Why stem cells?
When there is an injury or other cause of tissue damage, the body responds by trying to heal or regenerate the damaged tissue. This consists of an initial inflammatory response mediated by platelets and other inflammatory cells. These cells secrete many growth factors and chemical mediators which in turn activate the regenerative response. This response includes activation of mesenchymal stem cells. Mesenchymal stem cells are found in all tissues of the body and are the cells most important in healing or regenerating tissue.
Stem cells act in a number of ways. First, they have the ability to change into other cell types depending on the tissue that is in close proximity, for example bone, muscle, tendon, cartilage or fat. Second, they have the ability to migrate to the areas of tissue damage. Third, they can stimulate growth of new blood vessels, prevent cell death, modify the immune response, prevent infection and decrease the amount of scar formation.
In areas of chronic injury or damage, the local stem cells may become depleted. Therefore, adding new stem cells to the area may help to restart the healing or regenerative process.
Where do we get the stem cells?
Although mesenchymal stem cells may be found in most body tissues, they are most abundant in bone marrow and fat, and both of these areas are currently being used as a source of stem cells for therapy. One should also note that the concentrate used in treatment is a mixture of many types of cells, not just stem cells. It is thought these cells all work in conjunction to maximize the healing response.
At this time we are using bone marrow to obtain our stem cell concentrate even though the total numbers of stem cells are actually higher in fat. We are doing this because there is a longer experience using stem cells from bone marrow and so far, at least the healing effects, seem very similar. Also, processing fat to obtain stem cells is more complicated and expensive. Furthermore, there remains some question as to whether the processing of fat is acceptable under current federal health guidelines.
Does everyone respond and how long will it take?
We still do not have enough data to completely answer this question. Most studies suggest that 60-80% of patients will have improvement in their symptoms. The limited data we have for our own patients suggest that most of them are responding as our average patient has reported a 76% reduction in pain after 6 months. We are continuing to collect more data in hopes to be able to identify who and what part of the body will benefit most from stem cell therapy.
The response is usually a process of gradual improvement with time and often takes 3-6 months to see optimum results and this improvement may even continue for 1-2 years or longer.
What are we treating with stem cells?
The most common problem we treat is arthritis, especially of the knees, hips, and shoulders but other joints are also treated including ankles, hands and feet and low back facet joints and SI joints. Other areas which may respond include chronic tendon damage such as rotator cuff of the shoulder, and tendons of the lateral hips, elbows, knees.
We use the initial assessment to determine which areas may be treated and may use test injections with local freezing and dextrose to assess which areas are most likely to respond.
How do we assess our results?
Each patient will fill out an initial pain assessment and we will then reassess the pain using the same validated pain questionnaire at 3, 6 and 12 months post treatment.
Is this a one time treatment?
Depending on the response at 3 and 6 months, we may suggest follow up treatments with dextrose or platelet rich plasma. As long as symptoms continue to improve or stabilize at a satisfactory level, no further treatments will be suggested.
We would like to wait at least 6 months before repeating any stem cell treatment to allow the original treatment adequate time to act on the affected site.