Musculoskeletal Care of the Mature Patient

Stem Cells May Prevent Need for Joint Replacements, if FDA Allows It June 1, 2011 PRNewswire-USNewswire

“Preliminary studies show that many patients with osteoarthritis might be able to avoid total knee replacement with this therapy.”

The orthopedic surgeon has historically depended on comparative effectiveness research to provide the science for supporting results. Yet the explosive growth in the number of costly orthopedic procedures-including joint replacements, back surgeries, arthroscopic procedures and other treatments-has attracted the attention of legislators, payers, employers, and experts in both health care and economics. In many of these cases, there is no scientific evidence to support the effectiveness of these procedures. I am trying to understand how Platelet Rich Plasma affects the healing process and whether there is an appropriate type of PRP for a specific orthopedic condition. Minimally Invasive Needle Injection of stem cells and PRP have very little draw back and are certainly less costly treatment options than major surgical procedures with their inherent complications.

Platelets provide an autologous source of growth factors for healing and tissue regeneration. Studies involving the use of PRP for cartilage degeneration have shown consistently favorable results. PRP injections in the knee have resulted in less pain, improving function and enhancing quality of life. A comparison of Platelet Rich Plasma with hyaluronan injections (visco-supplementation) for osteoarthritis of the knee found improved scores with PRP.

Mesenchymal stem cells (MSCs) secrete large quantities of various cytokines and growth factors thereby modulating the local immune response. They can be harvested in large quantities, expanded and used to regenerate bone and cartilage.

The emerging field of regenerative medicine aims to provide the required elements to promote tissue regeneration; total joint resurfacing to manage conditions such as osteoarthritis. Development is being stalled by the Federal Food and Drug Administration regulation of cellular therapy. The potential for rebuilding tissue is similar to our embryonic development. What we know is that cartilage rebuilt from MSC influence is very functional; what is unknown is long-term remodeling behavior, which may compromise the biologic resurfacing. Before making any clinical decision regarding any and all forms of treatment be it surgery, Platelet Rich Plasma or Stem Cells, discuss your candidacy with an orthopedic surgeon as all medical procedures have a success and failure rates.

In continuing to assure my reader fairness and balance in the field of reconstructive surgery, I want to call your attention to the OA of the Knee Registry paper of which I am co-author that will be published as a supplement in the October, 2011 edition of Rheumatology News.

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