WHEN HIPS HURT: NEW APPROACHES

WHEN HIPS HURT: NEW APPROACHES

Degeneration of the hip is a common arthritis affecting 15% of the world population (Egloff et. al., 2012) This is a painful condition that limits the ability to walk and generally affects the overall the quality of a persons life. The current approach to this disease is to control symptoms associated with its destructive nature. As with any other arthritic disorder exercise is important to prevent loss of range of motion. Anti-inflammatory medication is also a helpful adjunct in controlling symptoms. Unfortunately, the typical end of this story is failure of the joint and total hip replacement.

Arthritis or Degenerative Joint Disease (DJD) is a condition as the name implies, is degenerative. It is a result of previous injury to the joint, previous inflammatory processes or incident to age. DJD affects the cartilage of the joint. It also causes thinning of the cartilage in general (Anitua et. al., 2007) in a particular joint. (Figures 1 and 2). This is a white, smooth, frictionless surface that allows joint to move without resistance. It can be compared to the white, smooth surface seen at the end of a chicken bone.

The purpose of this cartilage is to resist compression on the ends of a bone. In the hip the end of the long bone (femur) has a ball that fits into a socket (acetabulum). Both of the surfaces have a cartilage that provide smooth movement and resist compression. When the cartilage is cracked or missing from either surface pain begins and increases as more cartilage becomes involved. (Figure 3)


Fig. 3

Today stem cell therapy has been all over the airways and newspapers. There are many clinics offering this form of treatment as a “cure all” to failing or failed joints. While I believe most of these clinics are altruistic in trying to help patients, there are those who see this as a money making opportunity and are offering products that may not actually have viable stem cells in them.

Currently there are 4 types of stem cells that are available in the United States. The type of stem cell that is optimal for hip arthritis is called a Mesenchymal Stem Cell (MSC). A MSC is a cell that is unspecialized and is able to transform into another type of cell. This is called pluripotency.Studies have shown that stem cells have an affinity for damaged joint tissue. Stem cells have the ability to localize and participate in the repair of damaged joint structures (Agung et. al., 2006) .

The least and rarely used for arthritic purposes is Hematopoietic stem cells. This is collected from a venous blood source. Blood is drawn from a vein.In order to obtain stem cells from this source blood is put through a process called apheresis. The stem cells are separated through a mechanical process and reinjected a given joint. This process can take 2 – 3 hours.

Bone marrow aspirate is a common source of obtaining MSC’s. This process requires a minor surgical procedure where a large bore needle is placed into the pelvis and bone marrow is aspirated. The aspirate is then placed in a centrifuge to separate the MSC’s from the other marrow products and then the stem cells are injected into the joint. Optimally the stem cells are injected under fluoroscopic guidance to insure placement into the joint. This is particularly important with the hip joint as the joint cannot be readily palpated. The whole process of bone marrow aspiration and transplantation can take up to an hour or more and can be somewhat painful.

Adipose derived stem cells are also a common source of MSC’s. The method of extraction, like bone marrow aspirate, requires a minor surgical procedure. Fat is aspirated from the abdomen and placed in a centrifuge to separate the stem cells from the adipose tissue. The stem cells are then injected into the joint. These stem cells along with hematopoietic and bone marrow derived stem cells are called autologous stem cells. That is; they are derived from the patient. As a result the efficacy of the cells and amount of viable cells derived is age dependent.

Umbilcal Cord Mesenchymal Stem Cells (UB-MSC’s) are not autologous. They are termed allographic. That is; they are from a donor. The source of these MSC’s is umbilical cord and placentas voluntary donated from donors after live cesarean section birth. The donors are screened rigorously for any diseases or risk. The umbilical cord and placenta is cryopreserved for processing later. There are advantages of using this source of stem cells. Most importantly is that the cells are day 0. They are the most potent they can be.

At Intermountain Stem Cell we use only UB-MSC’s and placental products. We obtain these from Predictive Biotech. The products we use are of the highest quality and deliver high volume, viable stem cells. The stem cells are transplanted using sterile technique with fluoroscopic guidance into the joint by simple injection. The process takes 15 – 20 minutes and is relatively painless. The patient leaves with no residual effects from the procedure.
We believe that this is the most contemporary and efficient use of stem cell therapy. At this time we have had no adverse effects and have only had reports of improvement.