The Top 8 Things to Know About Orthopedic Stem Cell Treatment
POSTED ON 11/9/2016 IN Regenerative Medicine Education BY Christopher Centeno
You're considering orthopedic stem cell treatment, but how do you know which clinic and doctor is the right choice? Today, I'm going to share the top 8 things to know to make sure you get a quality stem cell procedure and maximize your chances of a successful outcome. If your clinic and doctor meets all 8, you can be pretty confidant you're in good hands.
The Most Important Factors In Orthopedic Stem Cell Treatment
1. Specialty and Training
This makes number 1 on the list because an orthopedic stem cell treatment is only as good as the doctor performing it. It can be the most highly advanced orthopedic stem cell treatment in the world, but if the doctor doesn't know what he or she is doing, nothing else matters. It's very, very important that that doctor has training in advanced-imaging placement of needles and cells. Physicians trained in the field of orthopedic surgery, for example, are not usually trained to properly perform image guided injections. Advanced-imaging placement of stem cells requires precise training on specific equipment, and less than 1% of orthopedic surgeons in the United States are trained on the equipment. Watch the video at the top of this post to see the equipment that should be used to get those stem cells into very specific spots. Find out what your stem cell doctor's training consists of. In the world of stem cells, many providers ascribe to the “see one, do one, teach one” training methodology after taking a weekend course. This degrades the quality of stem cell treatments as, in reality, more advanced hands-on training is needed to properly perform these procedures. A good way to see if your doctor is qualified is to contact the Interventional Orthopedics Foundation to see if your doctor has been trained in a rigorous curriculum.
2. Cell Source Is Important
This one is simple and straightforward. It's been determined that the best stem cell source for treating orthopedic conditions is bone marrow, and I've shared a great deal of research supporting this over the years. Stem cells from fat just don't work as well for orthopedic conditions as they are less able to repair musculoskeletal structures like cartilage and tendons. Find out which stem cell source your provider is using for orthopedic conditions. If it isn't bone marrow, find another provider. You may also hear about “amniotic stem cells” as you do your research. There is no such thing as commercially available amniotic tissue contains no viable stem cells.
3. Harvesting Technique Is Critical
Bone marrow aspiration (BMA) is the procedure used to harvest bone marrow stem cells. How the BMA is done is critical. Ultrasound or X-ray guidance is imperative to assure the harvesting is being done properly and from the right spots. Notice I said “spots.” Many doctors just harvest bone marrow from one single spot; however, we've known for many years that is not the correct way to do a BMA as it reduces the number of stem cells you get. It may be faster and easier for the doctor, and he or she can fit more patients on the schedule that way, but it's not what's best for the patient. Find out how your doctor does a BMA. If he or she is only harvesting bone marrow from one site rather than multiple sites, keep looking because you won't be getting a top-quality orthopedic stem cell treatment there. In addition, as above, see if your doctor has taken a rigorous stem cell harvesting course like the one offered by the Interventional Orthopedics Foundation.
4. Count the Cells and Know the Dose
There is no other area of medicine in which it is acceptable to have no idea of the dosage of what's being injected. And while it shouldn't be OK in the world of stem cell treatments, unfortunately, all too often, the doctor has no idea of the dosage. And not only do many doctors not know the dosage that's being injected, but it wouldn't matter anyway because they also have no idea what dosage is actually required for the treatment. Find out if your doctor knows the dosage required for your orthopedic stem cell treatment, and find out if he or she also knows how to measure the dosage being injected. This requires a sophisticated processing lab (see number 7 below), which most doctors do not have, and this lab is a critical component to a successful orthopedic stem cell treatment.
5. Getting the Stem Cells to the Right Spot
Once injected, stem cells don't magically know how to make their way to the right spot. Advanced imaging is critical to injecting the stem cells in the specific area of injury. There are a couple of key pieces of equipment your doctor should be using, and you can see these on the video at the top of this post. One is a C-arm fluoroscope, which allows us to place stem cells into specific areas of the spine or deep inside other joints like knees, shoulders, and hips. The other is an ultrasound, which allows for placement in things like tendons and ligament and other structures that are best viewed with this device. Find out if your doctor is using both of these technologies. One or the other device isn't really enough since some things are best seen with fluoroscopy and some with ultrasound. For example, watch a video of an advanced image-guided injection of the shoulder here to see both technologies being used during a stem cell procedure.
6. Some Meds Kill Stem Cells
Anesthetics are used during a stem cell procedure to numb the area. Certain common anesthetics, such as bupivacaine (e.g., Marcaine), kill stem cells. So if your doctor uses one of these anesthetics during your orthopedic stem cell treatments, this is bad news. On the other hand, if your doctor uses ropivacaine at the proper concentration, this will not kill your stem cells. So the anesthetic used can make all the difference between living and dead stem cells, or, in other words, a successful or an unsuccessful procedure. Find out what anesthetic your doctor uses during his or her orthopedic stem cell treatments. If it's bupivacaine (Marcaine), this is not the right place to get your orthopedic stem cell treatment.
7. Level of Lab Sophistication Matters
If numbers 1–6 have been met, and the stem cell clinic has a sophisticated, on-site lab, it's very likely you're getting a top-notch orthopedic stem cell treatment. One of the most important things we do as doctors is to tell our patients how we do what we do and to provide transparent results of our work to our patients. Patients need to know that what they are getting is real and that it's based on prior results, not fiction. Find out if the stem cell clinic has a sophisticated lab. In addition, find out if they are studying and publishing and if they are maintaining a patient registry and providing their own treatment results (the good and the bad). If so, these are great signs you are in the right place.
At Regenexx, we've looked at the long-term safety of our bone marrow stem cell procedures through the International Orthopedics Foundation's nonprofit registry. We tracked and then published in a top tier medical journal the results of 2,372 patients (or 3,000 procedures) out to nine years. We're also currently tracking more than 9,000 stem cell treated patients. Find out what your clinic or doctor does to assure the orthopedic stem cell treatment he or she is providing is safe. The upshot? If you are considering an orthopedic stem cell treatment, at the very least, make sure your provider has these 8 things covered. Doing so will give you the best chance at success both during and after your procedure.
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