside of this, manipulated stem cells are restricted to clinical trials, where patients are not charged for treatment.

Clinical Applications and Limitations
Stem cell therapies, including PRP and non-manipulated stem cells derived from fat and bone marrow, have shown promise primarily in the early stages of arthritis. These therapies help slow disease progression, reduce inflammation, and provide temporary symptom relief. Importantly, they
do not reverse advanced arthritis or restore full joint function.

While they offer significant benefits in symptom management and may also help decrease further rapid cartilage cell death, they are not a cure for arthritis. It is crucial to emphasize that stem cell therapies are fully safe, with extensive safety studies confirming their lack of harmful side effects. However, despite their safety, they are sometimes
misused, particularly in advanced cases where their effectiveness is limited. These therapies should not be offered in advanced arthritis, as they provide no meaningful benefit in such stages.

The primary role of stem cell therapies is in slowing the progression of arthritis and offering symptomatic relief, which is, in itself, a breakthrough. However, their efficacy is limited to these functions and they should not be seen as a disease-reversing solution. Their long-term benefits continue to be evaluated, but they have proven to be safe and effective for symptom management and slowing disease progression in early stages of arthritis.

New age treatments often come with a price tag! Given that affordability of such treatments is a necessity in India’s healthcare system, how are you at Apollo ensuring cost -effectiveness of such
progressive treatments?

Affordability remains a critical consideration in India’s healthcare landscape. The Apollo Joint Preservation Programme strives to ensure cost- effectiveness through various strategies:

Value-Based Care Models: Emphasising high-quality care while minimising unnecessary procedures helps keep costs manageable for patients.

Insurance Collaborations: Partnerships with insurance providers facilitate coverage options for various treatments under the programme, making advanced care more accessible.

By focusing on cost-effective solutions while delivering innovative treatments, Apollo Hospitals aims to enhance patient access to essential orthopaedic care without compromising quality or outcomes.