Osteoarthritis of the knee is a progressive degenerative condition that affects the cartilage lining of joints. The condition may affect any joint but is particularly prevalent in the hip and knee joint. This results in pain, stiffness and swelling of the joint, causing disability and dysfunction.
There are a number of treatment options that aim to address the symptoms, including pain killers and steroid injections, but few options to actually address the cause of the disease.
Stem cell therapy and PRP injections are foremost in this line of treatment. Stem cells are multipotential cells in the body that may transform themselves to any other cell, including bone, skin, nerve or cartilage cells.
The aim of stem cell therapy is to harvest these cells from the patient’s own blood or fat and place them in arthritic knees where the cartilage has been worn, and then allow these cells to regenerate into cartilage cells and replenish the missing cartilage. The procedure is also used to treat other problems in the body, ranging from COPD (chronic obstructive pulmonary disorders) to spinal injuries.
It may take several months to achieve results and the procedure may need to be repeated. A success rate of 70 per cent is frequently quoted. Stem cell therapy does not work in knees where the native cartilage is completely eroded. The only effective therapy in this case is TKR (total knee replacement).
The other knee regenerative therapy similar to stem cells treatment is platelet-rich plasma (PRP). This also promotes the body’s own healing but through a different mechanism.
Recently, prolotherapy is gaining popularity. It is an ambulatory therapy with very good results and side effects are virtually absent
Your body’s first response to soft tissue injury is to deliver platelets. Platelets carry cells, proteins and other growth and healing factors that initiate repair and attract the critical assistance of your own stem cells.
In this technique, a small sample of the patient’s blood is withdrawn and spun at high speed in a centrifuge, separating the platelets from the other components.
The concentrated platelet-rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. The injection may need to be repeated after six weeks to achieve a result. Again, although results are excellent, outcomes are not guaranteed.
Recently, prolotherapy is gaining popularity. It is an ambulatory therapy with very good results and side effects are virtually absent.
The goal of prolotherapy is to inject an irritant into a joint, ligament or tendon that temporarily increases inflammation. This inflammatory response increases blood flow and stimulates new growth and healing in the damaged tissues. The most commonly used irritant in a prolotherapy injection is dextrose (sugar).
This injection causes local tissue injury and causes release of inflammatory mediators. This stimulates a powerful regenerative response. Cytokines form in response to the inflammatory process and regeneration of damaged tissues is stimulated.
As in PRP, repeated injections over several weeks may be required to achieve discernable results.
Prolotherapy is also very effective in the treatment of ligament laxity, ligament degeneration, incomplete ligament healing and post-traumatic damaged ligaments. Results with this technique are very promising.
Alistair Melvyn Pace is a consultant orthopaedic surgeon at St Thomas Hospital, Qormi, St James Hospital, Sliema, and Da Vinci Hospital, Birkirkara. Josie Muscat is a certified prolotherapist (SIPRO) and certified stem cell therapist (Cell Surgical Network, California).