Conservative approaches to osteoarthritis treatment include the use of analgesic or non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy, weight loss, and injections of cortisone or viscosupplements (lubricants). So what happens when that no longer works?
Most baby boomers are under the impression that when the time is right and their osteoarthritis is bad enough, they’ll just get that joint replaced. Right? Wrong.
More than 700,000 total knee replacements were performed in the United States last year and that number is expected to climb exponentially as the Baby Boomers rocket into their 60’s and beyond. So why’s that a problem? Well, it’s because there are short term complications associated with the process including infection, blood clots to the lungs, and death. And longer term complications including breakage and loosening of the prosthesis, infection, and persistent pain. And the replacement itself needs to be replaced within ten to fifteen years. This revision surgery is a much more difficult procedure. With people living longer, the odds of having to undergo revision are pretty high.
Fortunately, there is an alternative: the use of mesenchymal stem cells.
While the early research looks very promising, there are some precautions one should take before seeking out a treatment such as mesenchymal stem cells for your osteoarthritis.
- know about mesenchymal stem cells
- your homework
- maintain ideal weight
- stay active and eat a healthy diet
- ask questions
- get your imaging procedures done
- rush into things
- go for low price
- fall for a fancy website
- believe statistics
- think it’s just injecting the cells into the joint
Do know about mesenchymal stem cells
Mesenchymal stem cells are non-blood derived stem cells found in a number of places including the bone marrow, fat, periosteum of bone, and the lining of the joint. Mesenchymal stem cells are ‘blank slate’ cells that can be programmed to become any type of tissue, given the right instructions and the right environment. In addition, they have immunomodulatory and anti-inflammatory effects. Multiple studies conducted in animal models have shown that mesenchymal stem cells can regenerate cartilage in osteoarthritis. Also, many small studies done in humans have demonstrated that mesenchymal stem cells can heal cartilage damage and possibly reverse the process of osteoarthritis.
Do your homework
As with any type of medical procedure you need to do some research, in fact, do a lot of research in order to determine what the right treatment approach is for you. The topic of stem cell therapy, unfortunately, has gained much publicity because of the multiplicity of charlatans and quacks that have pounced on unsuspecting and unwitting patients. In fact, the show “60 Minutes” has done at least two exposes on the topic. Stem cells are not a cure-all for every condition.
While dismissing the hype is key, so is avoiding the naysayers. Some people think it’s all hocus-pocus. Don’t believe them either. Do your research and make sure where you are thinking about getting stem cell treatment is reputable, qualified, and certified.
Do maintain ideal weight
Regardless of the type of treatment, it’s important that ideal weight be maintained. There are two reasons. First, the obvious mechanical one. Since osteoarthritis preferentially attacks weight-bearing joints, the more weight you have to carry around, the worse things will be. In fact, there is a multiplication factor. For every one pound extra you carry around your middle, your weight-bearing joints see five extra pounds. Also, recent research has shown that fat cells produce leptins, proteins that aggravate inflammation. So if you’re above ideal weight, you’re carrying around an inflammation producing factory.
Do stay active and eat a healthy diet
The best results that have been seen are in patients who are active and who continue to stay active. While protection of stem cell growth early is important, once things are established, activity actually stimulates stem cell growth.
Not only do you need to stay active, you need to maintain a healthy diet as well. The stem cell procedure will help, but you may need to alter your lifestyle as well.
Do ask questions
There are certain questions you should ask your physician before undergoing the procedure. Here are some of the main questions you should ask, and if you have any other questions not listed here, don’t be afraid to ask.
- Is the physician board-certified? If not, walk away.
- What are they board-certified in? It should have something to do with arthritis, either rheumatology or orthopedics.
- Have they published? They should have published their findings and presented their work at meetings.
- Do they use both ultrasound and arthroscopic guidance for their procedures? They should use both.
- How many cases have they done? It should be well above fifty.
- Do they use standard operating procedures (SOPs) and checklists? All airline pilots, regardless of experience, use checklists before flights. A team that does stem cell procedures should do the same.
- How responsive are they? Do they return your calls and emails?
- What type of anesthesia? A stem cell procedure can be done using either local anesthetic or block. General anesthesia is not necessary.
- What kinds of stem cells? Are they autologous (meaning your own stem cells) or are they allogeneic (meaning coming from a donor). There are advantages and disadvantages with both. Make sure to discuss this with the physician.
- Is the procedure done in a sterile environment? An ambulatory surgical center procedure room or operating suite is best.
- And more straight forward, are they recognized as an expert in the field?
Do get your imaging procedures done
Both x-rays as well as MRI are important roadmaps for the doctors to use to aid them in the treatment. Get your imaging procedures done by a facility that has up-to-date x-raying machines and can perform an MRI to help the doctor recognize soft tissue areas of concern.
Do not rush into things
Your osteoarthritis didn’t happen overnight, and neither should your decision to get stem cell treatment, or joint replacement surgery for that matter. You need to do your homework and make sure you make the right decision.
Do not go for low price
A properly performed mesenchymal stem cell procedure is expensive to perform, so if you’re looking for low price, remember that you get what you pay for. The cost of a procedure varies widely and it is dependent on a number of factors including the type of procedure, the types of equipment used, the experience of the team, and the expertise of the physician. I have seen the charges range anywhere from $2,000 up to $30,000. Don’t expect to get a Mercedes for the price of a Kia.
Do not fall for a fancy website
The internet is replete with offers from supposed stem cell clinics that promise an instant cure. Don’t believe it. What you want is good information, skill, experience, and a good team, not a fancy website that appears more like a gimmick than a skilled and certified in joint therapy.
Do not believe statistics
Sure, a center can tell you they have 100% success. Do you think that’s true? All medical procedures have both good results as well as not so good results. There is no procedure that works 100% of the time.
Do not think it’s just injecting the cells into the joint
A properly done stem cell procedure is not just shooting stem cells into a joint. Besides the stem cells, a matrix (scaffold), growth factors, and coagulation inducers are need, so is injury induction guided by arthroscopy. The procedure that appears to work the best is called the guided mesenchymal stem cell layering technique.
Keep in mind too that the procedure isn’t an overnight quick fix. A properly done stem cell procedure requires a period of recovery, just like any procedure. Listen to the physician. They will guide you in your recovery and give you instructions for post-care follow ups and what you can do and not do after treatment.