Orthokine® (Autologous Conditioned Serum, ACS) is a patented technology for treating degenerative joint disease and radicular pain, based on increasing the patient’s own natural anti-inflammatory protein production. It works ‘in reverse’ to steroids – instead of suppressing, it modulates the inflammatory response at the cytokine level.

Mechanism of Action – Why is Orthokine Unique?

Degenerative joint disease (OA) is not merely mechanical wear of cartilage – it is a chronic inflammatory process in which the cytokine interleukin-1 beta (IL-1β) plays a key role. IL-1β stimulates chondrocytes to produce matrix metalloproteinases (MMPs) that degrade cartilage, and also sensitises nociceptors to pain. The natural antagonist of IL-1β is the protein IL-1 Receptor Antagonist (IL-1Ra), which blocks the IL-1 receptor, preventing its activation.

Orthokine is a method of conditioning the patient’s blood so that their monocytes produce very high concentrations of IL-1Ra. In practice – as observed in studies – ACS achieves IL-1Ra concentrations many times higher than baseline (5,000–50,000 pg/ml vs 200–600 pg/ml at baseline). The ratio of IL-1Ra to IL-1β after incubation often exceeds 100:1, and in optimal preparations even 999:1 – meaning complete blockade of the IL-1 pathway in the joint.

What Does Orthokine Serum Contain?

  • IL-1Ra – the main active factor, blocks the IL-1 receptor and interrupts the inflammatory cascade in the joint
  • IL-10 – a potent anti-inflammatory cytokine
  • TGF-β1 – a growth factor with anabolic action on cartilage
  • Other growth factors (PDGF, FGF, IGF-1) – supporting tissue regeneration
  • Cell-free serum – distinguishing Orthokine from PRP
  • 100% autologous origin from the patient’s own blood – no risk of rejection or allergy

Preparation Process – How is Orthokine Made?

  • Venous blood collection into a special Orthokine syringe containing medical glass beads coated with chromium sulphate (these beads are crucial – their surface stimulates the patient’s monocytes to produce IL-1Ra).
  • Blood incubation for 6–9 hours at physiological temperature 37°C – during this time monocytes ‘respond’ to the bead surface by producing high concentrations of IL-1Ra, IL-10 and TGF-β1.
  • Centrifugation of incubated blood → separation of cell-free serum rich in anti-inflammatory cytokines and growth factors.
  • The serum is divided into 6 doses (or 2/4/6 aliquots as appropriate), frozen at –20°C and warmed to body temperature before each injection.
  • Thanks to this approach, blood is collected only once, and subsequent administrations (usually 4–6 in a cycle) are performed from ready frozen doses.

Indications for Orthokine® Therapy

  • Degenerative joint disease (knee, hip, shoulder, elbow, small hand joints) – mild, moderate and advanced stages
  • Radicular pain in lumbar and cervical radiculopathy (nerve root compression from disc herniation) – Orthokine administered periradicularly, an alternative to steroid block with significantly longer duration of action
  • Post-operative spinal conditions – supporting regeneration
  • Facet joint disease (facet joint syndrome)
  • Chronic tendinopathies and enthesopathies
  • Patients with contraindications to steroids (diabetes, osteoporosis)
  • Therapeutic trials in trigeminal neuralgia

Advantages of Orthokine Over Steroid Block

  • Anti-inflammatory effect comparable to steroids, but maintained for significantly longer (months rather than weeks)
  • No typical steroid side effects: no hyperglycaemia, no steroid-induced osteoporosis, no fat atrophy, no blood pressure rise, no adrenal axis suppression
  • No limit on the number of injections per year (steroids intra-articularly typically max 3–4×/year due to chondrotoxicity)
  • Safe for use in diabetics, post-menopausal women and athletes
  • Acts in a modulatory, not suppressive manner – supports natural tissue repair processes

Treatment Schedule

The standard Orthokine cycle consists of 4–6 injections every 7 days. Depending on the joint and condition, the physician may offer an individualised schedule.

Preparation

  • 24 hours before blood collection: no alcohol, coffee or tea
  • Discontinue NSAIDs 7 days before the first injection (they may interfere with cytokine production)
  • No need to fast
  • Due to the need to freeze the preparation, the first injection is given 7–10 days after blood collection
  • Contraindications: active infection, autoimmune disease in active phase, cancer and blood diseases

Effects

  • First effects: 1–2 weeks after the first injection
  • Full effect: 6–8 weeks after completing the cycle (4–6 injections)
  • Duration of effect: typically 12–18 months, longer in some patients
  • The cycle can be repeated after 12 months
  • Efficacy confirmed in randomised controlled trials (including GOAT, Baltzer 2009, Yang 2008)

FAQ

How does Orthokine differ from PRP?

PRP contains platelets and their growth factors – it acts primarily regeneratively. Orthokine is a cell-free serum rich in the anti-inflammatory cytokine IL-1Ra – it acts primarily anti-inflammatory and modulates the degenerative disease process. In many indications both therapies are complementary; Orthokine is preferred when the inflammatory component dominates, PRP – for structural damage.

Why are 4–6 injections needed?

IL-1Ra has a relatively short half-life in synovial fluid, so repeated administrations maintain high anti-inflammatory factor concentrations for several weeks, giving time for complete modulation of inflammatory processes in the joint. The 6-injection schedule has been validated in randomised clinical trials.

Is Orthokine safe for diabetics?

Yes – unlike steroids, Orthokine does not disrupt glucose metabolism. This makes it a safe alternative for patients with diabetes who cannot or should not receive intra-articular steroids.