Often we will get a phone call or email asking about stem cell therapy as a possible option in the treatment of “bone on bone knees.” Then we will be asked about the different types of stem cells that we may use in treatment, what are the long-term results, and, of course, most importantly, “will this work for me?” Let’s get to some research and answers.
The main types of stem cell therapy are:
Bone Marrow derived stem cells. There are stem cells taken from your own bone marrow and injected back into problem areas.
Adipose derived stem cells. There are cells taken from your own adipose or fat cells and injected into problem areas. The fat is taken typically from your abdominal area in a liposuction type procedure.
Umbilical cord stem cells and placenta derived stem cells. These are cells taken from the afterbirth umbilical cord blood and placenta material donated by the new birth mothers. These mothers donate the afterbirth materials to laboratories, after a screening process, the laboratories make these cells available to us for use in our patients. The donation does not harm either baby or mother in anyway. These cells are tested for infectious disease and the laboratories send us those testing results when we order the product.
Umbilical cord stem cells and placenta derived stem cells are the primary stem cells that we use in treatment. We use these stem cells for many different problems, they can be given as Intravenous (IV) or as an injection. The IVs can be given for general wellness, the injections are given into the knee.
Umbilical cord stem cells and placenta derived stem cells are the primary stem cells that we use in treatment.
Umbilical cord stem cells and placenta derived stem cells are a rich source of haematopoietic (blood) stem cells: Research shows these stem cells to be effective in repairing joint damage because they are “undifferentiated.” Undifferentiated means that they could turn themselves into material needed to repair a joint, for example bone, cartilage, or ligament and tendon cells.
The appeal of using Umbilical cord derived stem cells and placenta derived stem cells are that they are the youngest stem cells available for osteoarthritis treatment. They are considered “Day Zero Cells.” On the other hand, your own stem cells are as old as you are. The young stem cells are considered more robust, have more energy, and are in a better position to start the regenerative process.
Research on mesenchymal stem cells regenerative properties in knee osteoarthritis.
In this study, researchers suggest that Stem Cell Therapy has the potential to regenerate lost cartilage, stop and reverse cartilage degeneration, provide pain relief, and improve patient mobility.
Mesenchymal stem cells are stem cells that differentiate into connective tissue.
In a study, (1) from doctors at Georgia Regents University suggest: “(stem cell) cellular therapies have the potential to regenerate the lost cartilage, combat cartilage degeneration, provide pain relief, and improve patient mobility. One of the most promising sources of cellular regenerative medicine is from mesenchymal stem cells (MSCs). MSCs can be isolated from adipose tissue, bone marrow, synovial tissue, and other sources.” The excitement surrounding research on stem cell therapy for osteoarthritis centers on the possibility of stem cell therapy reducing the need for joint replacement as primary care for diseased joint. As noted in a well cited research study (2): “Our study has shown that injection of MSCs in different osteoarthritis affected joints is safe and therapeutically beneficial. However, further studies are needed with larger sample sizes and longer follow-up periods to confirm these findings.”
In a March 2020 study using Adipose derived mesenchymal stem cells, researchers tested Autologous stromal vascular fraction (adipose derived stem cells) versus placebo in the treatment of knee osteoarthritis. They wrote in The American journal of sports medicine:(3) “Intra-articular (adipose derived stem cells) injections can significantly decrease knee osteoarthritis symptoms and pain for at least 12 months. The efficacy and safety demonstrated in this placebo-controlled trial support its implementation as a treatment option for symptomatic knee osteoarthritis.”
A December 2016 study, (4) demonstrated findings that umbilical cord stem cell injections, once a month for for two months, significantly improve the joint function and quality of life for patients with degenerative knee osteoarthritis. It takes effect after 1 month and the treatment effect can be sustained for 6 months.
A June 2019 study (5) examined the bone repair characteristics of stem cells. The researchers wrote: “Stem cells have the ability to renew and differentiate into various tissues such as bone as part of bone tissue engineering. Several sources of mesenchymal stem cells (MSCs) are human amniotic MSCs within the amniotic membrane and human umbilical cord MSCs derived from the umbilical cord. The advantage of human amniotic MSCs and human umbilical cord MSCs is due to non-invasive and lack of morbidity during procurement process.”
Are stem cells a realistic treatment option for knee replacement?
In recent research doctors note that since joint cartilage possesses only a weak capacity for repair, its regeneration potential is considered one of the most important challenges facing doctors. Techniques such as drilling of bone (marrow stimulation techniques), Osteochondral transplantation and autologous chondrocyte implantation results have shown limited results.
Stem cells have been compared favorably to more traditional treatments such as surgery because they repair damage. Stem cells have also been compared favorably to chondrocyte therapy (injection of cartilage cells). The reason, stem cells can change the joint environment from degenerative to healing.
The challenges people face with knee osteoarthritis are many. One challenge is what type of treatments should they have short of knee replacement? For many people they have made a trip to the orthopedist and the run down of treatment options available seemingly all carry the same outlook. “Eventually you will need a knee replacement.”
In our practice, these inadequate treatments would be:
Many of the patients we see at the Magaziner Center come in for a first visit and tell us:
They have osteoarthritis.
They had a lot of treatments that were inadequate.
They have had a lot of costly treatments prescribed.
Research says stem cell injections to knee are long-lasting treatments
Many patients come into our office with knowledge that their previous treatments were not long-term solutions. Frequently they will ask, “how long do the injections work?” The stem cell injections are designed to work long-term. The factors involved in each case determine the number of treatments required to attain this goal.
Doctors at Chinese Academy of Medical Sciences and China’s Cellular Biomedicine Group (6) found that one of the reasons stems cell therapy is effective is that after a single injection, the new stems cells remained active (healing) for 10 weeks. This study was conducted on Human adipose-derived (fat) mesenchymal stem cells. The doctors also noted that this extended duration stay is required for stem cells to exert their functions on promoting joint regeneration and/or cartilage protection.
What is important here is that the stem cells are still healing 10 weeks later. This does not mean however that treatments should be scheduled 10 weeks apart or that a single treatment will heal years of degenerative damage. Significant joint damage requires significant treatment, and that is something we discuss with our patients.
Now that we understand that stem cells are very active in healing up to 10 weeks, what kind of long-term results does this offer?
Doctors at the Department of Orthopedics, Medical College of Shihezi University in China (7) published findings suggested in treated patients stem cell therapy offered long-term relief of symptoms. The doctors were able to conclude their long-term study by saying: “Stem Cell treatment in patients with knee osteoarthritis showed continual efficacy for 24 months compared with their pre-treatment condition. “
Here again we two years effectiveness following a single treatment. The goal of stem cell therapy is avoidance of joint replacement and increase in quality of life. It is important to know that if you have treatments and you go back to a job or sport that is very physically demanding you may need to expect more treatments down the road.
Having said that:
In the International journal of rheumatic diseases, (8) doctors from Tehran University found at the end of the five-year follow-up that stem cell treated knees were still better than before treatment.
Doctors affiliated with the University of Louisville (9) also reported good news for athletes seeking knee osteoarthritis repair without surgery, reporting that stem cell treatments not only restored damaged cartilage, but the repair also acted to prevent future deterioration of the knee joint.
University research from Italy (10) says stem cells have shown promising results in relieving pain and reducing inflammation in patients with more advanced osteoarthritis, helping many halts the progression of the disease and the need for joint replacement.
We have specialized, since 1999, in the non-surgical treatment of degenerative knee disease and injury recovery. We have performed tens of thousands of procedures. If you would like to explore more information on treating your knee pain, please contact our office so we can start a conversation with you.
1 Burke J, Hunter M, Kolhe R, Isales C, Hamrick M, Fulzele S. Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and Translational Medicine. 2016;5:27. doi:10.1186/s40169-016-0112-7.
2. Emadedin M. et al. Long-Term Follow-up of Intra-articular Injection of Autologous Mesenchymal Stem Cells in Patients with Knee, Ankle, or Hip Osteoarthritis. Arch Iran Med. 2015 Jun;18(6):336-44. doi: 015186/AIM.003.
3 Pers YM, Rackwitz L, Ferreira R, Pullig O, Delfour C, Barry F, Sensebe L, Casteilla L, Fleury S, Bourin P, Noël D. Adipose mesenchymal stromal cell‐based therapy for severe osteoarthritis of the knee: A phase i dose‐escalation trial. Stem cells translational medicine. 2016 Jul;5(7):847-56.
4 Wang, Y., Jin, W., Liu, H., Cui, Y., Mao, Q., Fei, Z. and Xiang, C., 2016. Curative effect of human umbilical cord mesenchymal stem cells by intra-articular injection for degenerative knee osteoarthritis. Zhongguo xiu fu chong jian wai ke za zhi= Zhongguo xiufu chongjian waike zazhi= Chinese journal of reparative and reconstructive surgery, 30(12), pp.1472-1477.
5 Hendrijantini N, Hartono P. Phenotype Characteristics and Osteogenic Differentiation Potential of Human Mesenchymal Stem Cells Derived from Amnion Membrane (HAMSCs) and Umbilical Cord (HUC-MSCs). Acta Inform Med. 2019 Jun;27(2):72-77. doi: 10.5455/aim.2019.27.72-77. PMID: 31452562; PMCID: PMC6688306.
6 Li M, Luo X, Lv X, et al. In vivo human adipose-derived mesenchymal stem cell tracking after intra-articular delivery in a rat osteoarthritis model. Stem Cell Research & Therapy. 2016;7:160. doi:10.1186/s13287-016-0420-2.
7 Cui G-H, Wang YY, Li C-J, Shi C-H, Wang W-S. Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis. Experimental and Therapeutic Medicine. 2016;12(5):3390-3400. doi:10.3892/etm.2016.3791.
8 Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal Stem Cell Therapy for knee osteoarthritis: 5 years follow-up of three patients. Int. J. Rheum. Dis. 2015 May 20. doi: 10.1111/1756-185X.12670.
9 Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.Open Access Journal of Sports Medicine. 2016;7:21-32. doi:10.2147/OAJSM.S72332.
10 de Girolamo L, Kon E, Filardo G, et al. Regenerative approaches for the treatment of early osteoarthritis Knee Surg Sports Traumatol Arthrosc. 2016 Jun;24(6):1826-35. doi: 10.1007/s00167-016-4125-y. Epub 2016 Apr 27.