WHAT TO DO WITH MY KNEE ARTHRITIS
Oscar C. Johnson MS PA-C PhD
Intermountain Stem Cell
It is estimated that the is 54.4 million adults in the United States have been told that they have some form of arthritic condition[i]. Though any joint in the body can experience the pain of arthritis it is particularly common in the knee.
To review anatomy, the knee is basically a hinge joint the bears the weight of the upper body along with the hip and ankle. The upper bone in the thigh is the femur, the lower, shin bone is the tibia. The patella, (knee cap), sits in front of the knee in the middle. Over the surface of the end of the femur, the top of the tibia and the undersurface of the patella is a white tissue that is frictionless. This is the hyaline cartilage and allows smooth movement when bending and straightening the knee. Attached to the top of the tibia between the tibia and femur is a cartilage that acts as a shock absorber called the meniscus. (Figure 1) The whole knee is encased in a capsule that holds a fluid that lubricates and provides nutrients to the cartilage. This is the synovial fluid and has a high concentration of hyaluronic acid. This molecule coats each cartilage cell and traps water to give cartilage the ability to resist compression.
[i] Barbour KE, Helmick CG, Boring MA, Brady TJ. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation — United States, 2013—2015. Morb Mortal Wkly Rep. 2017 March 7.
The Knee Joint – Figure 1
In osteoarthritis, the most common form of arthritis, the joint becomes worn from degeneration over time. Once the condition begins it will progress without reversal. Somewhere in our 40’s our cartilage begins to dehydrate. This reduces its ability to resist compression. As a result, there is eventual fissuring and fracturing of the cartilage and eventual cartilage loss. (Figure 2) The next step is bone rubbing on bone. (Figure 3) When this occurs the bone starts to develop spurs and deforms. It’s about this time surgeons start conversations about replacement.
Contemporary treatments include the use of non-steroidal anti-inflammatory drugs, (NSAID’s), opioid medication, counter-irritant ointments or creams, cortisone injections, hyaluronic acid injections, bracing and physical therapy. These methods are geared to control symptoms but not produce a curative effect.
In an effort to alleviate the pain of osteoarthritis in the knee scientist have focused their research towards biologic methods to seek a cure. This research has led to a branch of medicine called Regenerative Medicine. This branch of medicine deals with the functional restoration of tissues and organs for patients suffering from diseases and disorders that previously had no cures.
In orthopedics, regenerative medicine attempts to restore the function of joints by
restoring cartilage. The knee is of particular focus as there is a excessive amount of people that suffer from knee arthritis. In one study conducted by the Japanese, Caucasians in the United States and Europe have shown that the prevalence of knee osteoarthritis with Kellgren–Lawrence(KL) grade 2 or higher was 30–40%; whereas studies in Asia have found a prevalence of 60% or higher[i].
This brings us to stem cells. In particular, Umbilical Mesenchymal Stem Cells. Patients world wide have been receiving injections of these cells into their knees with very good results. Anecdotally, there are many reports where surgery has been taken off the table as the only available treatment left.
Basically, a stem cell is a cell that is unspecialized. That is, a cell that is waiting to become something. These cells are present in our bodies and are responsible for regenerating damaged or injured tissues. When injected into the damaged knee these cells will work to regenerate cartilage and/or heal ligaments or other soft tissues structure. As a child, we have an abundance of these cells but they diminish in function as we get older. This explains why children heal faster than adults. For years we have used adult stem cells harvested from the patients own bone marrow or adipose tissue and reinject them into the knee with varying positive benefits. These benefits again were dependent upon the amount of cells harvested and the age of the patient.
Umbilical cord mesenchymal stem cells are harvested from the umbilical cord after a baby has been delivered by cesarean section. Umbilical cord is rich source of hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs), which possess enormous regeneration potential. All umbilical cords are voluntarily donated and the donors are vigorously screened to meet the standards for transplant.
The procedure for stem cell transplantation is simple. The knee is prepared as with any other intra-articular (joint) injection adhering to sterile standards. A local anesthetic given in the skin to diminish needle penetration pain. A small gauge needle is placed in the joint. The product we use is called Corecyte (Predictive Biotech Inc.) and contains 1 million umbilical cord mesenchymal stem cells per milliliter. This is injected into the knee as a one time application. Patients have reported improvement in as early as two weeks. The most reported detail is a decrease in pain with extended walking and a decrease in grinding.
We believe that regenerative therapy is going to be the standard of care in the near future. As more patients benefit from these procedures the amount of total replacement surgeries will decline. Most importantly though, is that patients will begin the road to recovery and repair which is the ultimate goal.
[i] Muraki S, Tanaka S, Yoshimura N. Epidemiology of knee osteoarthritis. OA Sports Medicine 2013 Nov 26;1(3):21.
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