Stem cell therapy as a possible alternative to joint replacement

The joints have a complex anatomical structure. Every day they are exposed to heavy loads during the performance of normal tasks, work and sports. Over time, the articular cartilage covering the heads of the bones loses moisture, becomes more fragile and wears out. This process is often accompanied by severe pain, inflammation, and stiffness.

To alleviate the symptoms at the first stage, conservative drug therapy is prescribed. If it does not help, the only way to restore the quality of life is an arthroplasty (complete or partial replacement of the joint). However, not all patients are candidates for surgery. Some of them are afraid of possible side effects, others have contraindications to surgery. With the development of regenerative medicine, a new method of treatment has appeared, which, in certain cases, can be considered as an alternative to endoprosthetics. It’s about stem cell therapy.

What diseases may require joint replacement?

When it comes to large joints such as the knee and hip, symptomatic osteoarthritis is the most common cause requiring hip replacement surgery. More than 80% of hip and 96% of knee surgeries are associated with symptomatic degenerative changes in the articular surfaces caused by osteoarthritis.

Other possible reasons for arthroplasty are:

• Chronic inflammatory rheumatic diseases;
• Pathological changes in the bone substance due to primary tumors, metastases or osteoporosis.

However, they are much less common.

Available treatments for osteoarthritis

Osteoarthritis is a progressive, painful condition that can affect both young and old people. The symptomatic form occurs in 10% of men and 18% of women over 45 years of age.

The current treatment strategy for osteoarthritis focuses on reducing pain and controlling symptoms rather than addressing the cause of the disease. Pharmaceutical therapies are limited and are associated with the risk of side effects.

Total joint replacement is currently the standard choice for symptomatic osteoarthritis that is not controlled with conservative therapy. The number of such operations carried out in the world is steadily growing. However, this treatment method is not without its drawbacks. Approximately 20% of patients will continue to experience pain and other symptoms after a hip or knee replacement. There is also a risk of serious complications such as thromboembolism and infection requiring readmission, which occur in 2% of patients.

Stem cell therapy is a method that can help delay or avoid arthroplasty when treated in the early stages of osteoarthritis, when cartilage has not yet been completely destroyed. Mesenchymal stem cells are used to restore joints. The essence of the technique is to introduce them into the damaged area.

What are mesenchymal stem cells (MSCs)?

More than 40 years have passed since mesenchymal stem cells were described by Dr. Alexander Friedenstein. Initially, they were found in the bone marrow. Later, they were also found in peripheral and umbilical blood, skeletal muscle, heart, and adipose tissue.

MSCs are capable of differentiating (transforming) into bone cells (osteoblasts), cartilage (chondrocytes), and adipose tissue (adipocytes). Their presence throughout the body suggested that they play a role in tissue repair and regeneration.

How do stem cells work in the treatment of joints?

Currently, scientists are considering two mechanisms of action of mesenchymal stem cells:

• MSCs differentiate (turn) into cells of a certain type and replace damaged or missing cells in bones, cartilage, ligaments or tendons;
• MSCs secrete paracrine factors, specific molecules that reduce inflammation, which plays a key role in cartilage degeneration.

In general, treatment contributes to the restoration of damaged articular structures. In the first few days after administration, the inflammatory process decreases until it is completely eliminated, which is accompanied by pain relief. In addition, cell therapy contributes to:

• Strengthening and growth of new blood vessels, normalization of blood circulation (articular tissues receive more nutrients and growth factors that stimulate the healing process of damaged areas of bones, cartilage, tendons and ligaments);
• Slowing down the progression of the disease, which makes it possible to delay or avoid endoprosthetic surgery;
• Restoration of mobility and stability of the joint, so that the patient can return to a full life.

Regenerative cell therapy is not a unique or experimental treatment. It has proven itself in such areas as transfusiology (blood transfusion), bone marrow transplantation, reproductive in vitro fertilization. Now it is successfully used in other areas of medicine, including orthopedics.

What do the studies show?

In recent years, numerous clinical trials have been conducted that have proven the effectiveness of the treatment of joint diseases with stem cells. As an example, there are several studies conducted at the Prodromos Stem Cell Institute in Maryland.

1. Treatment with autologous (taken from the patient) mesenchymal stem cells has proven effective in the treatment of osteoarthritis of the knee. Regenerative therapy has shown good results in relieving the symptoms of the disease for at least 6 months after the procedure.
2. Cellular therapy using MSCs derived from adipose tissue and bone marrow, in combination with the use of platelet-rich plasma, is an effective alternative to knee arthroplasty in patients with moderate arthrosis. In some cases, after treatment, patients did not even need to take medication.
3. Injections of autologous mesenchymal cells for the treatment of osteo- and inflammatory arthritis are recognized as completely safe. During the study, scientists did not identify adverse events specific to stem cells, such as infection, oncogenesis, or chondrolysis.

Research is still ongoing, but the results already available suggest a high potential for cell therapy in the treatment of orthopedic diseases.

How is stem cell treatment performed?

The therapeutic process includes the following steps:

1. The doctor’s consultation. The doctor will conduct a physical examination, review the medical history, determine the indications and contraindications for cell therapy, and answer the patient’s questions.
2. Medical preparation. Based on the results of the diagnosis, the doctor may prescribe certain medications that will prepare the patient’s body for stem cell treatment.
3. Introduction of cells. The doctor will inject the cell preparation into the joint under ultrasound control. On average, the procedure takes 30 minutes.
4. Final reception. At the final stage, the doctor will draw up a medical report on the treatment performed and give further recommendations.

The cost of treatment of joints with stem cells

The price of joint cell therapy varies depending on the severity of the disease, the type of stem cells used, and the duration of the treatment. In general, we can say that the cost of therapy is comparable to the price of arthroplasty, but at the same time, stem cell therapy is not associated with operational risks and does not require long-term recovery.

Frequently Asked Questions about Joint Cell Therapy

Where do stem cells come from?

Stem cells can be autologous (own) or donated. In the treatment of own cells, they are obtained from the blood, bone marrow or adipose tissue of the patient. Then they are cultivated and propagated in the laboratory. The preparation time is from 14 to 21 days. When using donor cells, there is no need to wait. They are picked up in a cryobank and administered to the patient immediately after the diagnostic examination and drug preparation.

What orthopedic diseases can be treated with stem cells?

Cell therapy can be effective in treating:

• osteoarthritis of the hip, knee, shoulder and ankle joints;
• chronic partial rupture of the rotator cuff;
• persistent partial tendon ruptures (epicondylitis, plantar fasciitis, quadriceps and patellar tendon ruptures);
• muscle strain;
• meniscus tear;
• discogenic back pain;
• chronic radiculopathy;
• pain in the sacroiliac joint.

What is the success rate of stem cell treatment?

As with many other treatments, the success of stem cell therapy depends on many factors. These include: the severity of the disease, the age of the patient, the presence of concomitant diseases, the list of medications taken. Therefore, you can only find out if you are a candidate for cell therapy after an examination by a doctor.

How quickly can the result of joint stem cell treatment be assessed?

The time it takes to see the result of cell therapy varies from patient to patient. Some people report feeling better as soon as a couple of days after the procedure. However, on average, a significant improvement in symptoms and improvement in physical activity occurs after 4-6 weeks.

Please note that this article is for informational purposes only. The best way to determine if you are a candidate for stem cell joint treatment is to consult with your doctor. You can make an appointment for a consultation by phone or using the feedback form.

Frequently Asked Questions

1

Where do stem cells come from?

Stem cells can be autologous (own) or donated. In the treatment of own cells, they are obtained from the blood, bone marrow or adipose tissue of the patient. Then they are cultivated and propagated in the laboratory. The preparation time is from 14 to 21 days. When using donor cells, there is no need to wait. They are picked up in a cryobank and administered to the patient immediately after the diagnostic examination and drug preparation.

1

What orthopedic diseases can be treated with stem cells?

Cell therapy can be effective in treating:

• osteoarthritis of the hip, knee, shoulder and ankle joints;
• chronic partial rupture of the rotator cuff;
• persistent partial tendon ruptures (epicondylitis, plantar fasciitis, quadriceps and patellar tendon ruptures);
• muscle strain;
• meniscus tear;
• discogenic back pain;
• chronic radiculopathy;
• pain in the sacroiliac joint.

1

What is the success rate of stem cell treatment?

As with many other treatments, the success of stem cell therapy depends on many factors. These include: the severity of the disease, the age of the patient, the presence of concomitant diseases, the list of medications taken. Therefore, you can only find out if you are a candidate for cell therapy after an examination by a doctor.

1

How quickly can the result of joint stem cell treatment be assessed?

The time it takes to see the result of cell therapy varies from patient to patient. Some people report feeling better as soon as a couple of days after the procedure. However, on average, a significant improvement in symptoms and improvement in physical activity occurs after 4-6 weeks.

Published: 05.03.2023

Updated: 06.03.2023

Medical author, Medical editor:

Olena Kursabaieva

Medical author:

Ilona Baidiuk

Information on this webpage verified by the medical expert

Medical Doctor, oncologist, PHD student

Kateryna Maliarchuk