A new therapy for patients with osteoarthritis (OA) experiencing chronic joint pain of wrists, elbows, shoulders, hips and knees has been developed by Mark D Wagner, MD, a primary care physician, specializing in sports medicine, based in Seattle.
OA is the most prevalent joint disorder in the United States, affecting 13% of women and 10% of men 60 years and over.1 Age, obesity and female gender are risk factors, and as the population is growing older and increasingly overweight, the need for new treatments for this disorder is becoming paramount.2 For most OA patients, pain is the primary reason for seeking medical care, and often precedes disability, as OA is the most common indication for total knee and hip replacement surgery.3 OA pain results from deterioration of cartilage at articulations, which can no longer act as a cushion between bones, leading to bone grinding.
Dr Wagner’s treatment is aimed at patients who have lost a significant range of motion in certain joints, and are experiencing substantial pain levels as a result of mild to moderate OA. This treatment consists in an autologous cells transplant: the patient’s Platelet Rich Plasma, bone marrow cells and fat cells are collected. Platelets are purified from blood samples; bone marrow and adipose stem cells are concentrated by centrifugation. The combination is then injected into the affected joint.
Activated platelets release a number of growth factors, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF), epidermal growth factor (EGF), which are thought to contribute to the healing process4, although evidence for such a claim is slim. 5 Stem cells isolated from bone marrow have been shown to efficiently support repair of injured ligaments and tendons6, and adipose stem cells have some benefits for cartilage repair.7
This procedure, which falls under the category of regenerative medicine and is minimally invasive and mostly painless, has shown promising results, according to Dr Wagner who stated that the patients he has treated are experiencing reduced levels of pain, starting 3 months after the procedure. Dr Wagner is hopeful they will regain a normal range of motion within a year.
1.Thomas AC, Hubbard-turner T, Wikstrom EA, Palmieri-smith RM. Epidemiology of Posttraumatic Osteoarthritis. J Athl Train. 2016.
2.Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133(8):635-46.
3.Kim HJ, Cha ES, Ko Y, Kim J, Kim SD, Lee WJ. Pesticide poisonings in South Korea: findings from the National Hospital Discharge Survey 2004-2006. Hum Exp Toxicol. 2012;31(8):751-8.
4.Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012;32:150-63.
5.Khan M, Bedi A. Cochrane in CORR (®): Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review). Clin Orthop Relat Res. 2015;473(7):2207-13.
6.Kushida T, Iida H. Bone marrow cell transplantation efficiently repairs tendon and ligament injuries. Front Cell Dev Biol. 2014;2:27.
7.Orth P, Rey-rico A, Venkatesan JK, Madry H, Cucchiarini M. Current perspectives in stem cell research for knee cartilage repair. Stem Cells Cloning. 2014;7:1-17.