Stem cell therapy is a form of regenerative medicine that utilizes the body’s natural healing mechanism to treat various conditions. Stem cells are being used in regenerative medicine to renew and repair diseased or damaged tissues, and have shown promising results in treatments of various orthopedic, cardiovascular, neuromuscular and autoimmune conditions. Stem cells are present in all of us acting like a repair system for the body. However, with increased age sometimes the optimum amount of stem cells are not delivered to the injured area. The goal of Stem Cell therapy is to amplify the natural repair system of the patient’s body.
Types of Stem Cells
There are two major types of stem cells embryonic stem cells and adult stem cells. Embryonic stem cells (ESCs) are stem cells derived from human embryos. They are pluripotent, which means they have the ability to develop into almost any of the various cell types of the body.
As the embryo develops and forms a baby, stem cells are distributed throughout the body where they reside in specific pockets of each tissue, such as the bone marrow and blood. As we age, these cells function to renew old and worn out tissue cells. These are called adult stem cells or somatic stem cells. Like embryonic stem cells, adult stem cells can also replicate into more than one cell type, but their replication is restricted to a limited number of cell types.
Use of Stem Cells in Orthopedics
The unique self-regeneration and differentiating ability of embryonic stem cells can be used in regenerative medicine. These stem cells can be derived from eggs collected during IVF procedures with informed consent from the patient. However, many questions have been raised on the ethics of destroying a potential human life for the treatment of another. Adult stem cells are most commonly obtained from the bone marrow, specifically the mesenchymal stem cells, which have the ability to replicate into cells that form the musculoskeletal system such as tendons, ligaments, and articular cartilage. They can be obtained from the iliac crest of the pelvic bone by inserting a needle and extracting the stem cells from the bone marrow.
Currently, stem cell therapy is used to treat various degenerative conditions of the shoulder, knees, hips, and spine. They are also being used in the treatment of various soft tissue (muscle, ligaments, and tendons) as well as bone-related injuries.
Who is a Good Candidate for a Stem Cell Procedure?
You may be a good candidate for stem cell therapy if you have been suffering from joint pain and want to improve your quality of life while avoiding complications related to invasive surgical procedures.
Preparing for the Procedure
It is important that you stop taking any nonsteroidal anti-inflammatory drugs (NSAIDs) at least two weeks before your procedure.
Preparing for a stem cell procedure is relatively easy and your doctor will give you specific instructions depending on your condition.
Stem Cell procedure
The procedure begins with your doctor extracting stem cells from your own bone marrow. Bone marrow is usually aspirated from your hip region. Your doctor will first clean and numb your hip area. A needle is then introduced into an area of your pelvic bone known as the iliac crest. Bone marrow is then aspirated using a special syringe and the sample obtained is sent to the laboratory. In the laboratory, the aspirate is spun in a machine for 10 to 15 minutes and a concentrated stem cell sample is separated. Your doctor then cleans and numbs your affected area to be treated and then, under the guidance of special x-rays, injects the stem cells into the diseased region. The whole procedure usually takes less than one hour and you may return home on the same day of the procedure.
- You will most likely be able to return to work the next day following your procedure.
- You will need to take it easy and avoid any load bearing activities for at least two weeks following your procedure.
- You will need to refrain from taking nonsteroidal, anti-inflammatory medications (NSAIDS) for a while as this can affect the healing process of your body.
Advantages & Disadvantages
Stem cell therapy is a relatively simple procedure that avoids the complications associated with invasive surgical procedures.
- As stem cell therapy uses the cells derived from your own body it reduces the chances of an immune rejection.
- The disadvantage of adult stem cell therapy is a lack of data about its long-term effects as it is a newer evolving therapy.
Risks and Complications
Stem cell therapy is generally considered a safe procedure with minimal complications, however, as with any medical procedure, complications can occur. Some risks factors related to stem cell therapy include infection as the stem cells may become contaminated with bacteria, viruses or other pathogens that may cause disease during the preparation process. The procedure to either remove or inject the cells also has the risk of introducing an infection to the damaged tissue into which they are injected. Rarely, an immune reaction may occur from injected stem cells
Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.
Indications for PRP Injection
PRP is a relatively new method of treatment for several orthopedic conditions such as muscle, ligament, and tendon injuries; arthritis; and fractures. PRP injections can help alleviate painful symptoms, promote healing and delay joint replacement surgeries.
Your doctor will first draw about 10 cc’s of blood from the large vein in your elbow. The blood is then spun in a centrifuge machine for about 10 to 15 minutes to separate the platelets from the remaining blood components. The injured part of your body is then anesthetized with a local anesthetic. The platelet-rich portion of your blood is then injected into your affected area. In some cases, your doctor may use ultrasound guidance for proper needle placement.
It is normal to feel some discomfort at the injection site for a few days after your procedure.
- You will be prescribed pain medications by your doctor.
- You may use cold compresses to alleviate your symptoms.
- You will be instructed to stop any anti-inflammatory medications.
- You may resume your normal activities but should avoid any strenuous activities such as heavy lifting or exercises.
Risks and complications
- There are very minimal risks associated with PRP injections. Some of the potential risks include Increased pain at the injection site
- Damage to adjacent nerves or tissues
- Formation of scar tissue
- Calcification at the injection site
What is Bone Marrow Aspirate Concentrate (BMAC) Treatment?
BMAC is a concentrate of regenerative stem cells obtained from your own bone marrow. Bone marrow is the soft, spongy tissue that is found in the center of bones, including your hip or pelvic bone. Bone marrow is the section of the body where blood is generated. The stem cells from BMAC are specialized cells that are known to replicate themselves into various types of tissues and help to speed up the healing process by boosting the body’s natural healing abilities and promote tissue growth.
Indications for Bone Marrow Aspirate Concentrate (BMAC) Treatment
Some of the indications for BMAC include:
- Osteoarthritis of the joints
- Improve wound healing
- Osteonecrosis (bone death)
- Improve tendon healing
- Treat fractures of the bones
- Delay progression of the disease, such as arthritis
- Treat cartilage injuries
Preparation for Bone Marrow Aspirate Concentrate (BMAC) Treatment
In general, preparation for BMAC treatment includes the following:
- A thorough examination by your doctor to check for any medical issues that need to be addressed prior to the procedure.
- Depending on your medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting the procedure.
- You will be asked if you have any allergies to medications, anesthesia, or latex.
- Inform your doctor of any medications, vitamins, or supplements that you may be taking.
- Eat a balanced diet that is low in fat and high in protein.
- Drink lots of water for a few days leading up to the treatment.
- Refrain from alcohol or tobacco at least 24 hours prior to the procedure.
- Avoid NSAIDs (Non-steroidal Anti-inflammatory Drugs) or blood thinners a week before the procedure.
- Arrange an escort to drive you home after the procedure.
- A written consent will be obtained from you after the procedure has been explained in detail.
Procedure for Bone Marrow Aspirate Concentrate (BMAC) Treatment
In general, the BMAC treatment procedure involves the following:
- The skin over the injection site is sterilized and numbed with a local anesthetic.
- A suction syringe attached to a long needle is inserted into the back of your hip bone.
- The bone marrow is suctioned out through a small needle puncture in the bone.
- The collected bone marrow sample is transferred to the centrifuge for processing.
- The sample undergoes a thorough processing and bone marrow aspirate concentrate with specialized cells are obtained.
- The concentrate is collected into a sterile syringe.
- The concentrate is then injected into the affected area under ultrasound guidance.
- The whole procedure takes about 2 hours to complete and you can go home the same day.
The number of BMAC treatments required depends on the degree of the injury and will be decided by your surgeon.
Post-Procedure Care and Instructions
Post-procedure care and instructions will include the following:
- Avoid strenuous activities for a couple of days.
- Apply ice on the injection site for comfort.
- Rest, elevation, and medicines are recommended to relieve pain and swelling.
- Gentle range of motion exercises are recommended.
- Avoid anti-inflammatory medications for at least two weeks.
- A follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Bone Marrow Aspirate Concentrate (BMAC) Treatment
BMAC treatment is a relatively safe procedure; however, as with any procedure, there are risks and complications that could occur, such as:
- Damage to blood vessels and nerves
- Pain, swelling, or soreness at the injection site
- Blood clots
Benefits of Bone Marrow Aspirate Concentrate (BMAC) Treatment
BMAC treatment offers several potential benefits, including:
- Minimal invasion and discomfort
- Safe, feasible treatment option
- Reduced inflammation and less pain
- Robust healing of the injured or damaged tissue
- Decreased chronic orthopaedic conditions