Stem Cell Therapy

Orthopedics

• Regenerative therapies including platelet rich plasma (PRP), stem cell therapy and others are gaining popularity for the treatment of various orthopedic conditions such as osteoarthritis, musculoskeletal pain, soft tissue injuries, sport injuries, etc.
• Due to quick recovery time after the procedure, minimal side effects and long term results including pain reduction and improvement in function, these therapies are often considered as an alternative treatment to conventional treatment such as cortisone injection and surgery.
• Conventional treatment using over the counter and prescription pain medications are commonly used to reduce symptoms, however have been shown to have significant side effects when used long term.
• Cortisone injections are also a commonly used conventional treatment to reduce pain and inflammation, however similar to previously mentioned medication, also have significant side effects. Furthermore, cortisone injections do not stimulate the repair of injured tissue.
• Surgery and/or joint replacement can be beneficial but is associated with potential surgery related complications and often involves a lengthy recovery time of many weeks if not months.
• Unlike, medications, cortisone injections and surgery, regenerative therapies support the natural repair process of injured tissues. Since chronic pain is often due to injured or damaged tissues treatment with regenerative therapies ultimately results in reduction of pain, inflammation and improvements in function and stability. In addition, patients often find they are able to reduce their use of over the counter and prescription pain medications.
• A multitude of research has been published on the safety and effectiveness of stem cell therapy in the treatment of orthopedic conditions, such as pain, osteoarthritis, cartilage degeneration, degenerative disc disease, and others.
• In 2015 Centeno et al conducted a multicenter analysis of over 2000 patients who received stem cell therapy for various orthopedic conditions involving multiple affected joints. The therapy was deemed safe and well tolerated with low rates of reported adverse events and substantially lower rates of serious or treatment related adverse events. More recent trials of stem cell therapy in orthopedic conditions also show safety and efficacy. A randomized controlled trial by Freitag et al revealed no serious adverse events during 12 month follow up and statistically and clinically significant improvements in knee osteoarthritis as measured by common assessments including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury Osteoarthritis Outcome Score (KOOS). Similarly, Hong et al observed significant improvements in knee osteoarthritis as measured by WOMAC scores, visual analog pain scale (VAS) and cartilage repair on MRI and no severe adverse events during 12 month follow up. A double blind randomized controlled trial by Lee et al also showed significant improvement in WOMAC scores as well as stabilization of cartilage defects and no serious adverse events. A 2018 systematic review and meta-analysis by Iijima et al of 35 studies involving over 2000 patients with osteoarthritis concluded that stem cell therapy improved VAS, self-reported physical function and cartilage volume and quality.
• A 2017 pilot study by Murphy et al assessed the efficacy of stem cell therapy in osteoarthritis of the thumb. They observed significant improvements in pain at rest and during activity, range of motion and strength during 12 month follow up. They also found that all patients who had a positive grind test at baseline had a negative grind test at 12 months.
• Mardones et al assessed the efficacy of multiple stem cell injections in patients with osteoarthritis and cartilage defects in the hip. They observed improvement in radiographic scores, hip range of motion and function during follow up period. They concluded that stem cell therapy proved to be safe and clinically effective for osteoarthritis of the hip.
• Sanapati et al conducted a systematic review of 21 studies to assess the effectiveness of PRP and stem cell therapy in the treatment of low back and lower extremity pain. Their data shows that both stem cell therapy and PRP may be effective in managing local and radiating low back pain originating from intervertebral discs, facet joints and sacroiliac joints.

References

• Centeno, C. J., Al-Sayegh, H., Freeman, M. D., Smith, J., Murrell, W. D., & Bubnov, R. (2016). A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. International Orthopaedics, 40(8), 1755–1765.
• Freitag, J., Bates, D., Wickham, J., Shah, K., Huguenin, L., Tenen, A., Boyd, R. (2019). Adipose-derived mesenchymal stem cell therapy in the treatment of knee osteoarthritis: A randomized controlled trial. Regenerative Medicine, 14(3), 213–230.
• Hong, Z., Chen, J., Zhang, S., Zhao, C., Bi, M., Chen, X., & Bi, Q. (2019). Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial. International Orthopaedics, 43(5), 1123–1134.
• Lee, W. S., Kim, H. J., Kim, K. Il, Kim, G. B., & Jin, W. (2019). Intra-Articular Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Phase IIb, Randomized, Placebo-Controlled Clinical Trial. Stem Cells Translational Medicine, 8(6), 504–511
• Iijima, H., Isho, T., Kuroki, H., Takahashi, M., & Aoyama, T. (2018). Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. Npj Regenerative Medicine, 3(1).
• Murphy, M. P., Buckley, C., Sugrue, C., Carr, E., O’Reilly, A., O’Neill, S., & Carroll, S. M. (2017). ASCOT: Autologous Bone Marrow Stem Cell Use for Osteoarthritis of the Thumb – First Carpometacarpal Joint. Plastic and Reconstructive Surgery – Global Open, 5(9).
• Mardones, R., Jofré, C. M., Tobar, L., & Minguell, J. J. (2017). Mesenchymal stem cell therapy in the treatment of hip osteoarthritis. Journal of Hip Preservation Surgery, 4(2), 159–163.
• Sanapati, J., Manchikanti, L., Atluri, S., Jordan, S., Albers, S. L., Pappolla, M. A., … Hirsch, J. A. (2018). Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. Pain Physician, 21(6), 515–540. Retrieved from

NOTES: In addition to stem cell therapy, other regenerative treatments for orthopedic conditions including platelet rich plasma, prolozone therapy, etc., are commonly used. Non-injection based supportive treatments are also important to maximize effects of regenerative therapies. This includes nutritional intravenous therapy, natural supplements, bio-identical hormone replacement, peptide therapy and more.