The most common form of arthritis, osteoarthritis (OA), affects more than 20 million Americans. One of the primary targets for this disease is the knee.
Osteoarthritis is a wear and tear disease involving hyaline articular cartilage. It arises as a result of the lack of ability of cartilage to keep up with excessive breakdown.
The basic treatment approach for osteoarthritis has not changed in more than 50 years. Basically, physicians have been trained to treat the symptoms of pain and try to restore function and wait for the inexorable journey to joint replacement.
Different modalities such as physical therapy, analgesics (pain relievers), non-steroidal anti-inflammatory drugs (NSAIDS), exercises, braces, topical agents, and injections of either corticosteroids (“cortisone”), or viscosupplements (lubricants) are all tried and then the doctor throws up his or her hands and says to the patient “you need a knee replacement.”
So essentially there is a huge void between management of symptoms and eventual surgery.
Recently, excitement has swirled around the role of regenerative medicine techniques in solving the osteoarthritis conundrum. These include the use of platelet-rich plasma and stem cells.
Unfortunately, this interest has had untoward side effects. The first is the proliferation of practitioners who have jumped on the band wagon without the requisite training.
The second is the media hype generated by this relatively new treatment approach.
An example recently is the headline in an Australian newspaper, “A “MIRACLE” cutting-edge stem cell operation could have saved Sharks forward Anthony Tupou’s career.”
In case you’re not up on rugby, Anthony Tupou was a former star in the sport. He underwent a stem cell procedure involving the use of fat-derived stem cells for a knee issue. And this procedure has apparently resurrected his career.
Dr. Paul Annett, a sports physician, raised an interesting counterpoint on his blog. He quite rightly pointed out that many procedures performed in the realm of sports medicine are performed because they “might be helpful” and are relatively innocuous.
He then posits that “there are many potential reasons this procedure may of benefit to some patients, including the ‘placebo effect’, the normal fluctuation of arthritic disease or some mechanical effect of the injection itself. Anthony’s knee may just feel better as he had an off-season without running!
And he then goes on to say, “The ethical way of getting around this is for the proponents of this technique to perform some randomised double-blind clinical trials (the ‘gold standard’ of studies) to rigorously confirm the relative benefits…”
And I couldn’t agree more. While there is abundant anecdotal evidence that these procedures have benefit, there are no rigorous double-blind controlled trials. The reasons are probably two fold.
First, it’s difficult to get a biotech or pharmaceutical company to fund a study involving the use of a patient’s own body tissue. Where’s the profit?
The second is that the process of getting grants from institutions such as the National Institutes of Health (NIH) or the Arthritis Foundation in the U.S. is unbelievably arduous.
At our center we have done what we can to systematize the procedure as well as document various measures so that while uncontrolled, there is at least data collection being done. (Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48)