| 1 | Dr. John Tait | Stem Cell Therapy for Joint Repair, DOES IT REALLY WORK? | 19225 | 562 | 97 | 74.3 | neutral | 13:34 | Is stem cell therapy the future of joint repair? Is it hype or is there a lot of hope around this topic? I'm Dr. Fontaydom, non-surgical orthopedic specialist and that's what I want to dig in today to answer this question here. Is stem cell therapy a bunch of hype or is there hope around these emerging treatments that, but they've been using stem cell therapy in the US since the early 2000s. We have a lot of data on this and if you search PubMed which is a search engine for public scientific literature, you'll find hundreds of not thousands of articles at this point in regards to stem cell. Okay, now in orthopedics we're looking at this for a few very directed aims, one of the most common ones being near-thritis. So if we look at worldwide disability, near-thritis is going to compromise more people than just about any other condition combined after, say, low back pain and compared to other conditions like heart disease and diabetes and cancer and we kind of roll those up. If we look at the amount of disability in the duration of disability that people have from arthritis, it's staggering. And so it's one of those solutions, or it's one of those problems we need better solutions for. And what a lot of people are seeking me out as a non-surgical orthopedic specialist is to get there without surgery. So I wanted to dig into a little bit of the science around stem cells. First, talk about some basic science of what stem cells are. Then pull some of the recent literature to try to answer this question. Is there a lot of hope here? Is it still a lot of hype? A lot of, you know, kind of marketing and other things that some companies may put out there in the space? But what is the real science show on this? What am I seeing in my clinical experience and my practice now doing this stuff for more than a decade? So first of all, if we look at stem cells, you know, if we take a stem cell and first go to the basic science of what stem cells are, well, there are cells that are made inside the bone marrow of our body. And stem cells are called mesenchymal and pluripotent, and that they can differentiate into many different cell types in our body. And they can help grow new tissue. They can regenerate old failing tissue. And in fact, more than a million cells per second in our body die out and they're replaced by new cells every day. So if we look at this concept first, stem cells can come from really two banks in your own body. So we call that autologous, meaning from you. They can come from your bone marrow and they can come from your fat tissue. Okay. So in the U.S., most of the treatments we're using are bone marrow derived. And some people are using fat tissue derived stem cell. And those are the two things we can take. That's really where we can access stem cells from one's own body. Pierp on the other hand, which I've detailed in other videos is not a stem cell. So Pierp stands for platelet rich plasma. And platelets are cells within your blood. So if we do a standard blood draw, we're going to get platelets. Platelets have growth factors. Inside of stem cells, we have packets of other growth factors. So when a stem cell encounters a problem in the body, okay, it's getting a chemical signal back this way. Because our body communicates, cell to cell chemically through the signal. So if we have a distress signal over here that attracts a stem cell to the environment, then we're going to get a release of these little packets of stem cells stem cell growth factors with instructions on what to do. So it's pretty cool. So this releases those growth factors in the environment where there's that failing tissue. It helps to recharge and regenerate the body's own healing potential in that environment to stop the degeneration and turn over their cells a little bit faster in that environment. So in the case of a knee joint, like I have here where we have arthritis chewing away at the cartilage in one's cap of cartilage on the end of the bone here, as that is breaking down, the body is getting signaled for reinforcements. It needs a resupply to help battle against that degradation and that degeneration that's there. So when we look at stem cell therapies, this is the ability to take stem cells from elsewhere in your body and replenish the supply of cells that are needed in the failing part of your body. So most commonly where we take these cells is from the pelvic bone, we call the ilium, the back of your hip bone. And through a local block with anesthetic, we're able to punch a little hole through the bone and aspirate the bone marrow. And from there we get stem cells. Okay, we get a lot of all your blood cells are made inside the bone marrow, but after we take what we call that aspirate, we're able to concentrate it down and get the fraction that is mostly stem cells. And it's that fraction that we want to put back into the environment, the failing joint, say a knee arthritis situation where it needs a resupply to help things heal. So very simply, that is what stem cells in the U.S. that's how we do it. Another country is they can do other things than what we can do in the U.S. where they can grow those cells out and they can replicate them and make larger banks and supply those cells to return to the patient. But in the U.S. it's all same day. I can take your bone marrow out, I can concentrate down to the stem cell fraction I want, and I can inject that back into you via precision injections with ultrasound or x-ray guidance to place them back into the joint or into a ligament or tendon or whatever we're treating. So then if we go over to, you know, the the hype versus hope, I want to bring our attention to an article that was done by a French orthopedic surgeon, Philippe Hurnigel. In 2021, he published this data, okay? But this data, they were tracking for more than 15 years at that point. And it was a very well done study and a very interestingly done study in the fact that what they did is they took 140 patients that qualified to have joint replacement, okay? So 140 patients is what they started with. Of those 140 patients, they randomized them to get joint replacement or stem cell, okay? So they had knees that were comparable in their pain. They both required joint replacement, okay? And these were patients that were 65 to 90 years of age. So what he did in this study is he took an aspirate of their bone marrow just like I shared a moment ago. He replaced the one knee, okay? Randomly, they selected which knee was going to be replaced and which knee was going to get stem cells at the same time under anesthesia while the person was getting their joint replaced. They put stem cells in the other side, okay? And then they followed these patients out and they waited and they waited and they waited because this study, they followed people out for 15 average follow-up was 15 years, which is remarkable in a study because three to five years in a lot of studies is a long-term follow-up. But they followed people out for 15 years. So they published this in 2021, but they started tracking these people back in 2006. So what they found out in this data, again, they replaced one knee on the patient. They put stem cells in the other knee on that patient and then they let them go for a while, a long while. What they figured out in the latest follow-up before they published this data was pretty staggering that when you look at who crossed over, okay, to get joint replacement, it was only 18% of the patients, okay? So the patients that had stem cells, they needed a joint replacement, okay? Metal criteria for it, they had high rate arthritis that put them in a position in knee joint replacement, but instead they got stem cells, okay? Only 18% of those people crossed over over that follow-up period to get the other joint replaced. That means 72% of the people that had stem cells placed in their knee never crossed over to get the other knee replaced, which is kind of mind-blowing to think about when the norm, what we see with people, is the knee starts to fail. They get treatments like anti-inflammatories and when those fail to get improvement, then they make it cortical steroid injections put in the knee. And when that fails, maybe they get HA hyaluronic acid injections put in the knee and when that fails, eventually, they get joint replacement. So again, these people were already there, right? They needed joint replacement. They were 65 to 90. These weren't young people, but this was a great model of real life when what these people wanted is a higher quality of life. They want to be able to, this was a study is from France. So people there, maybe they walk a little bit more than people do in the US. They walk to the grocery store, they carry things home, they go up a flight of stairs, they walk the dog, they want to get on the ground, play with their children, ride their bike, maybe play around a golf, something like that. So their outcomes that they were looking for were really realistic and that's real life. You know what most people are looking for is realistic. Sometimes people come in looking for things that are unrealistic, like we're going to inject stem cells and it's going to repair all the cartilage damage in their knee, which isn't going to happen. So we want to catch things on this slide down the hill. If somebody is at a high grade of arthritis, you know, our outcome data is obviously less good and as far as prognosis of first front end success and then duration of benefit. But if we can catch somebody in that middle act, okay, and intervene with stem cells, then think of it as a halting of this progression. It shuts off this chemical process that's looping, it shuts off pain and allows people to get back to function. And ideally kind of holds this downhill, what we know is this downhill progression towards joint replacement. But this to me was really just a landmark study and I had the honor and privilege to sit in a room a few weeks ago to conference and listen to them present this data because he's now I believe 80 years of age. He did his first joint replacement when he was 50 years ago. He did his first joint replacement. But he got attracted to this concept of trying to figure out are there other ways they could help people without doing surgery. And so again, a study like this 140 patients 15 years of follow up and only 18% of those people ended up getting their other joint replaced. After getting stem cells as a pretty convincing argument that stem cells have a place here in treating orthopedic conditions like joint arthritis, knee arthritis, which is very prevalent condition. As I mentioned, it's one that's going to impact many many people over their lifetime. And the treatments we have available to us look joint replacement is transformational when you can replace one's joint and they're up walking around on it that day. I mean, that is remarkable on itself. But what is even more remarkable is maybe we don't need to do that. Maybe we don't need to do that as early or as to as many people as that study showed it had a great benefit for pain reduction functional improvement elevating that person's quality of life and giving them really what they wanted, which is the outcome to have that function without surgery. So I think, you know, there is to sum this up today. There's a lot of hope around directionally where things are moving with stem cells. Obviously different countries, different rules, different regulations, different things they can do. But he's done studies on this for a very long time in a population there in France to publish this data and really collect it or very long period of time, which again, the deficiency in a lot of studies is maybe the numbers aren't big and subjects I looked at or the duration of them following patients wasn't great. But this kind of hit the mark on both of those. So I think it's very encouraging. I think there's a lot that can be explored here. It's why we've used it in my practice personally for over 11 years with our patients with a good amount of success, particularly in near arthritis. When we look at it for hip arthritis, shoulder arthritis, other conditions like partial rotator cuff tear, it has a roll there. So if you're sitting there watching this and you have those conditions, you may want to be thinking about these treatments. I would recommend you do find somebody who's qualified trained competent to do these in your area in the Tucson area. That's where I am. But we'd be happy to look at that information you have around the joint, the state of it, how severe is the condition? What is your functionality currently? Where do you want to be? And is this the right match treatment? So in summary, I don't think this is hype. I think there's a lot of hope here. I think there's a lot of work yet to do to really get to a point where we know empirically, what do we need to do with each case to have more success? And on the flip of that, who's not going to have success? And we know what some of that criteria is already. If somebody's got a joint that's declined so much, it's angulated. They don't have full range of motion. But if you have full functional range of motion, your shoulder and your hurt, we know that these treatments are very, very successful. At least in my hands and the hands of a lot of my colleagues that have been doing these procedures for well over a decade in the US. So that's the short summary on stem cell therapy is where they sit today in 2025 in this country. What we can and can't do with yourselves. And so if this helped you in any way, click the like button so you get more information like this when we publish it here out of my practice. If you have comments around this topic specifically, drop them below so that we can make future content to answer those questions for you. And subscribe to the channel so you'll know every time we post up a new video. | ↗ |