22 February 2024
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Will stem cell therapy eradicate knee replacements?

Dr Ross Walker
2 May 2019

Stem cell therapy has long been hoped to end the reign of total knee replacement as the mainstay of therapy for severe osteoarthritis of the knee. Having personally had two separate treatments with stem cells derived from my own abdominal fat, on my dodgy right knee, the first 10 years ago making me worse and the second more recent attempt giving only minimal benefits, I found the entire exercise rather disappointing, not to mention, quite expensive.

But recent work published in the journal, Stem Cells Translational Medicine, from the University Health Network in Toronto used a different form of stem cells. These stem cells are derived from the person’s own bone marrow, thus requiring the rather uncomfortable bone marrow aspiration to harvest these particular cells, known as mesenchymal stem cells. This small study of only 12 people with moderately severe knee osteoarthritis used one of three different doses of mesenchymal stem cells. The levels of inflammatory biomarkers, the rate of cartilage breakdown, general review of the knee with an MRI scan, along with questionnaires to determine the level of pain, impairment and mobility were all measured over a 12-month period.

During this time, there was a significant reduction in pain and self-reported improvements in quality-of-life. It is no surprise that the best results occurred in the patients given the highest doses of their own stem cells. There was significant reduction in the inflammatory markers but interestingly no cartilage regrowth. This suggests that it’s much more likely that the improvements come from the anti-inflammatory chemicals liberated by these mesenchymal stem cells, rather than any magical regrowth in cartilage. This raises the question as to the long-term viability. It’s all well and good to have a significant improvement over 12 months but at present these therapies are rather expensive, costing up to $10,000 per treatment with no guarantee of success.

There have been a handful of studies to date showing promise from this technique but again in all studies there has been no dramatic regrowth in cartilage. I must assume that it was the pure anti-inflammatory benefits of the stem cells that has given the benefits. Having had recurrent injections of Synvisc with weak benefits, a few bouts of PRP (your own platelets taken from your blood stream, spun down & injected into the knee), again with weak to reasonable benefits, there is still no doubt that as we approach 2020, the definitive therapy for knee osteoarthritis, especially for people over the age of 65, is a knee replacement.

Knee replacements are successful in 90% of cases but if you are in the 10% where they don’t work or complications arise, a reduction in your quality of life is a strong possibility in a minority of cases.

Regardless, knee osteoarthritis is a common cause of chronic pain. This has a profound and negative effect on the quality of life and whatever works for you should be pursued.

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