Ortho Stem Cell Treatments: The Importance of Delivery

Stem cell therapy is a alternative to traditional orthopedic knee surgery.  Mesenchymal stem cells (MSC) can differentiate into cartilage, bone, tendon, ligament and disc.  Studies have demonstrated that the use of cultured expanded mesenchymal stem cells are both safe and effective in the treatment of knee osteoarthritis.

Does it matter how the stem cells are delivered to a targeted area?

In the case of soft tissue this is not a concern since the surrounding tissue will confine the spread of the stem cells to the targeted area.

In the case of a joint such as the knee the delivery of cells  is of critical significance. The key is that stem cell function through local attachment to the damaged site.  Animal studies have demonstrated that cells injected into a large joint often times have difficulty finding their way to the damaged area.

The key is delivering  stem cells directly into the damaged site.  Koga demonstrated this by comparing the results of blindly injecting stem cells into a joint vs dripping the cells directly into the damaged area.  The illustration below tells the story.  A defect in the cartilage was created and different methods of delivery were examined.  On the left there was minimal cartilage growth after the injection of saline.  In the middle there was minimal cartilage growth after blindly injecting stem cells into the joint. On the right where cells were injected directly into the area of damaged there was robust cartilage growth.  The new cartilage is purple in color.

Bottom Line:  The exact placement of stem cells within a joint is of critical importance.

At the Centeno-Schultz Clinic we utitlize x-ray and MSK ultrasound to guide bone marrow and platetlet derived stem cells into the  area of damaged tissue to maximize clinical outcomes.

Knee Replacement Complications

Stem cell therapy is an alternative to knee replacement.  Studies have documented the success and safety of using bone marrow derived cells in the treatment of knee osteoarthritis in patients who were candidates for knee replacement.  Many of the patients at the Centeno-Schultz Clinic are concerned about the risks of knee replacement.

Listed below are some of the risks which have been discussed in  previous blogs.

1)  44% of patient s/p knee replacement continue to have knee pain.

2)   1 in 10 patients who have a knee replacement suffer a serious complication.

3)    Blood clots and potential pulmonary embolism.

4)     Premature failure as noted in hip replacements.

5)      Alteration in gait, creation of new pain and degeneration when incorrect prosthesis size is utilized.

6)      1 in 10 continue to have knee cap (patella) pain.

7)      Post operative pain in patients s/p knee replacement may have pain originating from structures other than the knee

8)      Patients who smoke are at increased risk for complications and death.

9)      Association with wear particles.  Wear particles are microscopic pieces of metal, ceramic, or plastic that break off of from the knee replacement or hip prosthesis and irritate the local tissues and/or enter the bloodstream.

10)   Increase in serum metal ion levels.

11)   Increase risk of death after age 70  The odds of dying from the surgery are 4 times higher in patients aged 70-79 years old.

13)  Patella resurfacing does not improve outcome

Distal Quadricep Tendinitis: A complication from blind knee Injection

The risks and possible complications associated with blind injections include failure, increased pain and injury and have been previously discussed.

At the Centeno-Schultz Clinic knee injections are performed under x-ray or MSK ultrasound guidance to ensure accurate placement of the PRP, Regenexx SCP or other platelet derived or bone marrow derived therapies.

Unfortunately when guidance is not used complications can occur.  SG is a case in point.

SG is an athletic 45y/o patient who sustained a meniscus injury and declined traditional surgery where a portion of the tear would be cut out.  Removal of a injured meniscus places increased force on the remaining knee structure and is associated with acceleration of the degeneration process.(blog).

SG acknowledged stem cell therapy as an alternative to knee surgery and opted to proceed with Regenexx SD.    He had undergone multiple therapies which included physical therapy, chiropractic adjustments and injection of  Synvisc, a medically approved DW40.  MSK ultrasound was not used.  SG reported that not only was the injection painful since the provider stuck him three times but after the injection the top portion of his knee cap was red, painful to the touch and movement of the knee was difficult.  It remained painful for weeks thereafter.

Diagnostic knee ultrasound at the Centeno-Schultz Clinic demonstrated inflammation and partial tear of the distal quadriceps tendon.  The previous knee injection most likely injured the tendon.  Complications such as these can be avoided with the use of MSK ultrasound guidance.