Stem Cells Therapy for Arthritis (Part 1)
Dr. Leon Mead has become the pioneer orthopedic surgeon in South Florida when it comes to stem cell therapy applied to orthopedic procedures such as a knee replacements. With more than 100 plus successful cases, Dr. Mead is writing a new chapter in the investigation phase the procedure requires. This excerpt below is extracted form the presentation patients undergo before surgery. We have divided in two parts for a more comprehensive understanding.
“It is important to understand that at this time stem cell treatments hasn’t been studied long enough to consider it a substitute for joint replacement surgery, but is certainly an excellent alternative. Early steam cells result are extremely encouraging. Long term studies are still needed. Total knee replacement remains the gold standard for arthritis treatment of the knee but is not a perfect operation. Recovery can be painful and lengthy and nearly 20% of patients are permanently dissatisfied with their outcome. Stem cell option is a good choice for patients that are deemed to ill or unable or unwilling to go trough the process necessary to get a good result from knee replacement surgery.
The stem cell procedure for bone on bone arthritis is best done in conjunction with an arthroscopic procedure. Injections of stem cells alone have unpredictable outcomes. I have seen many failures of injections alone particularly using fat derived stem cells for bone on bone arthritis. Stem cells obtained from fat want to regenerate fat and can not create joint surfaces alone because they lack bone morphogenic proteins 2,4 and 6. At the time of revision surgery this patients have shown no regeneration of the joint surface.
Stem cells derived from marrow are more closely related to muscle, bone and joint surface than fat and have a more natural ability to regenerate this tissues than the fat derives stem cells. Second look arthroscopy have demonstrated impressive regeneration of joint surface with marrow derived stem cells. However, if less than 50% of the joint thickness is loss, all this injections alone can be helpful. Procedure is done as an outpatient under general anesthesia with a nerve block. The nerve block reduces the post-operative pain.
While you are asleep, generally between 60 and 120cc of marrow is aspirated, filtrated and centrifuged and condensed to 6cc. This contains between 6 and 9 million stem cells and many important growth factors that are not found in fat derived stem cells. The bone marrow does regenerate and takes about 30 days to do so. While the centrifuge is working, the arthroscopy procedure is completed. The cells and then injected in the knee upon the completion of the procedure. In the past, bone marrow aspiration was quite painful. With new instrumentation, 99% of the time the procedure is painless or mildly discomforting. The lighting needle minimizes premature stem cells activation and can also be done in an office procedure under local anesthetic with the patient only experiencing only a mild sensation of pressure.
Why is it necessary to do it with an arthroscopic procedure
In an arthritic knee there are many bad enzymes of the knee that are actually the cause of the damage of the joint surface. This allow us to flush out the bad enzymes. It also allow us to trim of damaged meniscus and to remove debris. If there is irritation in the joint line this can also be removed. But must importantly this is done so we can perform a microfracture. It is essential that we prepare the damaged joint surface so that cartilage can regenerate. Microfracture is a procedure that has been done for decades and has been well studied.”
Stay tuned for part two, where we will talk more about microfracture and amnion.
Orthopedic Corner | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201 Naples Florida 34102 | Phone: (239) 262-1119