Lipogems: New Advances in Orthopaedic Treatments

QUESTIONS FOR A SPECIALIST

What is Lipogems?

An FDA cleared system, Lipogems is used by physicians to treat patients who experience pain and swelling from an array of orthopaedic conditions and injuries (Box). This sterile medical device  and closed-loop processing system is used by physicians to remove adipose (fat tissue) from a patient’s body and then transfer it via an injection into the patient’s injured or diseased joint or soft tissue.

Why not use bone marrow instead?

Your own fat is loaded with reparative cells that can assist with healing orthopaedic conditions that affect your joints, ligaments (tissues connecting 2 bones), tendons (tissues connecting muscle to bones), and muscles (Fig. 1). The Lipogems procedure uses fat because it has regenerative properties that can help heal soft tissues or cushion a joint, which may delay a more traumatic treatment, such as total joint replacement. In fact, fat has a great number of reparative cells, they are easier to get to, and the procedure is more comfortable for patients, especially when compared to harvesting bone marrow.

How is the procedure performed?

The entire Lipogems procedure usually takes less than an hour and is performed in a hospital or doctor’s office using local anesthesia. The physician makes a tiny puncture through your skin to harvest a small section of fat from your midsection. The physician then processes the collected fat in the Lipogems device using a sterile saline solution. This occurs through a very gentle process called micro-fragmentation, during which your fat is washed, rinsed, and resized into smaller clusters while maintaining the natural beneficial properties of your fat. The system removes blood, inflammatory cells, and fatty oils, leaving only the desirable concentrated fat. Next, the physician injects the resulting cells into the treatment site. The reason why it works is that the cells inside your own fat stay intact and act harmoniously in the body to repair, cushion, and support the tissue while it heals.

What are the benefits of the procedure?

The procedure is minimally invasive, only takes about an hour, and can boost healing after a surgical procedure or physicians can use it as a stand-alone treatment to encourage soft tissue healing. It can also be used to cushion the joint because the fat tissue tends to stay together; therefore, it can be used as a procedure that delays the need for total joint replacement. This is especially useful for patients who are young and want to delay a total joint replacement to avoid a later need for revision surgery. Additionally, multiple joints can be treated at one time, such as injecting both knees to reduce pain and swelling. It is also ideal for patients who cannot undergo an extensive surgery due to other health conditions.

Who will benefit from Lipogems treatment?

Lipogems can provide relief if you suffer from an injury or ailment that limits your normal daily or physical activity, or if you have a soft tissue defect or tear in your tendon, ligament, or a muscle. If you had other treatments such as physical therapy, NSAIDS, or steroid injections that did not provide significant or long-lasting relief, Lipogems may be a viable solution. You may want to try Lipogems if you would like to explore a minimally invasive alternative to a major surgical intervention. Presently, insurance does not cover Lipogems as well as other new biologic treatments offered today; however, patients have weighed the benefits and have decided to self-pay for the procedure. Lipogems is not suitable for everyone. Your doctor will determine if the procedure will be beneficial to use in addition to your surgery or as a stand-alone treatment.

The treatment is helpful to many people participating in sporting activities. Whether you are a young athlete participating in high school sports or a weekend warrior, most athletes want a faster return to sports. It also offers an alternative for athletes who do not want a more extensive surgery that requires longer recovery. Using Lipogems during tissue repair surgery, such a meniscus or labrum repair, can promote healing after surgery.

Many patients suffering from orthopedic pain are not ready for invasive surgery like a total joint replacement. They are also looking for longer lasting alternatives to cortisone injections and one that has fewer side effects. Patients can become frustrated with the duration of relief of other nonsurgical options, such as medications and physical therapy. This is why using an individual’s own fat tissue to help them heal is appealing, especially since 1 treatment is usually all that is needed.

Does this treatment have side effects?

The risk of side effects exists for most medical treatments and Lipogems is no different. Rare, but possible, complications caused by the fat transfer include an allergic reaction to the local anesthetic, damage to the underlying structures, infection, and hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal). Additionally, you can experience a blood clot at the treatment or donor site, changes in sensation, calcification, discoloration, an indentation in the area of the tissue harvest, scar tissue, and unsatisfactory results that may necessitate additional procedures.

How long do I have to wait to resume my daily activities?

Return to work and activity restrictions will be dependent upon your treatment and the specific activities you typically do; however, patients often begin to notice an improvement in reduced pain and increased function within 2 to 8 weeks following the procedure. Depending on the harvest and injection sites, your physician may restrict high-impact and strenuous activities for a couple of weeks. Lipogems is often a chosen treatment because it allows the patient to return to work without much loss of time. Most patients are able to return to their normal activities within 1 to 2 months. The recovery from the procedure is minimal when compared to a more invasive surgery.

Whether Lipogems is used as a simple nonsurgical option or part of a surgical procedure, the physician and patient can decide what fits best with their lifestyle and current medical situation. Adding the Lipogems procedure as a treatment option has given patients another choice when it comes to managing their orthopaedic condition. Ultimately our goal is to get the patient back to living life and spending time doing the things that they love.

Author: Champ L. Baker, Jr., MD

Reprinted with permission from the Hughston Health Alert, Volume 30, Number 3, Summer 2018.