Regenerative medicine is a very promising for orthopedics. If orthopedic surgeons continually face challenges with regards to healing the joints and muscle-skeletal tissues affected by disorders, regenerative medicine offers to develop new therapies able to replace, repair or promote the regeneration of tissues.
Natural healing processes exist that the body uses each time tissues are traumatized or ruined due to degenerative pathologies of all kinds.
These “auto-repair” mechanisms however, are less effective in some conditions and for some types of tissues where blood supply is poor, for example in the tendons (especially where they are inserted into the bone) or in joints where cartilage damage is difficult to repair. And even bone, which possesses a very distinctive regenerative capacity, sometimes cannot heal.
The regeneration of muscular-skeletal tissue requires four key components: cells, morphogenetic signals, an adequate structure and an appropriate environment.
When one or more of these components are missing, the healing of the tissue does not happen effectively and this can lead to chronic pain and strongly invalidating functional limitations.
Regenerative medicine offers to develop new therapies able to substitute, repair, or promote tissue regeneration.
Morphogenetic signals are normally provided by single growth factors, for example platelet rich plasma (PRP) which could potentially have the ability to regenerate tissue.
Although the blood is formed mainly by liquid (plasma), the corpuscle component is the functional one. It includes red blood cells, (carrying oxygen), white blood cells (immune cells) and platelets. These latter, in addition to having the main function of controlling coagulation, are rich in hundreds of proteins, the so-called growth factors.
The PRP is the plasma richer in platelets than that which is normally found in the blood (5-10 times more) and is obtained through the centrifugation of the patient’s blood.
The product obtained, PRP, although the mechanism is not totally clear, seems to accelerate and promote the healing of tissues in particular muscle and tendons.
Its main use, in fact, is in muscle injuries, tendinitis or in surgery, applied in the area of suture of torn tendons to help with the scarring/healing process.
Although differentiated cells of these tissues can be used for the treatment of diseased tissues, most of the research efforts in recent years has been focused on mesenchymal stem cells.
These can be taken from various tissues and can differentiate towards different cellular lines, for example to chondrocytes (cartilage cells), myocytes (muscle cells) or osteocytes (bone cells).
The use of these mesenchymal cells through local injection helps to promote the regenerative capacity of the cartilage, muscles and tendons.
These cells also have anti-inflammatory properties and therefore help with the pain and bruising that are the main symptoms.
The mesenchymal stem cells are also a rich source of trophic factors.
The main sources of mesenchymal cells are bone marrow and fat.
The latter is currently the best source because adipose tissue is one of the richest sources of stem cells in our organism (approximately 2500 times more with respect to those in the bone marrow) and even more effective because they are protected by their “biological niche”.
Stem cells coming from adipose tissue have an immunomodulatory capacity much higher than that present in the bone marrow and this can be a big benefit for patients with autoimmune disorders or conditions.
The added advantage of the use of stem cells from fat is the ease and minimal invasiveness of the removal which is done through a mini abdominal liposuction done with local anesthesia.
How can stem cells be effective in treating arthrosis?
Currently, arthrosis is treated through rehabilitative programs, joint mobilization exercises, muscular reinforcement and weight control and finally, through prosthetic surgery; drugs are also used either systemically (anti-inflammatories – FANS, painkillers) or through infiltrations (cortisones, hyaluronic acid), however, although they provide temporary relief for symptoms, they are not able to cure damaged cartilage. Prosthetic surgery, on the other hand, is invasive and poses risks.
Many studies from recent years have looked at the use of adult mesenchymal cells for the cure of degenerative joint pathologies. Through complex mechanisms which are not totally clear, it seems that these cells promote the healing of damaged cartilage.
What can I expect after stem cell treatment for an arthrosis disorder?
After the procedure, some pain could appear, along with bruising in the abdomen that normally lasts 1-2 weeks. After an immediate sensation of well-being, some slight to moderate pain could develop in the joint treated; this is due to the reactive inflammatory process and can last from 4-6 weeks. It is therefore recommended to get as much rest as possible to allow the stem cells to take root and best develop their regenerative power.
How long will it take to see benefits and how long will they last?
Considering that each patient and each joint reacts in different ways, we can affirm that the benefits could start immediately (or after a few weeks) and slowly progress toward the best result which is reached approximately 6 months from the procedure.
The beneficial effect obtained from this type of therapy depends on the size of the injury to the joint: it could last a few months to a few years. The infiltration is a single one and it is not necessary to repeat it unless new indications are received from the orthopedic surgeon.
How long does the infiltration take and how is it done?
The procedure of removal and infiltration lasts approximately 1 hour. After a brief check-up, the patient will be asked to lie down on a surgical bed. A sterile spot is prepared around the abdomen and disinfected with iodine solution. The procedure of fat removal starts with an injection of local anesthetic under the skin and the withdrawal is done with a cannula needle and a syringe; it is a mini-liposuction that allows for the collection of a quantity of material that varies from 50cc to 80cc. This amount can be withdrawn even from very thin patients.
The fat removed is then filtered and processed with a special system (LIPOGEMS) and is immediately injected into the joint with one or more infiltrations.
A compression bandage will be placed on the abdomen and should be kept for 24 hours to limit the formation of bruises as much as possible, while simple bandages will be used to protect the area of the joint infiltration. The patient is able to walk and perform normal activities immediately after the procedure. A rest period of a few days is in any case recommended to avoid acute joint inflammation.
What complications could arise?
Complications seen so far with this procedure are slight and mostly linked to the withdrawal; these can include bruises and pain in the abdomen that generally goes away on its own after 1-2 weeks. No major complications are described, in particular at the joint level. Even the theoretical risk of septic arthritis (joint infection) from any type of infiltration, seems to be reduced due to the immunomodulatory power of the fat derivative injected.