| 1 | Jeffrey Peng MD | PRP Injection vs Stem Cell Therapy for Knee Arthritis | 194481 | 4597 | 498 | 70.6 | neutral | 9:12 | So you have really bad pain in your knees and you've tried everything to treat them, but nothing is getting you relief. You've heard of a lot of success stories with regenerative medicine treatments such as PRP injections and stem cell therapy, but you're wondering are these stories too good to be true? Do people really feel better and who can you trust to learn more about these treatments? Well, you're in the right place because we're going to go through the most up-to-date clinical trial data. And these studies will tell us whether PRP injections and stem cell therapy actually work. They will hopefully help you decide which treatments may or may not be worth pursuing. Let's get started. Hey everyone, Dr. Jeff Payne here. Now if this is the first time you are watching one of my videos, my goal is to help each and every one of you live an active and healthy lifestyle. So if that's something you're interested in, please consider subscribing to my channel. Okay, so let's talk about PRP versus stem cell therapy for knee arthritis. Both PRP and stem cells fall under the big umbrella category of treatments called regenerative medicine or orthobiologics. These are very new techniques with the goal of using your own body cells to help relieve pain and inflammation. Both PRP and stem cells contain an enormous amount of growth factors. They initiate cascades, which are responsible for tissue healing, tissue remodeling, tissue proliferation, and in controlling pain and inflammation. But more specific to osteoarthritis, they are incredibly important in altering the biochemistry of a knee suffering from arthritis. And that's because arthritis causes a very toxic environment in the knee. It's incredibly inflammatory and all of this leads to pain and disability. So the goal of biologic treatments such as PRP and stem cells is to use your own cells to reset the environment in the knee to create and maintain a healthy and neutral environment. Our hypothesis is that these cells will not only reduce symptoms, but they can also decrease the progression of arthritis. So let's talk about stem cells first. What are they? When most people talk about stem cells, they are thinking of pluripotent stem cells. These are cells that can divide and grow into pretty much anything. Think of embryos that are just starting to grow and create new organs. They are incredibly versatile and can potentially regenerate or repair disease tissues in organs. But when we talk about stem cell procedures or stem cell injections, we are actually using and referring to another type of stem cell, not the pluripotent stem cells. Instead, we are using a special type of adult stem cell called the mizenchymal stem cell. These cells have limited capacity when compared to pluripotent stem cells, but they still have tremendous ability to reduce pain and symptoms. So the two most common places to get mizenchymal stem cells are either from adipose or fat tissue or from the bone marrow. And it's important to point out that once we isolate the mizenchymal stem cells and then inject them, there's no current evidence to suggest that we are re-growing or regenerating anything. Remember, these cells are not pluripotent. You don't get a new knee after stem cell injections. So you may ask, what's the point then? Well, mizenchymal stem cells are incredibly strong signaling cells. They initiate cascades in the body that provide all sorts of health benefits, but most important among them are reducing pain and reducing inflammation. And how does that compare to what PRP does? PRP stands for platelet-rich plasma. In PRP, we draw your blood into a specialized tube, put it in a centrifuge, and then separate out your platelets in all the growth factors that circulate in your blood. We then take that out and then eject it into your knees. Again, we are not growing or regenerating anything, but we are using the cells that initiate incredibly strong cascades in the body to provide pain relief and reduce inflammation. Our current understanding of mizenchymal stem cell injections and PRP injections is that they initiate similar pathways to help improve symptoms. The question then becomes, do they work? In which one is better? Let's tackle the first question. Do they work in treating knee arthritis? So this study looked at people with knee arthritis who were treated with adipose derived mizenchymal stem cells, so adult stem cells from fat tissue, and published their results at two years follow-up. In terms of pain, the researchers found that there were significant improvements at six months. At 12 months, pain was slightly worse than six months, but still better than before treatment was started. At 24 months, pain was essentially back to the pre-treatment baseline. In terms of function, the researchers found gradual improvements at six months, 12 months, and then a plateau effect at 24 months. These results included people with wild, moderate, and severe arthritis. Now I think it's important to point this out because our current medical thinking is that once you reach grade four or bonon bonarthritis, there's almost nothing we can do except for a new replacement surgery. In this study, people with severe arthritis definitely had improvements from their baseline, just not as much as those with mild arthritis. So what about mizenchymal stem cells obtained from bon marrow and how do they compare to the ones from adipose tissue? So this study was a systematic review and meta-analysis looking at 19 studies, and compared those who got mizenchymal stem cell injections from bon marrow and from adipose tissue. They found that both groups had significant improvements in pain and function for the treatment of knee arthritis. More interestingly, they found that the patients who got bon marrow mizenchymal stem cell injections had significantly better outcomes compared to people who got adipose derived mizenchymal stem cells. So from these studies, we know both types of mizenchymal stem cell injections are effective at treating symptoms related to knee arthritis, and it seems that bon marrow may be better than adipose tissue. Now what about PRP? Playlist-rich plasma injections have also been shown to be incredibly effective at treating symptoms related to knee arthritis. I made an entire video discussing PRP injections, which I will link here, so please check that out if you are interested. But here is one of the most recent studies looking at the use of PRP injections to treat knee arthritis. It's a systematic review and meta-analysis looking at 40 different studies comparing PRP to hyoronic acid, corticosterates, and placebo injections. They found that at six months, PRP was as effective and in some studies more effective than other therapies regarding pain, function, and stiffness. So all of these studies add to the growing body of literature, which supports the use of orthobiologics to help treat and relieve symptoms related to arthritis. But which ones are better? So the next question we want to ask is, are there any studies that directly compare mesenchymal stem cell injections to PRP injections? And the answer is yes. This study was published very recently and is a two-year outcome study, comparing bon marrow mesenchymal stem cells to PRP treatment. Patients with knee arthritis were randomized to get either one bon marrow injection or one PRP injection. And they found that both groups had significant improvements in both pain and function at three months, six months, nine months, 12 months, 18 months, and 24 months. But what they found was there was no difference. There was no difference between PRP and bon marrow mesenchymal stem cell at any time point. The researchers go on to conclude that for the treatment of osteoarthritis, PRP and bone marrow concentrate performed similarly out to 24 months. Bon marrow was not superior to PRP. So from these studies we can conclude the following. Both stem cell injections and PRP injections work similarly well for the treatment of knee arthritis. Again, we think they work by treating and changing the biochemistry inside a knee with arthritis. The hypothesis was that stem cells would provide a greater effect than PRP. But at this point in time, that hypothesis has not been proven to be correct. Both PRP and stem cells are equally effective. But here's the thing. Let's talk about cost. Both of these treatments are not covered by insurance and they are cash pay. However, stem cell injections can cost thousands and even tens of thousands of dollars. PRP is significantly cheaper in the hundreds of dollars. And until clinical trials start to show otherwise, when we do a cost benefit analysis, PRP is the clear and easy winner. Hopefully that provided a good summary of PRP versus stem cell therapy for the treatment of knee arthritis. My channel has an entire playlist going over PRP and orthobiologics. So check that out if you are interested in more content. And lastly, everyone who has knee arthritis really should take a multimodal approach to treating their knees. So check out this video next where I go through all the treatment modalities that I recommend most. Thanks for watching. | ↗ |
| 2 | Jeffrey Peng MD | Stem Cell Therapy For Arthritis - The Truth You Need To Know | 90426 | 1328 | 272 | 67.5 | negative | 7:04 | imagine a future where a simple treatment could repair your damaged joints solve chronic pain and restore Mobility stem cell therapies promise just that for those suffering from arthritis yet among soaring expectations and bold claims there remains an essential lingering question does the actual effectiveness of these therapies match their groundbreaking potential today we're going to take a dive into the world of stem cell treatments for Osteo arthritis we'll discuss the science scrutinize the evidence and I'll give you my recommendations on whether this novel treatment is the Breakthrough we've been hoping for hey everyone Dr Jeff paying here stem cell therapies are a cuttingedge treatment and offer high hopes for those suffering from osteoarthritis however while there has been substantial media coverage and marketing efforts surrounding stem cell therapies they often highlight anecdotal success stories and while personal stories can be very compelling they can create a perception of Effectiveness that may not be fully supported by clinical evidence so let's briefly explore the three main types of stem cells used in osteoarthritis treatment first there's bone marrow aspirate concentrate or BAC for short BAC is obtained from bone marrow and is usually harvested from the patient's iliac crest in the pelvic bone next we have atopos stromovascular fraction also known as svf svf is derived from fat tissue and is harvested through lipo suction last there are stem cells from umbilical cord which are ethically sourced and processed for clinical use each stem cell treatment whether it's BAC SP SPF or umbilical cord derived shares a common goal they utilize mesen kyal stem cells and growth factors to potentially repair and regenerate damaged tissues like bone cartilage and connective tissue in addition these therapies also aim to reduce pain and inflammation through their anti-inflammatory and immunomodulatory effects so that's all in theory but what does the actual clinical evidence indicate while numerous case reports and some smaller studies suggest positive outcomes with stem cell therapies the overall evidence remains inconclusive this is why many experts who follow the orthobiologic space have been eagerly awaiting the results of this latest clinical trial the study investigated the three types of stem cells again that's bmac svf and umbilical cord tissue the researchers compared each of these three stem cell injections to corticosteroid injections and reported outcomes at one year the results showed that there was no difference in pain scores between any of these stem cell therapies when compared to cortisone injections in addition no treatment group saw any notable Improvement in MRI scores this suggests that none of these cellular treatments helped repair or regenerate anything within an arthritic knee now I want to reflect on these findings and emphasize a couple key points first this was a very well- conducted study with a large sample size of nearly 500 patients this is significantly more than the 20 to 30 patients in other clinical trials and therefore lends greater reliability to its findings second the study questions the effectiveness of stem cell treatments compared to corticosteroid injections for knee osteoarthritis this raises an important question is it worth paying thousands of dollars for a treatment not outright Superior to less expensive Alternatives now some critics would argue that a one-year study may not be sufficient to evaluate the long-term benefits or structural Improvement improvements that stem cell treatments could provide however it's important to note that individuals considering stem cell therapy often seek immediate results and may be reluctant to invest a significant amount of money in a treatment that requires several years to potentially show benefits for all these reasons I currently do not recommend stem cell therapy for the treatment of osteoarthritis this decision is based on the mixed results from recent clinical trials many of which show little to no benefit from these treatments furthermore the high cost of stem cell procedures represents a substantial Financial Risk especially considering the uncertainty of their effectiveness now a quick note on cortisone injections although the mentioned study showed no significant difference in Effectiveness between Cortisone and stem cell treatments this doesn't mean that everyone should be getting cortisone injection I've covered the risk of corticosteroid injections in a separate video which I'll link here for further details okay so what's a better alternative to cortisone or stem cells I recommend considering platelet rich plasma injections PRP has been proven highly effective in treating osteoarthritis and is considerably more affordable than stem cell treatments more importantly a wide range of studies including randomized control trials systematic reviews and meta analyses have shown that platelet rich plasma injections are more effective than Placebo cortisone injections and hyaluronic acid injections other Studies have even compared PRP injections to arthoscopic surgery and reported similar outcomes long-term studies suggest PRP injections can slow down the progression of arthritis and delay the need for knee replacement surgery in fact both the American Academy of orthopedic surgeons and the American Medical Society for sports medicine have acknowledged the effectiveness of PRP they've released summaries and consensus statements highlighting prp's significant benefits in reducing pain and enhancing joint function in knee osteoarthritis so for those considering orthobiologic therapies and regenerative medicine I generally recommend against stem cell injections they tend to be more expensive and inv Ive without necessarily offering better results instead I advocate for platelet rich plasma injections which I suggest to my patients as a more viable option lastly you need to know that not all PRP injections are the same there are many factors that influence the effectiveness of PRP and not paying attention to these can result in less favorable outcomes so check out this deep dive where I discuss the critical factors to consider and potential pitfalls to avoid during the treatment process | ↗ |