We see knee, hip, shoulder, ankle and other arthritis patients who have everything from mild to severe arthritis. While through the years we’ve observed some really impressive MRI changes in many patients after stem cell arthritis injections, some start out with such severe arthritis that seeing significant changes on the MRI’s isn’t possible. When these patients get long term responses with decreased pain and increased function, how does that work? We believe it works by replenishing the lost “stem cell reserve” in the arthritic joint. While you may not know it, normal healthy joints are chock full of their own stem cells. These live in the cartilage, on the surfaces of the bone, in the synovial tissue (part of the joint capsule covering), in the synovial fluid (the lubricating “grease” of the joint) and in and around the ligaments, meniscus, and/or labral tissue. Why do all of these joint stem cells exist? They help keep the joint healthy by repairing small amounts of normal wear and tear damage. They also help to keep the chemical environment of the joint focused in the right direction-what we’ll call an “anabolic” state (meaning capable of repair and building). Think of these stem cells as millions of tiny maintenance men that are there when you need them to keep things in working order. However, what happens when we age or the chemical environment of the knee gets toxic? We have less of these tiny workmen to keep up with the normal wear and tear. So what happens as we lose these critical joint stem cells? The environment shifts to become “Catabolic”-meaning that the breakdown of tissue overtakes the ability of the joint to repair and maintain itself. We believe that stem cell injections work in severely arthritic joints by replenishing these lost stem cells (see illustration above). This provides a more normal amount of stem cells in the joint, restoring it’s ability to maintain itself. The upshot? The arthritis mantra may have to change from “Got Milk?” to “Got Stem Cells?”.
Before you allow someone to decide on surgery based on an MRI finding…you might want to get a good exam and try a hip labrum surgery alternative first. A study just presented at the AOSSM conference demonstrates what we’ve been saying for years-operating or obsessing on MRI findings is a bad idea. Many patients these days often see a surgeon who spends more time looking at the MRI than performing an examination. This most recent study found that a whopping 73% of patients without hip pain (n=45) had abnormal hip MRI findings. Patients over the age of 35 were more likely to have abnormalities, showing a 13.7 times greater likelihood of having cartilage defects and 16.7 times greater chance of having a bone cyst! I’ve blogged before that we’ve seen many patients with hip pain who were told that they needed a hip replacement who later turned out to have no hip problems (their “hip pain” went away when we treated the patients low back). I’ve also blogged on what we call “hip labrum mania”, this is when patients are told they have a labral tear on MRI and sign up for a big surgery to reshape the hip socket. The upshot? If the surgeon spends more of his time with hands on the MRI than hands on the patient in the examination, find a new surgeon.