Limping out to her car as the mid-summer Tucson sun turned the asphalt parking lot into a frying pan, her knee normally would be aching but she wasn’t thinking about that at all. She was replaying the prior 10 minutes in her head over and over again.
She sat in her car for a few minutes. She felt disappointed, defeated, discouraged, and frustrated. Why? All because of an interaction with a physician that she had allowed to be on her treatment team, and just minutes earlier had systematically dismantled the hope she had for achieving her desired outcome for her arthritic knee.
In her words:
“All my positivity has been squashed by the negative consultation with Dr. X (name deleted out of courtesy to my Orthopedic surgeon colleague).”
What she wrote really disappointed and frustrated me. To be more correct it really pissed me off that a patient would be treated this way.
Stick with me on this, because that noise you just heard was me jumping onto my soapbox. It will be worth the next 5 minutes of your time. I promise. (Email me at email@example.com if you feel it was not and I’ll answer any question you have about the advantages of stem cells and what they can or can’t do).
Here’s why this doctor-patient interaction bothered me so much:
- She was “following orders” to come in for her annual check-up on her arthritic knee and was hoping to get some encouraging news.
- She was looking for some support and advice from a specialist
- She was counting on to assist her on her personal journey to what she desired most – avoiding a knee replacement surgery.
- And what she got was more like a sucker punch in the gut
Many of her friends had had surgery with mixed results and she just wasn’t ready to accept that fate. She wanted to try every other option out there first, because that is her choice (not the doctor’s), and she also knew that it may not be possible to avoid the knee replacement but she was going to try her best.
She had put a ton of hard work in over the past year (because she understood she was not living as healthy as she should be):
- Improving her nutrition (to eat a diet less likely to fuel the inflammation and degeneration)
- Taking a couple of strategic supplements (to help give the joint further nutrition and support needed to heal and repair)
- Losing weight – knowing the impact it was having on her arthritis
- Being more consistent with her exercise.
From a treatment standpoint, she elected to work with me and have stem cell therapy for the knee about a year prior. Afterwards, she reported:
“I strongly felt that my knee was getting better. The pain has significantly decreased since last year and I don’t get the feeling that my leg will slip out from under me anymore. I haven’t had the need to use my knee brace in a few months.”
Based on the improvement she had felt with our treatment she was looking for some reassurance, support, encouragement, and continued advice to help her meet her desired outcome.
Instead, she was told:
- Stem cell or platelet therapy would not work for her “bone on bone” knee – because they are still experimental
- Hyaluronic acid, or viscosupplement, injections (what people refer to as lubricating shots) would also not be an option because she had “no cartilage left”.
- Steroid injections would help the inflammation
- Physical therapy could also help
- And, that surgical knee replacement would be the best option for her
- Oh, and the longer she waits, and older she gets, the less successful her surgery would be
Well, let’s play a little game of fact or fiction, shall we?
Stem cells are elective, rather than “experimental”, treatments.
More correctly, stem cell therapy is categorized as elective, not experimental, meaning you can elect to have this treatment much like electing to have some form of cosmetic surgery.
In my office we use approved stem cell therapies from the FDA- We have an FDA-approved device for preparation of the stem cells. This is not an experimental device, it is an FDA-approved device for the purpose of separating stem cells from the bone marrow.
However, EVERYTHING in medicine is a perpetual “experiment” as we work to figure out through practice, research, and studying patient outcomes, how to perfect procedures, the effect of medications, or the long-term potential problems with surgical equipment and implants, etc.
And, each patient is biologically unique, so any treatment is an experiment to see if it will work. We must first try, observe, and then continually tweak on the journey to get each patient the best outcome.
Personally, I would far rather have an injection of cells into my knee – and see if that works – rather than chopping off the ends of my bones and plugging in some metal parts. But maybe I’m on my own here. I doubt it.
What you need to know about stem cell therapy:
- Having stem cell therapy will NEVER keep you from having a knee replacement should it not work.
- Having a knee replacement will ALWAYS keep you from trying adult stem cell therapy from the joint, as we cannot put cells into an artificial joint. And there is no FDA-approved “joint grease” if your knee continues to be painful after.
- Stem cell therapy is a legitimate alternative to knee replacement surgery, but it will either work or will not, and we will know that between 3-6 months after your treatment.
- It WILL NOT work for every patient. Anybody who tells you otherwise is a fraud.
Hyaluronic acid injections can work for “bone on bone” arthritis.
First, the “bone on bone” terminology is overused, and in my opinion, incorrectly used to make patients believe the only option for them is a knee replacement.
While true you can have an area of your cartilage that has worn completely through the cartilage to the bone underneath (much like a crack or pothole in a road surface), but rarely in my experience of 15 years have I seen complete obliteration of all knee cartilage in the entire knee joint.
Translation: This means that there are always some cartilage cells remaining in the knees of patients who are told they are “bone on bone”. If you could miniaturize yourself and take a hike around inside your knee, you would see that to be the case.
And if there are some cartilage cells, then it is possible that these injections could have an effect to protect and preserve the remaining cartilage, coat over the cracks and potholes, and potentially provide some pain relief.
This is a symptom treatment, meaning it is not going to repair or heal the damaged areas, but it could slow the progression of degeneration.
And it is true that they may be less effective for more advanced arthritis, but every patient is unique, and for some, they may have months of pain relief. As a minimally invasive, low-risk procedure, why wouldn’t that be offered?
In this patient’s case, she had actually had this type of injection previously – and they had helped her. Her insurance covered them and she wanted to explore them again, but in this office, they were not willing to even give it a try for her. Wonder why.
Steroid injections will help inflammation, but they will accelerate degeneration.
This is not my opinion to get people to have stem cell therapy, it is a scientific fact proven multiple times over.
Corticosteroids (cortisone shots) have a potent anti-inflammatory effect and they certainly work to reduce pain and inflammation quickly if you ever had an injection. This is not in question.
However, they will dramatically impair your body’s natural ability to work through the steps from (healthy) inflammation to healing.
In an excellent study done by Wernecke et al. at Stanford University, published in 2015 in the Orthopedic Journal of Sports Medicine, they demonstrated that a dose of corticosteroid around 3mg or less may show positive benefit for decreasing inflammation. (1)
But here’s the kicker. They found that doses exceeding just 3mg could be toxic to the cartilage.
You are reading that correctly. When evaluated in the lab it decreased inflammation but also killed some of the cartilage cells. As they increased the dose they showed even more cells were killed off.
What is the standard dose of corticosteroids generally administered in an injection?
At least 40 milligrams and some physicians may use as much as 80!
This is toxic to cartilage. The very tissue that we would want to be sparing if you have an arthritic joint you are literally killing off each time you receive a cortisone injection.
Despite this evidence being published in peer-reviewed journals and performed at reputable institutions, unfortunately, NSAIDS and corticosteroid injections are still considered to be “standard therapy”, i.e. covered by your insurance company, for “treatment” of arthritic conditions.
This is the practice of what I have coined “Degenerative Medicine” – a swelling field of medicine practiced by many Pain and Orthopedic clinics.
Physical therapy can help osteoarthritis of the knee.
This is, in fact, true, so one point to you Dr. X.
With long-standing pain in a knee joint, the supporting musculature gets turned off or inhibited, and as the muscles weaken, so does the mechanical efficiency of the joint.
There is no patient that I see and treat for arthritis of the knee that is not encouraged to plug into physical therapy to work on improving strength and function of their body – once we are able to effectively turn off the pain signals with stem cell therapy or other treatments.
Is surgical knee replacement your best option?
The best option for you is the option that aligns with your worldview about how you would like to treat your body. My patient above made that choice and was looking for help on her journey to reach her goal. It is her decision and hers alone. I doctor should never decide “what is best for you”, but support their recommendation for why they believe that. Then it is up to you to take that information to make an informed decision.
My job as a professional is to give you ALL the options, answer your questions thoroughly, and then you will decide what is best for you.
But to continue to play our game today, let us look at how many people who elected to have an artificial knee replacement surgery are genuinely happy with the result at 1-year.
Current data from the American Academy of Orthopedic Surgeons shows that more than 1 million patients per year in the United States are currently having knee or hip joint replacement surgery. This number is estimated to grow to 3.5 million by 2030, or a 673% increase!! (2)
Are that many people expected to reach end-stage degenerative osteoarthritis and have no other option for treatment?
The unfortunate answer is yes.
So at a year, are those 1 million+ people happy?
Vasilieos and colleagues in 2016 looked at patient risk and satisfaction with knee replacement at 1-year. (3)
More than 30% of the patients who had knee replacement surgery had persistent pain and low satisfaction with the outcome. In other words, they were worse off or no better than prior to surgery. In many of the patients followed further this was without explanation, meaning that it could potentially be persistent.
As I said above, stem cells are either going to work or they will not, and we will know that around 6 months. If they don’t work you can always proceed to knee replacement.
The reverse is not true. Once you have a knee replacement, there is no going back. It is permanent – good, bad, or ugly outcome.
The older you are, the less successful knee replacement surgery may be.
I am not sure how to ground this statement in science.
While true we would like to treat any disease process as early in the process as possible. It is also likely that the health of many will deteriorate to some degree with age, but not everyone. And, major surgeries definitely carry more potential risk (such as death, blood clots, etc.) with age, but age alone does not define your health – at least in my book.
In fact, I just saw an 87-year old guy for a consultation the other day that continues to work circles around guys half his age.
On the flip-side, non-surgical knee replacement procedures, such as stem cell therapy:
- Offer all of the potential benefits of surgery – less pain, better function
- Carry a fraction of the risk of a bad outcome
- Are generally safe to perform at any age
Ok. Jumping off the soapbox now.
I hope this exercise in separating the facts from fiction was of value to you, and also restored your belief that many other options are available to you – and, the coolest part is they will continue to get better as the research and technology propels us forward to new frontiers in medicine.
If you would like to learn more about stem cell therapy and see if you are a good candidate for treatment:
Option #1: Be on the lookout for live webinars that we do.
Option #2: Contact my amazing team of Regenerative Medicine experts at 520-777-9385 or firstname.lastname@example.org to discuss the specifics of your case.
Keep pushing for the summit of your best health, and choose the treatment you desire to get the outcome you want!
My patient couldn’t have summarized it better in the close of her email – “Giving up is not an option for me”.
If you feel the same, I am here to help you on your journey as well.
Have questions? Contact me now so I can help you.
(1) Wernicke et al. The Effect of Intra-articular Corticosteroids on Articular Cartilage. Orthopedic Journal of Sports Medicine, 2015.
(2) American Academy of Orthopaedic Surgeons. Total Knee Replacement Surgery by the Numbers.
(3) Vasilieos et al. Risk Assessment For Chronic Pain and Patient Satisfaction after Total Knee Replacement. Orthopedics. 2016