Orthopedic injuries and conditions can be painful and in many cases, difficult to treat. Osteoarthritis is one of the most common orthopedic medical conditions, affecting more than 30 million Americans. Especially prevalent in older people, osteoarthritis occurs when the cartilage in between joints wears down. Cartilage is a hard and slippery tissue that enables our bones to glide over one another when we bend our joints, such as the fingers, knees, elbows, toes and hips. Over time, the cartilage can deteriorate, causing bone to rub against bone and leading to pain, swelling and stiffness. The most commonly affected joints are the ones in the fingers closest to the nails, thumbs, lower back, knees, neck and hips.
There is no cure for osteoarthritis but there are various treatments, including surgical procedures, which can help to alleviate some of the pain and stiffness associated with the condition. In recent years, physicians have begun to explore new treatments for arthritis, including the use of stem cell therapy that has the ability to regenerate the cartilage and other tissue.
The Privia North Texas/Texas Health Care Bone and Joint Clinic, one of the oldest and most established orthopedic practices in North Texas, has provided stem cell treatments to patients since 2014.
“Regenerative Orthopedics is a new field of medicine that enables a patient to harness and amplify the body’s ability to heal itself using concentrated regenerative cells and growth factors,” explains Dr. Steven Meyers, a sports medicine physician. “Stem cells are at the center of regenerative orthopedics and their use has continued to expand over the past decade.”
“Many orthopedic conditions involve a failed healing response that leads to continued inflammation, pain and loss of function,” adds Dr. Donald Dolce, an orthopedic surgeon. “This is especially true of osteoarthritis and tendonitis, because cartilage and tendon tissue have extremely limited blood flow. Without sufficient blood flow, these tissues do not receive the proper nutrients, growth factors and cells required to mount a proper healing response.”
Stem cell therapy delivers concentrated cells and growth factors directly to the point of injury and stimulates a powerful healing response capable of regenerating and repairing tissue.
Not just for arthritis
Arthritis is one of the most common conditions that can be treated with stem cell therapy, but there are many other orthopedic conditions and injuries for which this treatment has been demonstrated to be effective:
Knee pain: meniscus tears, chondromalacia patella, patellar tendonitis, cartilage defect, MCL and LCL sprains
Hip pain: torn labrum, trochanteric bursitis, hip tendonitis
Shoulder pain: rotator cuff tendonitis and partial tears, torn labrum, biceps tendonitis
Elbow pain: tennis elbow, golfer’s elbow, ulnar collateral ligament (UCL) strain
Wrist/hand pain: DeQuervain's tenosynovitis
Ankle/foot pain: Achilles tendinitis and partial tear, plantar fasciitis, ankle instability and ligament injury
What are stem cells and how can they help?
Mesenchymal Stem Cells (MSCs) are unique cells located in many tissues of the body. One of the most important characteristics of MSCs is that they are unspecialized cells with the ability to mature and differentiate into multiple types of tissue, including bone, tendon, ligament, cartilage, muscle and meniscus. In addition, these stem cells can self-renew, producing more stem cells. They can even prevent other cells from dying due to lack of oxygen and they can also produce anti-inflammatory proteins.
When stem cells are injected into an arthritic joint or injured tendon, they attach to the areas of damaged tissue. The MSCs are able to sense the microenvironment of the injury and determine what kind of cells to grow and what molecules are needed to enhance tissue healing. The stimulated MSCs begin to grow new cells and also act as the body’s own natural pharmacy, producing and releasing the right combination of growth factors and proteins to stimulate healing and new growth of cartilage, tendon and other injured tissues.
Research and clinical data show that stem cell treatments are extremely safe, with minimal risk for any adverse reaction or complication.
Where do the stem cells come from?
“A lot of times, people assume stem cell therapy means taking the cells from the bone marrow, which can be a painful procedure,” says Dr. Meyers. “However, stem cells are also found in fat tissue throughout the body and it turns out these stem cells are far more effective at creating the regenerative impact needed than are bone marrow stem cells. Acquiring these stem cells is also a much less invasive procedure.”
How is stem cell treatment performed?
Stem cell therapy is a simple, non-surgical, three-step process performed in the physician’s office under local anesthesia.
Obtain the fat tissue: Usually, the fat tissue is taken from the lower belly or “love handles.” After cleaning and numbing the skin, a thin instrument is inserted into the fat layer. The fat layer is then injected with saline and anesthetic, which numbs the areas. Once numb, a thin tissue harvester is inserted and the fat is collected by lipo-aspiration. This takes only a few minutes and is virtually painless. About three to four tablespoons of fat are removed.
Fat tissue processing: The fat is transferred to a sterile device that gradually reduces the size of the fat clusters. The tissue is exposed to mild mechanical forces that further break up the fat tissue, while maintaining the native microenvironment. The tissue is rinsed with sterile saline to remove blood and oil residues. The stem cell injection is prepared from this remaining tissue.
Injection of stem cells into the joint or damaged tissue: All injections are performed using ultrasound guidance to ensure accurate delivery of the stem cell treatment to the area of injury. Depending on location, topical or injected anesthetic may be used to decrease pain.
The complete procedure takes about two hours and then the patient is allowed to go home.
Recovery & results
Most patients tolerate stem cell therapy very well and with minimal pain. The area of fat harvesting may bruise significantly. In the days following the procedure, the joints or areas injected typically become swollen, stiff and painful. This can limit mobility for the first few days, so patients are generally advised to take it easy and take a prescription for pain medicine to help with these early symptoms.
Typically, within four to seven days after the procedure, patients are able to resume normal activities. The patient is given instructions for a home exercise program in order to enhance treatment results. NSAID medications, such as ibuprofen, should be avoided for eight to ten weeks, as they can interfere with the regenerative process.
“The growth of new cells and healing of tissue takes time,” says Dr. Meyers. “Most patients will see mild improvement after one month and significant improvement within two to three months following the procedure. Every patient and case is different, so sometimes it may take longer for significant improvement to occur.”
Multiple clinical research papers conclude that stem cell treatment for knee arthritis significantly improves pain and function, in addition to increasing cartilage volume and quality on MRI imaging. Tendon and other soft tissue injuries have shown an even better response.
For arthritis and other orthopedic conditions for which there is no cure, regenerative stem cell therapy provides a viable option for many patients who are seeking to relieve pain and stiffness, as well as slow the progression of the condition. The human body is an amazing thing, and its ability to provide the self-healing power through stem cell therapy is just one of the latest and most promising examples of this.