Osteoarthritis: could stem cell therapies be the answer?

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Osteoarthritis: could stem cell therapies be the answer? Mr Giles Stafford, Consultant Orthopaedic Surgeon discusses….

I am often asked whether it is possible to reverse degenerative changes in the hip, or is there a way to turn back the clock. There is huge interest in “biologics”, which is wrapped up in the concept that you stimulate the body to fix itself without implanting foreign material. The majority of these therapies are designed to heal worn joints by regrowing cartilage, which is what is lost when you have osteoarthritis. Others claim to reduce the pain and disability associated with arthritis, meaning that the patient can continue sports or activities for longer, successfully putting off the need for joint replacement.

It’s an emotive subject. Arthritis is affecting more and more ‘young’ people as we are more active in middle and later life. We also expect to be able to do more and many are not prepared to compromise their lifestyle or give up on their hobbies or sport. Therefore, the idea that you can take something from your own body and after some preparation, reinject it somewhere else which will heal the problem is very attractive.

There has been quite a lot about it in the popular press in recent months. However, this is not all new technology. The concept of growing chondrocytes (cells that grow cartilage) and implanting them into damaged areas of joints has been around for probably twenty years. This has been shown to be effective if used for the correct indication. The newer treatments that have become interesting are not as involved as the cartilage cell transplant techniques.

The stem cell techniques involve harvesting cells from an area such as bone marrow or fat, and simply injecting them either straight into a joint or mixing them with a substrate or patch which can be directly placed into the area of damage as part of a larger procedure such as an arthroscopy (keyhole surgery). It is a relatively simple procedure and there are many reports of patients gaining huge benefit. The rationale is that the stem cells differentiate into cartilage producing chondrocytes as stem cells will metamorphose into any type of cell depending on the environment that it is placed. Therefore, the hope is that they will grow new cartilage where needed.

However, the studies which have been performed and published so far are not as conclusive as you may be led to believe. The issue is that it is too simplistic to believe that osteoarthritis is just wearing out of cartilage. Although it does not fall into ‘inflammatory arthritis’, there is an inflammatory process that goes on. This means that the joint is full of various hormones which are part of this process and are associated with production of pain and the other sequelae of degenerative change. It is for this reason that arthroscopic washout of arthritic joints used to be regularly performed for people wishing to put-off joint replacements. However, this process has been all but outlawed as in most cases there was only short-term benefit, as you would expect.

So what is the future with stem cell therapy? Clearly there needs to be more work done on how it may work and try and work out if it truly does. Cynics would describe it as an expensive placebo, but I think there is likely to be a benefit, even if we can’t quite work it out yet. It is certainly new and sexy and with that there comes a price premium, but this is nowhere near as bad as patients may fear. I think the main benefit is that the risk profile is extremely low, and therefore when your options are limited, it may be worth a try!

For further information, or if you would like to arrange an appointment with Mr Giles Stafford,
please call 020 7483 5148, or visit thewellingtonhospital.com