I love writing about what I see day in and out. Yesterday I evaluated a patient who had been to a local West2North “stem cell” seminar and was told that they could regenerate cartilage in her foot. However, the joint they wanted to treat was without any cartilage and didn’t hurt and caused her no functional disability. Hence, this is a great opportunity to talk about the ethical use of orthobiologics.
The idea behind stem cells is pretty cool. They can help damaged tissue heal and may be able to replace certain types of damaged tissue. We’ve been using stem cells to treat joints for longer than anyone else on earth. What we’ve learned is that while stem cells, used in the correct way, can help get rid of the need for some invasive surgeries, they are not magic pixie dust, and they do have limitations. One of those is that they will NOT regrow cartilage in a joint without any left. Let me explain.
There are countless animal models where stem cells, used in very specific ways, can help small holes in the cartilage heal. However, we have no research that shows that stem cells can regrow the cartilage in a joint that has severe “bone on bone” arthritis. This is what we have observed in the clinic as well. Meaning that we have never seen any evidence of significant cartilage growth in “bone on bone” arthritis regardless of which stem cell type or prep was used. To see what is and isn’t possible in real MRI results with actual stem cell procedures, see my video below:
Regrettably, you got scammed! Like every good magic trick, there is always something you missed. In this case, I created a little example below of how I tilted the X-ray beam slightly and created the appearance of more joint-space width (hence more cartilage) in my knee:
Another trick often used is to inaccurately place the cursors while measuring the width of the joint. Below is an actual before and after “stem cell” treatment X-ray from a chiro clinic where they seem to have purposefully (or unconsciously) mismeasured the “after” X-ray, which makes it look like more cartilage is there, but in reality, the real width of the joint never changed. In this case, the real width of the joint is shown by the dashed lines, while the arrows point to where the chiropractor placed the cursor to measure the joint width. See what I mean below:
The treatments that are often offered at chiro clinics are amniotic or umbilical cord based. Regrettably, these tissues don’t have any living and functional cells, let alone stem cells. See my video below to learn more:
My patient is an active elderly woman who developed severe arthritis in her midfoot. One joint on both sides has no cartilage. This area doesn’t hurt or prevent her from doing anything. She went to a local West2North chiropractic “stem cell” seminar touting amniotic “stem cells” (really nonviable amniotic tissue) and was told they could regrow her cartilage. She then went to our local seminar and found out the opposite, so she came in to be seen. I told her that there was no way that any stem cell therapy (even a real one) would regrow cartilage in these joints, and I refused to perform a stem cell procedure.
The chiropractic clinic chain she went to was recently fined and stripped of its ability to perform “stem cell” injections by the attorney general’s office in North Dakota because it was misrepresenting what the technology could do. In Colorado, the West2North chain was the subject of an investigative report that found many disturbing things. For example, that a nonmedical person was the one determining candidacy for these procedures.
In some severe arthritis joints that are “bone on bone” and are causing pain, an actual bone marrow stem cell therapy can help reduce pain and increase function without regrowing any cartilage. For example, patients with this type of knee arthritis typically do well. This can work through precise X-ray guided direct injections into the bone lesions that can cause pain in these patients or by injecting lax ligaments that are causing instability. Even just injecting specific parts of the joint sometimes will reduce inflammation for two to seven years. However, in other joints, like the hip, the success rate in severe arthritis is much lower. Hence, it’s critical to understand which patients can be helped and which patients should be told that this therapy is not for them.
This comment from a former patient was recently left on Facebook:
“Paul Lyon- Lots of “stem cell clinic’s” have been opening up recently…Regenexx has been around since I think 08?…ask yourself before you jump into something, how many procedures have they done, how much research do they do…if your going to look into stem cell therapy, do your research….
I’ve had both knees done 6 years ago…2 orthopedic Doctors wanted to replace..im pretty much pain free. I bike, hike, ski, very active at 72….
I’m in Denver now, my wife just had her hip done..no surgery…we walked around Boulder the next day…all with her own stem cells…do your research, you’ll end up with a trained Regenexx doctor, you won’t be sorry…”
The upshot? Please don’t get snookered into believing that an injection by a nurse in a chiropractor’s office will regrow you new cartilage in a “bone on bone” joint. That isn’t going to happen. In addition, actually getting long-term results using a real stem cell procedure is difficult and requires a precise diagnosis of what’s wrong and which structures should be targeted using X-ray or ultrasound guidance.
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.…