IO CORE PROCEDURE
What is The iO-Core™ Procedure and what is it intended to treat?
iO-Core stands for “Intraosseous injection of bone marrow cells combined with a core decompression and placement of a intact bone core.”
iO-Core is intended to treat the root cause of joint pain which is often undiagnosed and untreated leaving patients to deal with pain, discomfort and loss of movement.
The procedure is a minimally invasive outpatient procedure that involves treating defective cartilage and bone marrow lesions associated with arthritis and orthopedic injuries with a mixture of the patients own cells in a proprietary sequence of procedures designed to create the optimum environment for healing.
How is iO-Core intended to alleviate pain and restore function?
The iO-Core Treatment technique utilizes orthopedic procedures combined with biologics to decompress pain/pressure inducing lesions, edemas, cysts, and/or insufficiency fractures by introducing high quality autologous biologic material to accelerate and promote healing of degenerating cartilage and damage to underlying bone. The iO-Core™ procedure is covered by Insurance in most cases and is specifically designed to heal arthritic pain using the body’s own cells to heal the damaged bone from the inside out. The procedure will be performed by a board certified MD trained in the IO Core procedure to identify and treat the root cause of joint pain.
- Percutaneous intact bone graft is completed with the use of a small needle that extracts a healthy piece of bone which is placed into the area of dying, unhealthy bone (bone marrow lesion) to assist in structural support, re-growing and healing of the damaged bone.
- Bone marrow aspirate that is rich in growth factors, stem cells and progenitor cells will be harvested and delivered to the bone marrow lesion and intra-articularly to provide additional healing factors to these damaged areas of the joint
- Lesions will be treated using fluoroscopic imaging to perform a core decompression to insure precise injections at the exact location of the defect or lesion.
- The core decompression will be performed to relieve built up pressure caused from bone marrow lesions
- An injection of bone marrow into the damaged bone and within the joint space is intended to help with revascularization and signal to the body to began the repairing process to the damaged bone and cartilage.
IO Core targets the surface and beneath the surface to comprehensively treat the root cause of joint pain. It’s like nourishing the soil around the roots of a tree so it can fully blossom on the surface.
Recent research indicates that a majority of pain caused from advanced Level 2, Level 3, and Level 4 OA could be attributed to bone marrow lesions. This has shown to be an overlooked problem as most physicians are only trained to identify and treat the surface cartilage. IO Core provider clinics work to identify and treat the underlying source of your joint pain in a comprehensive manner and are experiencing higher than typical success rates compared to “standard of care” procedures.
Am I a Candidate?
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Some of the most common symptoms of iO-Core Candidates:
- Pain. Affected joints might hurt during or after movement.
- Varying degrees of pain, from mild to moderate, depending on the severity and Trauma.
- Stiffness. Joint stiffness might be most noticeable upon awakening or after being inactive.
- Inability to put full pressure on the knee, hip, or ankle to walk.
- Tenderness. Your joint might feel tender when you apply light pressure to or near it.
- Loss of flexibility. You might not be able to move your joint through its full range of motion.
- Grating sensation. You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
- Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected joint.
- Swelling. This might be caused by soft tissue inflammation around the joint.
- Prior injury to ACL, MCL, PCL, meniscus or traumatic incident that still ensues pain even after physical therapy or surgical repair.
- You have been diagnosed with knee, hip, ankle, or shoulder arthritis, bone marrow lesions, bone marrow edema, insufficiency fractures
What to expect after your iO-Core Procedure:
It is an outpatient procedure performed in a surgical center or hospital setting by a board certified physician who has been trained in the IO Core procedure. The procedure itself typically takes about 45 minutes from start to finish. General sedation is administered so patients will not be conscious the minimally invasive procedure. Most patients will be released within 2 hours after the procedure with discharge instructions that may include medication for pain and expected to rest. Usually within days patients are off pain medication and reporting a significant reduction in pain with restored mobility to the IO Core treated area.
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Why Treat the underlying bone instead of the cartilage surface?
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Past Problems with Treating Advanced Osteoarthritis :
Patients presenting with bone marrow lesions have been associated with more severe arthritis/pain, and less successful outcomes with traditional standard of care treatments.
Patient’s are often relegated to joint replacement surgery since the bone marrow lesions have historically been left undiagnosed and untreated. Left untreated these lesions quickly progress to collapse of compartments which leads to total joint replacements as the patients last option for pain relief and improved function.
What’s Wrong with Joint replacement Surgery?
- Mortality of 0.25 – 0.5% (Below age 65), Higher with increased Age.
- Morbidity of 4.5%, up to 9.5% if bilateral.
- Infection 1%
- Average Medical Knee Replacement Cost of $49,500 Surgery + $7500 Hospital Room + Nursing Home + PT + Anesthesia/Surgery Fees.
- Average Recovery time of 6 weeks if young and healthy, 6-12 months if not.
- Average Pt satisfaction is: 75-92%
- Average Duration of Benefit is: 20 years, 10% replacement in 10 years
www.arthritis.org/living-with-arthritis/treatments/joint-surgery/types/hip/hip-replacement-mortality-rates.php
Do Cortisone Steroids Just Mask the Pain?
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Potential side effects of cortisone shots increase with larger doses and repeated use. Side effects can include:
- Cartilage damage
- Death of nearby bone
- Joint infection
- Nerve damage
- Temporary facial flushing
- Temporary flare of pain and inflammation in the joint
- Temporary increase in blood sugar
- Tendon weakening or rupture
- Thinning of nearby bone (osteoporosis)
- Thinning of skin and soft tissue around the injection site
- Whitening or lightening of the skin around the injection site
Limits on the number of cortisone shots
According to a study funded in part by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) corticosteroid injections to the joint may speed cartilage degeneration. They also found that Among people with osteoarthritic knees, repeated steroid injections over two years brought no long-term improvement in reducing pain.
https://www.cnn.com/2019/10/17/health/steroid-injections-study-trnd/index.html
The iO-Core™ procedure may be covered by Insurance and is specifically designed to heal joint pain by using a proprietary combination of orthopedic procedures & the body’s own cells for healing.
The science and rational behind IO Core!
Arthritis is typically thought of as a “surface problem” with progressive loss of surface cartilage. This could be considered similar to a tree losing it’s leaves on the visual surface.
However, new studies indicate a more systemic degenerative process. A process with failure of the bone trophic factors underside, as well as loss of cartilage. It is unclear if the tree suffers problems with it’s roots first and then looses it’s leaves, or vice versa.
Advanced Arthritis involves both the loss of Surface Cartilage as well as a degeneration of the underlying bone connective tissue
What is the Theoretical Basis of the I-O Core procedure?
- Bone pathologies resulting from acute or chronic injury, including bone marrow lesions and osteonecrosis of the knee, cause severe pain and disability.
- Chronic swelling of the bone underneath cartilage is painful and can be a sign of chronic overload. It can also be a sign of lack of oxygen to the bone called avascular necrosis.
- The majority of these patients progress rapidly from initial diagnosis to total knee replacement surgery.
- These bone pathologies may also lead to cartilage degradation and loss.
What are the benefits of the IO Core procedure?
- Decompression of the subchondral surface facilitates pain relief https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007334/
- Bone grafting Provides a Biologic Scaffold and facilitates Revascularization of the Bone
- Intraarticular
- Intraosseous Grafting introduces inflammation-reducing Cytokines and that may help relieve pain https://www.ncbi.nlm.nih.gov/pubmed/29589086
Another Reason To Treat The Bone!
Increase in bone marrow lesions associated with cartilage loss: a longitudinal magnetic resonance imaging study of knee osteoarthritis.
https://www.ncbi.nlm.nih.gov/pubmed/16646037
A Pain in the Bone: Bone Marrow Lesions
Chronic Bone Marrow Lesions of the Knee and the Association with Osteoarthritis. Bull Hosp JT Dis (2013). 2016 Mar;74(1):24-36.
https://www.ncbi.nlm.nih.gov/pubmed/26977546
Why decompress the pressure beneath the lesions? The Correlation between arthritis, bone lesions, and a build-up of pressure inside the bone…
Intraosseous Hypertension And Pain In The Knee
https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620x.57b3.360
Treatment of Osteonecrosis With Autologous Bone Marrow Grafting
https://journals.lww.com/clinorthop/Fulltext/2002/12000/Treatment_of_Osteonecrosis_With_Autologous_Bone.3.aspx
Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: a thirty year follow-up prospective randomized study of one hundred and twenty five adult
https://link.springer.com/article/10.1007/s00264-018-3941-8
Bone marrow lesions predict increase in knee cartilage defects and loss of cartilage volume in middle-aged women without knee pain over 2 years.
https://www.ncbi.nlm.nih.gov/pubmed/18625617