Stem Cell Subchondroplasty for Arthritis
This past Sunday, I was in COSTCO and, noticed goods dealing with summertime recreation in the aisles. It was 27 degrees in Chicago with sheets of ice on the streets and sidewalks. Tuesday morning it was 60 degrees and tomorrow, snow is forecast; how quickly things change. The same applies to Cellular Orthopedics so let me introduce you to the future that is happening now. Subchondroplasty®, a new approach to the arthritic knee is gaining huge interest among orthopedic surgeons by providing a minimally invasive option for addressing one aspect of knee osteoarthritis. I have previously written that there are several possible explanations for pain generators in osteoarthritis. It turns out that the number one predictor of pain in patients with knee arthritis is thought to be something called a bone marrow lesion (BML), and it can only be seen on MRI. Once you develop BMLs, which can usually be found underneath a cartilage lesion, then two things are predictable. First, you will have pain. Second, your odds of going on to have a total knee surgery have increased…likely as high as 9x! The reason is because BMLs represent the healing response surrounding an insufficiency fracture within the subchondral bone. There is pain because the bone starts to collapse and eventually you will probably go on to a total knee replacement. With the Subchondroplasty® procedure, a small hole is drilled into the bone and the defect is filled to date with calcium phosphate lending support while the body tries to heal the fracture. The bone substitute being used is injectable into cancellous bone and is resorbable; so you can still have a knee replacement in the future if it is required. I have a different approach, why not inject Bone Marrow Aspirate Concentrate?
The purpose of Subchondroplasty® is to fill the defect while the insufficiency fracture undergoes healing. Patients typically notice a change within one week, but the bone substitute material continues being resorbed over one to two years. Instead of patching the bone marrow lesion, why not influence permanent healing with stem cells? Although still unproven, the technique developers believe that their approach will slow the cartilage changes and delay the inevitable total knee surgery. Might Stem Cells influence bone healing for permanent repair rather than a one to two year patch with Calcium Phosphate? They are getting about 80% good results at two years, and have just published articles in the American Journal of Orthopedics and Techniques in Knee Surgery. Several additional publications are coming out in the next couple months. Over 1,200 of these procedures have been performed in the past two years at The Rothman Clinic. I will be offering Stem Cell Subchondrolasty not with a patch but with stem cells to possibly permanently influence healing of the subchondral bone.