Do stem cells for bone on bone arthritis work? Based on questions from all sources, cartilage is something on many people’s minds. Patients often ask why we inject mesenchymal stem cells (MSCs) in patients with severe degenerative arthritis if the expectation is that we won’t be able to grow the large stretches of new knee cartilage in the way that a tire gets “retreaded.” The answer lies in the crucial need for an MSC reserve and the relief MSCs provide without resorting to drastic invasive surgeries, like joint replacements, that aren’t really all they’re cracked up to be.
The stem cells that live in many tissues in your body and allow for maintenance and self-repair are called mesenchymal stem cells (MSCs). Every healthy joint must have a certain number of healthy MSCs kept in reserve to assist the joint when the main MSCs kept for cartilage repair can’t function anymore. Like reserve soldiers, these cells are called upon when the main troops are burnt out. However, when even the reserve troops are all used up, an injection of your own stem cells into the joint may help replenish those critical warriors against continued joint breakdown.
A new study shows that stem cells for bone on bone arthritis is likely a good idea, as it was found that the MSCs within the joint weren’t sufficient to maintain the joint. The study found fewer MSC’s in arthritic joints, and the cells found were more likely to become bone or fat than cartilage. In addition, the MSCs found within the joint were less able to make additional copies of themselves, which is a critical function of stem cells.
While the MSCs in your joint may be all used up, there are other areas that are rich in stem cells. For orthopedic applications, two main MSC sources have been used: bone marrow and adipose (fat). Bone marrow MSCs are taken via a needle through a bone marrow aspirate. The bone marrow aspiration procedure sounds like a big deal, but we are consistently told by patients that the procedure is very comfortable.
The second type of MSC is derived from fat tissue (adipose). This can be obtained via liposuction. For orthopedic applications, fat derived MSCs consistently and dramatically underperform bone-marrow-derived cells. In studies of cartilage repair, bone repair, and soft-tissue repair, bone-marrow-derived MSCs are much more adept at these tasks. This makes sense, as they perform this function naturally every day. For example, if you break a bone, it’s these bone marrow MSCs that help mend that bone. Fat stem cells in your belly don’t perform these tasks naturally.
Watch my video below if you want a more in-depth lesson on bone marrow vs. fat stem cells. If you are considering stem cell treatment, this will also help you know what questions to ask your doctor regarding the types of MSCs he or she may be using.
The traditional orthopedic, or surgical, approach to severe arthritis is to amputate the joint and insert an artificial joint. What are the risks of cutting out a joint? A dramatic rise in heart attack and stroke risk, wear particles from the joint prosthesis, toxic metal levels in the bloodstream, and chronic pain.
The interventional orthopedic, or nonsurgical, approach? Discover and treat the underlying causes of the issue, and treat the arthritis in the joint itself. In addition, look at the whole body. Are there low-back nerves misfiring which affect the function of tendons and ligaments which in turn affect the function of the knee? Are the ligaments in the knee itself unstable, allowing for sloppy movement creating wear and tear beyond the knee’s ability to repair? Is there damage to the cartilage, meniscus, or bone marrow lesions? These issues are treated by highly skilled physicians with customized and precise image-guided injections of platelets and/or stem cells directly into the problem areas. Does this work for stem cells for bone on bone arthritis? Our treatment registry data suggests that it helps many patients.
While we have seen MRI evidence of smaller holes in the cartilage filled in, in general, we don’t see MRI evidence of cartilage regeneration in patients with severe arthritis where there is none. Having said that, stem cells can do some pretty cool things, all of which are pretty revolutionary:
The upshot? If you have small cartilage problems, bone-marrow-derived MSCs using precise placement of stem cells into the problem area, performed by an experienced interventional orthopedics provider, may help repair your cartilage or at least provide relief. If you have severe cartilage loss, then a stem cell procedure isn’t going to “retread” your knee with loads of new cartilage. However, based on our extensive registry data, stem cell procedures can often provide years of pain relief and improved function in “bone on bone” patients.
When considering a drastic surgery, such as a joint replacement, for your arthritis, it’s a good idea to look beyond the traditional orthopedic approach. Explore the interventional orthopedic approach to see if replenishing your MSCs might be the right answer for you.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…