Stem Cell Interventions for Knee? Where do we stand!!

These days orthobiologics and regenerative medicine  for musculoskeletal  pain conditions is making a big stride across the western hemisphere and also finding its roots in south Asia, but few questions always crop up how effectively stem cell work for knee? Can they repair knee cartilage? How long they last?

How this idea of injecting same day stem cell (orthobiologics) Come into existence?

Usually patients with moderate to severe knee arthritis are generally offered traditional remedy, mainly surgery if they fail to get better with physiotherapy and basic medicines, In Indian subcontinent option of surgery is given even a bit earlier due to various factors, in western studies approximately 7 lakh knee replacement were completed in 2006 alone in USA and that number was set to rise to 3.5 million annually by 2030 (1)

In India the incidence of Knee OA is around 28-30% for a population of over a billion, which makes it an epidemic if you look at it closely (2)

This is a big surgery, and though very safe due to advances in the techniques, a recent study demonstrated that in many patients the procedure did not work that well as expected (3), the problem was patient selection, younger age who are more in more age active group, plus the understanding that knee pain in OA is more complex than previously considered.

So the idea of knee stem cell came into play almost two decade back, which is less invasive, and pushes back the need for a knee replacement for years together in middle age group and younger till they are more older, and is also helpful in patients who do not want to undergo knee replacement by mitigating their pain for few years.

What do they do?

Lot of claims that it regenerates the knee cartilage, which is of course not right, most of publication is coming from same day BMC (bone marrow concentrate)(4) where, stem cell are obtained from your iliac crest on hip and after same day centrifugation re-injected on same day, it has shown to help small tears, cartilage defects by improving the microenvironment  and a positive view in MRI images (5,6), it helps by changing the chemicals in knee joint, improving your pain, improving the quality of remaining cartilage, avoiding fast progression of the knee arthritis , thus it makes the knee more healthier, so it does not regrow, but helps in improving the general health of knee joint which is more than just bone on bone.

How long does it last?

Studies have shown the beneficial of one time same day Bone marrow stem cell intervention to last anywhere between 2-7 years, depending on your wear and tear your activity level.

Reference:

1. Kurts S, Ong K, Lau E, Mowat F. Projections of primary and revision hip and knee arthoplasty in United states from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr; 89(4):780-5.
2. Chandra Prakash Pal, Pulkesh Singh. Epidemiology of Knee Osteoarthritis in India and related factors, Indian Journal of Orthop.2016 Sep;50(5):518-22.
3. Ferket Bart S, Feldman Zachary, Zhou Jing, Mazumdar Madhu et al. Impact of total knee replacement practice: Cost effectiveness analysis of data from Osteoarthritis Initiative BMJ 2017;356.
4. Centeno CJ, Jusse D, Kisiday J Karli D. Increased knee cartilage volume in degenerative joint disease using percutaneoulsy implanted, autologous mesenchymal stem cell. Pain Physician.2008 May-Jun;11(3):343-53.

Vangsness Ct Jr, Farr J, Boyd J, Dellareo DT, Mills CR, LeRoux-Williams. Adult Human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double –blinded, controlled study. J Bone Joint8. Surg