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Stem Cells

Orthopedic Stem Cell Therapy

 

You may benefit from orthopaedic stem cell therapy if you have:

  • Degenerative Joint Changes (Including Osteoarthritis)
  • Cartilage Injury
  • Rotator Cuff Tear
  • Athletic Injury

How Does Orthopedic Stem Cell Therapy Work?

Mesenchymal stem cells (MSCs) are adult stem cells found in bone marrow. The Joint Preservation Institute of Iowa performs autologous stem cell therapy, which means that the stem cells used in your treatment are taken from your own body, not from a donor. Using your own stem cells for the procedure helps reduce your risk of infection and eliminate the possibility of immune rejection.

In an autologous stem cell procedure, Dr. Goding will draw a sample of bone marrow from the iliac crest of your hip. The sample is filtered and concentrated in a sterile environment, then injected into the area of your body needing help to heal. This procedure is done on an outpatient basis while under sedation and leaves no scarring.

The idea behind orthopaedic stem cell therapy is that the injection of these concentrated regenerative cells at an area of your body experiencing degeneration will kick-start your body’s ability to heal itself. These injections can be given as an independent treatment or in conjunction with a surgical procedure.

What is a Stem Cell?

Most cells in the human body have an assigned purpose. They are liver cells, fat cells, bone cells and so on. These cells can replicate more of their own kind, but they cannot create another type of cell.

Stem cells are the primitive cells from which all other cells developed. They are undifferentiated cells with the ability not only to self-replicate, but also to become different types of human cells. There are several types of stem cells, but the kind used in orthopaedic stem cell therapy are called mesenchymal stem cells (MSCs).

 

Stem Cell Therapy Treatments

 

 

IRAP (Interleukin -1 Receptor Antagonist Protein)

IRAP is the newest treatment in the field of injectable orthobiologics. This procedure is essentially a further processing of platelet rich protein (PRP).

The tremendous advantage of IRAP is that it is derived from the blood instead of bone marrow. It is less painful, has less potential for injury, is less costly and it provides similar results.

After IRAP is derived from the blood, it is processed into IRAP and then processed into IRAP. Using IRAP prevents macrophage cells from destroying healthy cartilage cells and has a profound anti-inflammatory effect in the joint. It also promotes growth and health  of existing cartilage cells.

A recent study has shown up to 70 % pain reduction at 6 months in patients undergoing this procedure.

An MSC has strong potential for tissue repair because it can:

  • Self-replicate
  • Reduce inflammation
  • Combat cell death
  • Differentiate into more than one specialized cell of the body (including bone cells, muscle cells, cartilage cells and fat cells)

In medical research, tissues such as muscles, cartilage, tendons and ligaments have shown some capacity for self repair. As a result, tissue engineering and the use of MSCs and/or bio-active molecules, such as growth factors, are being tested and studied to determine the role they can play in tissue regeneration and repair.

Orthopedic Areas of Interest for Stem Cell Therapy

Articular Cartilage – Damage to the articular cartilage following an injury has poor potential for repair and can lead to arthritic changes many years later. Recent studies have shown favorable outcomes and better knee scores at two-year follow ups for bone marrow derived MSCs that those of current techniques of microfracture and autologous chondrocyte implantation.

Bone – Trauma and some pathological conditions can lead to extensive bone loss, which requires transplantation of bone and other bone substitutes to restore structural integrity. A large number of studies have shown great potential for mesenchymal cells to repair critically sized bone defects, producing better bone growth and more robust bone formation than controlled groups.

Tendons and Ligaments – Injuries to tendons and ligaments heal by forming new tissues of inferior quality. Autografts, allografts and resorbable materials have been used to repair defects in tendons and ligaments, but these carry risks, such as donor site morbidity, scar formation and tissue rejection. A number of studies on the use of MSCs to improve the repair of tendons and tendon defects have been carried out with favorable results when measured in histology and tissue strength. The use of mesenchymal cells with tissue allografts enhances the graft and improves the biomechanical properties compared to control studies.

Meniscus – Most tears of the meniscus occur in avascular zones with little or no potential for repair. Standard biological healing processes produce limited results and meniscectomy (removal of all or part of the torn meniscus) has been shown to have a strong association with subsequent development of osteoarthritis. Recently, studies have shown that self-paced therapy, including MSCs, demonstrates biological healing and adherence of meniscal tears in avascular zones.

What to Expect with a Stand Alone Stem Cell Therapy Procedure:

Initial Visit – An initial consultation with Dr. Goding will be required to find out if you are a candidate for stem cell therapy. In some cases, an MRI may be recommended to confirm your diagnosis and rule out any underlying conditions that could cause complications. If you are determined to be a candidate for stem cell therapy, your procedure will be scheduled for another day. This initial consultation is usually covered by your insurance plan.

Preparation – For two weeks prior to your procedure, do not take aspirin or anti-inflammatory medications (NSAIDS).

Procedure – Stand-alone stem cell therapy is done as an outpatient procedure, so most patients will leave the clinic and resume low impact activities the same day. Some patients have reported mild pain for 48-72 hours after their procedure, but this can often be attributed to the absence of their routine anti-inflammatory medications. After this time period, most patients will experience a gradual decrease in pain and some may begin to notice increased function.

Post-procedure – To give your procedure the best chance to provide lasting results, our physicians recommend the following post-procedure restrictions:

  • Do not take anti-inflammatory medication for two weeks after your procedure
  • Rest for the first 24-48 hours after your procedure
  • Restrict the treated joint to low impact/general use for the first two weeks
  • On weeks three and four, you may resume walking, cardio and light lifting
  • After four weeks, you may resume running and weightlifting
  • Pay special attention to the treated joint and contact your physician with any questions or concerns you may have

Please note: If you are having a stem cell therapy procedure in conjunction with another surgical procedure, your recommendations may change. Consult with your physician on the guidelines and restrictions for your specific case.

Is Orthopedic Stem Cell Therapy Covered By My Insurance?

No. Because mesenchymal stem cell (MSC) injections are considered investigational for orthopaedic applications, most insurance companies will not cover the cost. Please contact our office to discuss cash payment options.

References:
  1. Centeno, Christopher, et al, Regeneration of meniscus cartilage in a knee treated with percutaneously implanted autologous mesenchymal stem cells, Medical Hypotheses (2008) 71, 900–908.
  2. Kovacevic BS, David et al, Biological Augmentation of Rotator Cuff Tendon Repair, Clin Orthop Relat Res (2008) 466:622–633.
  3. Rotini, Roberto et al, New perspectives in rotator cuff tendon regeneration: review of tissue engineered therapies, Chir Organi Mov (2008) 91:87–92.
  4. Tow B., et al, Disc Regeneration: A Glimpse of the Future, 2007 The Congress of 128 Neurological Surgeons.
  5. Chen, Faye, et al, Technology Insight: adult stem cells in cartilage regeneration and tissue engineering, NATURE CLINICAL PRACTICE RHEUMATOLOGY, JULY 2006 VOL 2 NO 7, 373-382.
  6. Zantop, Thore et al, Extracellular Matrix Scaffolds Are Repopulated by Bone Marrow-Derived Cells in a Mouse Model of Achilles Tendon Reconstruction, Journal of Orthopaedic Research June 2006, 1299-1309.

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Our orthopedic surgeon, Dr. Richard Goding, is here to help. Call us at 515-381-3410 to schedule an appointment, or fill out an online form by clicking the button below.

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