MANILA, Philippines - Unknown to many, the Makati Medical Center is the only hospital in the Philippines where orthobiologics is practised. This new branch of orthopedics uses biologic substances such as bone, cartilage, and growth factors to fill in defects and restore bone and joint functions.
The basis of this type of medicine is stem cell science, which activates the body’s own ability to heal and repair itself with a more natural result. It also favors the use of allograft, which is actually cadaver bone that maintains its structural integrity but has no living cells.
Allograft acts as a functional support while the body replaces the inert bone with living bone over the course of several months. Compared to very expensive metal implants, like fusion, which have the risk of rejection, or amputation, which is drastic and has very far-reaching emotional and physical effects, the end result is that the grafted bone becomes living bone that lasts for years.
MakatiMed, whose orthopedic consultants are members of the International Society on Biological Orthopedics, has the only active bone bank in the country using freeze-dried human bones. It is also the only institution where large segment (meaning the shaft of the bone up to the joint) allograft reconstructions are available. The bone bank is administered by the Philippine Orthopedic Institute Foundation and provides bone for joint replacements or bone grafts and tendons for use in ligament (as in ACL) reconstructions.
Dr. Vince Gomez, orthopedic specialist and MakatiMed’s frontrunner of orthobiologics, explains that the procedure was initially conceived for cancer patients whose tumors affected their bones. Out of the seven cases he’s handled, the present one is “ideal” because the patient is not a cancer victim. Carlo’s case, according to Dr. Gomez, was ”sparing a limb to save a future.”
Carlo is a 22-year-old college graduate from the province who landed a job in a mega retail corporation in Manila. Several months into his job, he discovered a lump above his knee that grew and began interfering with his work. Walking tired him out and his knee would occasionally hurt. With HMO insurance, he was able to consult with Dr. Gomez who immediately ordered x-rays. The results showed that Carlo’s femur (the thigh bone above the knee) had signs of destruction due to a tumor in the bone and this needed a biopsy.
Initial reports read the tumor as malignant — meaning it would require amputation and the eventuality that Carlo would succumb to the disease if it spread to his liver, lungs, or other bones. Dr. Gomez did not accept the report and requested for a more intensive study. The final diagnosis showed that the tumor was benign; it was a rare giant cell that was aggressive because even when removed, it had the potential of growing back as long as the original bone remains.
Dr. Gomez performed an operation to clean out the entire tumor and treat the remaining bone with chemicals and electrocautery. Since the amount of bone destroyed was so large, bone grafts and bone struts were put in place. After several months, however, a lump reappeared and an MRI showed that the giant cell tumor was back. This meant removing the lower part of the remaining bone to ensure that the tumor would not return.
The doctors ruled out amputation as this would have devastating effects on Carlo’s future. Dr. Gomez said, “We wanted to help Carlo and make his dreams for a good future come true. Instead of an amputation, we performed a limb salvage procedure wherein we removed the femur and replaced it with an allograft femur. The muscles, nerves, blood vessels, and even the meniscal cartilage of the knee were preserved and a few days after the surgery, Carlo was bending and straightening out his knee without pain.”
Thanks to Dr. Vince Gomez, orthobiologics, and MakatiMed’s Hospital Service Program (HSP), which helps patients when they have fully utilized their health care insurance, Carlo is standing again and ready to go back to face newer challenges in his life.