Regenerative medicine
Scientists and doctors have made tremendous advances to make tissue regeneration a reality in treating many diseases. Through regenerative medicine, a person can take advantage of their body’s ability to heal itself by using the healthy adult stem cells that can be found throughout the body. Laboratory and clinical research has shown that it is possible to use adult stem cells to restore lost, damaged, or aging cells and effectively regenerate tissue in the body. Regenerative therapies are showing promise in the treatment of orthopedic pain.
Adult stem cells were discovered over 40 years ago when researchers found that cells derived from bone marrow had the ability to form various tissues. Adult stem cells are early stage cells and under the right conditions, are capable of developing into other types of cells with the potential to regenerate damaged tissue.
What is a Stem Cell?
In adults, stem cells are present within variety of tissues and organs, the most common sources being bone marrow and fat (or adipose) tissue.
How Are Adult Stem Cells Obtained and Prepared?
A mesenchymal stem cell is a primitive cell with the ability to:
- Self-replicate
- Differentiate into multiple tissues
- Bone
- Cartilage
- Muscle
- Reduce inflammation
- Fight apoptosis (cell death)
Adult stem cells are the means by which our bodies naturally heal throughout our lifetime.
Adult stem cells are being used to treat many types of chronic pain and degeneration. Currently doctors are treating shoulder, knee, hip, and spine degeneration, in addition to soft tissue (muscle, tendon, ligament) and other bone-related injuries.
What exactly are stem cells and how do they work with various body tissues?
Stem cells are cells found in human bone marrow and adipose tissue primarily that have the capacity to transform into other types of tissue that may have been damaged and are in need of repair. We are most interested in their ability to transform into musculoskeletal ticcue that has been worn away or damaged.
Where do adult stem cells come from?
In adults, stem cells are present within a variety of tissues and organs; the most common sources being bone marrow and fat (or adipose) tissue.
How are adult stem cells obtained and prepared?
One of the richest sources of adult stem cells is bone marrow, and the hip (pelvis) is one of the best and most convenient locations for obtaining bone marrow. In the harvesting procedure, the doctor typically removes (or aspirates) from the pelvis. A trained nurse or technician then uses specifically designed equipment to concentrate the adult stem cells in the bone marrow and provides the cells back to the physician for implantation at the site of injury.
Will my body reject the adult stem cells?
No, since they are cells collected from your own tissue, there is little threat of rejection.
How do you decide if someone is a candidate for stem cell therapy?
If individuals are suffering from joint or back pain, they are generally likely to be candidates if it can be determined that the cause is arthritis or degenerative joint disease. Orthobiologics are also useful adjuncts to arthroscopic shoulder surgery in order to hasten the healing of rotator cuff injuries.
Potential Applications
There are many potential applications where stem cell treatments can be very effective. The following are the most common:
SPINE
- Discogenic back pain
- Facet arthritis
- Degenerative disc disease (DDD)
- Sacroiliac joint pain
HIP
- Osteoarthritis
- Labral tears
- Articular cartilage injuries
FOOT AND ANKLE
- Mild to moderate osteoarthritis
- Tendon inflammation
- Partial Achilles tendon tear
- Plantar fasciitis
SHOULDER
- Partial rotator cuff tears
- Labral tears
- Mild to moderate osteoarthritis
KNEE
- Osteoarthritis
- Partial ligament tears
Partial meniscal tears
On what types of injuries or conditions does stem cell therapy work best?
Stem cells are used in many different medical specialties. In orthopedics and musculoskeletal medicine orthobiologics, stem cells and PRP are utilized for arthritis joints such as hips and knees in order to attempt to avoid joint replacements. That also holds true for shoulder and back problems. Rather than injecting steroid for back pain, we prefer to use a combination of BMAC (bone marrow aspirate concentrate) and PRP, which has stronger anti-inflammatory qualities and potentially long-term regenerative capacity, rather than the antimetabolic effects of corticosteroids.
Will my insurance cover this procedure?
While adult stem cells have been used for decades to treat a variety of diseases, their application in the treatment of pain is relatively new. Because of this, insurance companies do not currently cover the therapy.
How much does it cost?
The cost of a stem cell treatment varies based on the procedure performed. Our office staff can assist you with payment options and any other questions you may have.
How long does the procedure take and what is involved?
The procedure of harvesting your own bone marrow and injecting the bone marrow concentrate that has been prepared by centrifugation and separation of the stem cells from the other components and then reinjection of the product takes about 90 minutes. At Pueblo Surgical Center, affiliated with our orthopedic office, we utilize a light general anaesthetic so that there is no discomfort to patients, who generally awaken refreshed and without pain.
Is there a downtime like there is with traditional orthopedic surgeries?
Post-injection patients can resume essentially normal activities with the exception that they avoid strenuous physical activity for 48 hours.
Why have you decided to focus your practice on orthobiologics and specifically regenerative medicine?
I’ve been practicing orthopedic surgery for over 40 years and am the pioneer in stem cell and PRP treatments to avoid knee replacements and shoulder surgery on the central coast of Santa Barbara. I’ve done many major operations during that period of time and like to believe that I have positively impacted many lives. However, surgeons look at patients through the lens of a physician whose skills involve cutting people open to replace joints and correct problems with bionic parts. I believe there are many such operations that could be avoided utilizing the body’s own healing capacity. That is why for the past 10 years I have offered my patients the option of utilizing their own stem cells derived from a simple bone marrow aspiration to avoid major operations and achieve substantial if not complete pain relief. Our results have been astounding. They have been consistent with the results published by the major university medical centers performing the clinical research. Isn’t it far better to treat a chronic musculoskeletal problem with these less invasive techniques that require minimal rehabilitation than undergoing major surgery with all its inherent risks?
How long has this therapy been available?
Utilizing adult pluripotent* stem cells in musculoskeletal problems such as arthritis has been developing for many years. However, the field of orthobiologics, which encompasses mainly the use of stem cells and blood products such as PRP (platelet rich plasma), has been popularized only in the past 10 years.
What do you see happening with SCT in the next five to 10 years?
There has been some reluctance by a part of the orthopedic community to fully embrace orthobiologics as a major tool in the therapeutic armamentarium, in part because it eliminates some of the surgical procedures that are the mainstay of an orthopedic surgeon’s livelihood. There is also reluctance because it is new, and the clinical research on its efficacy is still in progress. Once those issues are resolved, I believe that utilization of biologic solutions to mechanical orthopedic problems will be well accepted and utilized extensively to avoid major surgical procedures. The insurance industry has been slow to embrace this area of medicine, which I believe will significantly change in the not-too-distant future. We are at the early stages in the evolution of harvesting the human body’s own capacity to heal itself. This area of medicine will continue to grow and eliminate more aggressive solutions to bone and joint problems such as metal and plastic implants. It stands to reason that biologic solutions are better than bionic ones.