Home › Blog › Understanding a Knee Arthritis Stem Cell Treatment Failure

One of the things that has always separated Regenexx is that we have no issues discussing our failures. Hence, I periodically blog on patients who didn’t get the expected result. This is the story of a stock futures trader who at first responded but ultimately still needed a knee replacement, despite getting treated with culture-expanded mesenchymal stem cells in Grand Cayman.

We Are Transparent on Outcome

If you really want to see all of our treatment data, it’s only a click away. You can load our outcomes tool and see real-time data from our registry that’s updated monthly. You can figure out how many patients we’ve treated and how the whole group fared on multiple different metrics. Nobody else on earth who uses stem cells to treat orthopedic patients has this capability.

How Does Knee Arthritis Severity Impact Stem Cell Treatment Outcome?

We have spent many years looking for a correlation between stem cell treatment outcome and the severity of knee arthritis. We have run data many times, from hundreds to almost a thousand stem cell treated patients with knee arthritis, and not seen that connection. We have seen many, many patients with severe arthritis get excellent results. Why? Given that knee pain is also not necessarily related to arthritis severity, that may explain the problem. However, a few other things we have observed seem to be more closely related to outcome. These include things like multiple prior surgeries, arthritis in three or more joints, and patients on multiple medications. In addition, we consider metabolic syndrome a poor predictor of the outcome from a knee stem cell procedure.

How Did Our Stock Futures Trader Fare on Candidacy?

The patient had severe arthritis in both of his knees. In addition, multiple lax ligaments were detected in his knees. A bigger issue for us was that his blood sugar was elevated with high triglycerides and that he needed to take blood-pressure medications. All of this means metabolic syndrome.

Hence, this patient was placed in the poor candidacy for one knee and the fair category for the other. This means that for the culture-expanded stem cell treatment provided by our licensed site in Grand Cayman, he had a 1 in 3 chance of success on the one knee and 50/50 odds on the other knee. He decided to live with the fact that Dr. Pitts told him he was not an ideal candidate.

Treatment

Dr. Pitts saw the patient down at our licensed site in Grand Cayman and first treated his knees in 2016. The patient reported moderate improvement and an increased ability to walk around with less pain, but still had difficulty climbing stairs. As an aside, Dr. Pitts actually had aspirations of becoming a stock futures trader on the Russell 2000 after speaking with this patient about what he was able to do and teach. However, that was short-lived when Dr. Pitts realized that he was too busy treating patients!

The patient returned to Grand Cayman in April of this year for the second round of therapy. He had an initial flare-up after this procedure that was more than with his first procedure. This is actually much more common in patients with metabolic syndrome as they have much more systemic inflammation. However, this procedure didn’t help, and, if anything, his arthritis has continued to advance and his function has continued to decline. In the end, he now has decided to pursue knee replacement.

Why Did This Procedure Fail?

A critical tradition in medicine is openly discussing why patient treatments fail. While some would believe that physicians like to keep their cases that don’t work secret, good physicians see them as valuable as the home runs. In this case, it’s more likely than not that the patient’s failure was linked to metabolic syndrome. So what do we know about how this disease state impacts stem cells?

Metabolic syndrome has dramatic and negative impacts on stem cells:

• It negatively impacts how stem cells are able to excrete chemicals to help tissue heal (paracrine activity).
• It impairs the ability of stem cells to establish new blood supply.
• It reduces the overall health of the stem cells.

Is one solution using someone else’s stem cells? That could solve half of the problem, but the cells are still going into a hostile environment of way too much systemic inflammation. In addition, if you think amniotic stem cells may help, in the U.S., as I have discussed before, there is no such product. More importantly is that new research shows that if the mother also had metabolic syndrome (something very common for donated tissues), the stem cells of the fetus will be similarly impacted.

The upshot? It’s incredibly important to note that even with the most advanced procedure we offer, we still candidacy grade patients. While we have patients placed in the poor and fair candidacy categories that do well, we also see a greater number of failures in those categories, which is why we use this grading system. In this case, our stock futures trader did well initially, but his own cells weren’t able to overcome severe arthritis and help his pain. Ultimately, I would attribute that to modifiable disease factors (i.e., metabolic syndrome). Hence, when our doctors tell you to clean up your diet, please follow their advice! A high blood sugar has one sure-thing solution: eating a strict low-sugar and low-carb diet. However, I should note that even correcting those issues on a temporary basis might not be enough in some patients.

The Regenexx-C procedure is not approved by the USFDA and is only offered in countries via license where culture-expanded autologous cells are permitted via local regulations. 

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile