Stem Cell Alternative to Knee Replacement?

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Is there a stem cell alternative to knee replacement? There’s much craziness out there in the wild west of “stem cells” with fake treatments being offered left and right. However, I was recently asked by a former patient whatever happened to one of the patients we had in a testimonial? How is he doing now? Let’s dig in.

Types of Stem Cell Treatment

Right now, if you’re looking for a stem cell alternative to knee replacement, the only treatment out there that we know contains stem cells and is permitted is called bone marrow concentrate. This is when the doctor takes bone marrow from a numbed up area in the back of your hip and uses a centrifuge to concentrate the stem cells. Since several studies have tied the effectiveness of this treatment to its mesenchymal stem cell content, it’s believed that this therapy works through stem cells (1-3). It also has other things going for it like being rich in cytokines that can reduce cartilage breakdown.

There are other things being offered as “stem cell” treatments, but the most popular right now that’s derived from birth tissues like amniotic membrane/fluid or umbilical cords have all been shown to contain no living stem cells (4-6). So while they may have some effect because of the growth factor in them (just like a less expensive PRP shot), they’re not stem cell treatments despite what’s advertised.

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The Data on Bone Marrow Concentrate

Bone marrow concentrate or BMC, has been around a long time. In fact, it’s first use in orthopedics dates back to the 1980s when Reagan was President and Devo was all the rage. Below I’ve placed my infographic showing all of the studies published to date on BMC use in orthopedics. Each circle is a study and link that takes you to that research. The results of almost 11,000+ patients treated for some 3+ decades that have been published. Our publications are in the yellow highlighted circles.

We’ve also published the results of a randomized controlled trial comparing our high-dose BMC treatment to physical therapy showing good results (7). Hence, we have pretty good data that BMC is one option for patients considering a stem cell alternative to knee replacement.

How Long Does this Stuff Last?

I get asked this question all the time by patients looking for a stem cell alternative to knee replacement. I’ve also highlighted various long-term results on this blog. However, the other day a patient asked me specifically how this guy was doing:

I frankly didn’t know, so I reached out to him. First, I looked him up in our registry and found out that he had last reported in November that he was still 100% better. Then I reached out via e-mail and this is what he said:

“My knees are great. No complaints. I have had numerous people reach out to me about my experience and my response is always the same “what do you have to lose? Try it. If it doesnt work than go the other route with surgery. A number of them have moved forward and have had very positive results. Mostly at your Florida clinic.”

Which brings us to how long Mike has been going. He was treated in 2012, which means that he’s 7+ years out from a high-dose BMC treatment. Hence, I think that we can safely say that Mike has found a credible stem cell alternative to knee replacement. After all, in younger and active patients, the duration of a knee replacement prosthesis on the short end is in the 7-year range with 1 in 10 patients needing a second knee by then (8).

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What Was Wrong with Mike’s Knee?

First. we told Mike in 2012, that because he had undergone multiple prior knee surgeries that he was only a fair candidate for this high-dose procedure. Second, we performed much more in Mike than a simple injection of stem cells into his joint. We also performed precise x-ray guided injections of his own BMC into multiple loose ligaments like the ACL and ultrasound-guided injections into the damaged meniscus.

Mike had severe arthritis in both knees. MRI of the left knee demonstrated osteoarthritis in all three compartments which was the most severe in the patellofemoral joint, a complex tear of the body and posterior horn of the medial meniscus, and slight tearing of the lateral meniscus. MRI of the right knee also showed tricompartmental osteoarthritis, also worse in the patellofemoral joint with a vertical tear of the posterior horn of medial meniscus. Hence, Mike’s knees were shot.

Mike had one knee treated by our Colorado HQ clinic in 2012 and the other in 2013. Why one at a time? We measure the dose of the cells we inject and oftentimes in patients who are Mike’s age, the amount we obtain from the patient necessitates two treatments. We’ve published on this dosing methodology (9).

The upshot? Mike’s doing great more than seven years out and has clearly found a stem cell alternative to knee replacement by using his own high-dose BMC precisely placed into various knee structures. It’s great to have been doing this stuff long enough to have many, many patients who are this far out from their treatment!

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References:

(1) Jäger M, Herten M, Fochtmann U, Fischer J, Hernigou P, Zilkens C, Hendrich C, Krauspe R. Bridging the gap: bone marrow aspiration concentrate reduces autologous bone grafting in osseous defects. J Orthop Res. 2011 Feb;29(2):173-80. doi: 10.1002/jor.21230.

(2) Hernigou P, Beaujean F. Pseudarthrosis treated by percutaneous autologous bone marrow graft. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(6):495-504. https://www.ncbi.nlm.nih.gov/pubmed/9587614

(3) Hernigou P, Beaujean F. Bone marrow in patients with pseudarthrosis. A study of progenitor cells by in vitro cloning. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(1):33-40. https://www.ncbi.nlm.nih.gov/pubmed/9161546

(4) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.org/wp-content/uploads/2017/08/AmnioProducts-Poster.pdf

(5) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf

(6) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 1230–1235. https://doi.org/10.1177/0363546519829034

(7) Centeno C, Sheinkop M, Dodson E, et al. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018;16(1):355. Published 2018 Dec 13. doi:10.1186/s12967-018-1736-8

(8) Castagnini F, Sudanese A, Bordini B, Tassinari E, Stea S, Toni A. Total Knee Replacement in Young Patients: Survival and Causes of Revision in a Registry Population. J Arthroplasty. 2017 Nov;32(11):3368-3372. doi: 10.1016/j.arth.2017.05.052

(9) Centeno CJ, Al-Sayegh H, Bashir J, Goodyear S, Freeman MD. A dose response analysis of a specific bone marrow concentrate treatment protocol for knee osteoarthritis. BMC Musculoskelet Disord. 2015;16:258. Published 2015 Sep 18. doi: 10.1186/s12891-015-0714-z

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

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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