Basis of ARO: Patients Deserve Better Options Than Replacement

Seeing the Problem First Hand: Investing in a Solution

Prior to AROmotion, Dr. Dean owned and operated a successful Internal Medicine Practice serving the Tampa Bay community. Loved by his patients for how deeply he cared about their well-being, he was voted one of the Top Doctors in Florida. Managing his patients care, he witnessed first hand how other medical professionals assessed and dealt with severe pain associated with osteoarthritis.

He observed that orthopedic surgeons almost always defaulted to total joint replacement surgery. Unfortunately, patients would often return to Dr. Dean with continued disability and pain, as total joint replacement surgery only provides a 75% success rate under the best conditions.

Dr. Dean firmly believed patients deserved a better option, and so, he assembled a think tank of Physicians, Surgeons, and University Scientists to research and develop a procedure that would fill the gap between addictive medications and invasive major joint replacement surgeries.

AROmotion's Innovative Approach to Orthopedic Treatment

Addressing the Underlying Causes of Joint Pain with RFA

AROmotion addresses the underlying factors that result physiologically in chondromalacia and clinically as joint pain, swelling, and weakness. Once the joint has been deemed mechanically intact, Radiofrequency Ablation (RFA) is performed on the base of the sensory nerves affected by the chondromalacia. By disrupting the signal of pain transmitted by these nerves, the feedback loop of cytokine and interleukin activation is also stopped. Pain is not just a symptom; it is the root cause and instigator of joint degeneration.

Immediate Benefits and Long-term Effects of RFA

Within days of the RFA procedure, the volume of inflamed fluid inside the synovial joint capsule diminishes, and mobility improves. The nerves are disrupted for approximately one year, during which time a much more "normal" non-toxic joint environment is present. There is a secondary benefit of the RFA which is the immediate reconditioning of the muscles and ligaments that move the joint. This is because we have "turned off" the nerves that have been causing the joint pain and altering their gait to a shuffle versus normal walking heel-to-toe.

Strategic Use of RFA in AROmotion's Treatment Approach

AROmotion uses RFA not only to stop the pain but more importantly, to turn off the production of Substance-P, the neuropeptide responsible for the inflammation or arthritis occurring inside the joint. AROmotion is using RFA to turn off the "pain-inflammation feedback loop," clinically known as knee osteoarthritis, to provide a healthier, calmer joint environment for various Orthobiologics to help promote healing.

Enhancing Orthobiologic Treatments with RFA

The current use of Orthobiologics is mainly by Orthopedic Surgeons as a "last ditch" effort to help with knee pain. It typically fails because the fragile Orthobiologic is placed in an angry, inflamed OA knee joint environment resulting in rapid degradation. RFA stops Substance-P, the key neuropeptide causing the OA inflammation inside the joint. Placing the hyaluronic acid or any other Orthobiologic in this now calmed, less toxic, joint environment allows for its maximum effect. AROmotion is the only group in the U.S. that combines the RFA with hyaluronic acid or other Orthobiologics to create an augmented environment for healing.

Surgical Competition

Resistance and Chronic Pain Issues

While there may still be some holdouts within the orthopedic surgeon field who believe that total joint replacement is the only lasting solution, even they will attest that a minimum of 25% of all total joint replacement patients continue to live with chronic pain. More concerning is that after joint replacement, the joint has been physically "sawed off," and this cannot be reversed. Our AROmotion procedure treats the pain and function without altering the joint anatomy, so total joint replacement surgery can always be an option down the road if needed.

Misunderstandings in Orthopedic Treatment

The general population has a poor understanding of the pathology of osteoarthritis (OA) and chondromalacia knee pain, allowing the "Bait and Switch" orthopedic pitch: you are "Bone on Bone" and must have a replacement. However, it is the less-dense fibrous meniscus that is responsible for the space seen on X-Ray. A lack of space between the calcified bones covered in even harder enamel is due to wearing out or prior surgical removal of this fibrous meniscus.

This is a critical point, because if there is no meniscus, then the patient's knee pain is typically not mechanical like a 'rock in your shoe' and cannot be treated with arthroscopy. Therefore, the cause of the pain must be from chondromalacia or the cavities in the hard articular cartilage coating the ends of the bone, and the only orthopedic surgical option is total joint replacement surgery. Therefore, if you want the orthopedic surgeon to help you with your OA/Chondromalacia pain, the total joint replacement operation in the hospital is the only thing they can offer.

Microfracture Surgery: An Alternative Approach

The only caveat is "microfracture surgery," where arthroscopically tiny holes are drilled into the bone where the chondromalacia exists. This causes bleeding of the bone marrow, which is rich in stem cells and other healing factors. When visualized a year later, the chondromalacia has resolved due to the activation of chondrocytes (cartilage cells) that grow the hard coating of articular cartilage. Surgeons rarely perform this surgery because of the associated long postoperative pain (4-6 weeks non-weightbearing) from the drilling trauma.

Pain Management Competition

Training and Challenges for Interventional Pain Management Physicians

Interventional Pain Management physicians are trained in RFA procedures and can perform RFA on the Genicular Nerves. Few Interventional Pain Management Physicians are interested in treating extremities due to the complex billing and coding and the poor reimbursement. Spine codes are more lucrative, and almost all their training is in spine pain management.

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