Stem cell injections have become a highly advertised and promoted alternative to surgical intervention for various joint conditions. So-called injection experts tout dramatic results from this procedure which is not typically covered by insurance. Patients often pay as much as $5-$6K out-of-pocket, sometimes with disappointing results. To maximize efficacy, we believe the recipient must have a healthy “host environment” for the stem cells to do their job, based on several lifestyle factors. Some of these include:
- Plant based diet backed up by healthy joint supplements including glucosamine and chondroitin
- Consistent low-impact exercise habits
- Low inflammation markers (hsCRP < 0.7)
- High carotenoid index scores (>400)
- Ideal BMI
- Good sleep habits
- Avoidance of stress/anxiety
- Avoidance of cover-up drugs
- Good posture and supple joints without serious contracture or angular deformity
- No comorbidities such as Type 2 diabetes, heart disease, metabolic syndrome, etc.
For most patients desiring a stem cell injection, a 3 month “tune-up” period may be recommended to work on the “host environment” mentioned above. While degree of efficacy is highly variable, careful patient selection and implementation of wholistic measures may help maximize treatment benefit and duration, possibly for 6 to 12 months. However, in our experience, the greater the degree of arthritis, the less likely stem cell therapy will be beneficial. Stem cell injections will not “create more spacing” on xrays, or restore an arthritic joint back to a completely normal state. They may help regenerate cartilage to some extent, help reduce inflammation, reestablish a healthier pH in the joint, and promote production of healthier joint fluid.
A three-fold process is implemented to obtain platelet rich plasma (PRP), adipose derived stem cells, and bone marrow aspirate concentrate. PRP acts as a signal caller to attract regenerative cells to damaged tissue. Adipose tissue is known to contain a large reservoir of regenerative mesenchymal cells which can differentiate to cartilage, bone, muscle, or fat cells. The concentrate from adipose tissue derived stem cells has a thicker consistency and is believed to act as a scaffold or lattice structure to help secure the broader range of regenerative cells PLUS growth factors found in bone marrow aspirate concentrate. To maximize efficacy of stem cell therapy in a joint, all three measures should ideally be implemented versus individually in isolation.
Description of the procedure
- Blood is drawn from your arm and spun in centrifuge, separating the components of the blood. PRP is drawn into a syringe in preparation for injection into the joint.
- The hip and flank area is sterilely prepped and draped. A numbing shot is given and a small incision is made.
- “Tumescent fluid” consisting of a local anesthetic, saline, and epinephrine is injected into the adipose tissue in preparation for liposuction.
- A special cannula is then introduced subcutaneously, collecting adipose tissue into a large syringe.
- Contents of the syringe is processed in a centrifuge and stem cells are collected into a separate syringe.
- The posterior pelvic bone is then anesthetized and a tiny incision is made.
- A specialized needle is placed into the marrow space.
- Marrow is collected into a syringe and processed in a centrifuge. Stem cells are collected into a separate syringe.
- The affected knee is prepped with iodine and anesthetized.
- If swelling is present, it is aspirated.
- The contents of each of the three syringes is then injected with a fixative (PRP, bone marrow aspirate concentrate, and adipose derived stem cells)
- Physical therapy is implemented within 1-3 days.