Your Current Choices for Regenerative Medicine in the US
As its name implies, regenerative medicine is a type of healthcare that seeks to promote healing by generating new, living tissue to repair and replace damaged or diseased tissue. Instead of attempting to manipulate the body through surgery or medications, your doctor uses your body’s ability to heal itself naturally (and more quickly, in many cases).
Regenerative medicine is still an evolving sector of medicine, and some techniques are more established than others. The types of treatments available for orthopedic injuries and conditions vary depending on your location, unique health situation, and the specific condition you want to treat.
The following methods represent the major types of regenerative medicine therapy in use in the U.S. today that are revolutionizing the treatment of orthopedic injuries.
Stem Cell Therapy - Pain Relief, Tissue Repair, and More
Stem cell therapy is the most widely recognized form of orthopedic regenerative medicine. Because stem cells are able to differentiate into other types of cells, as well as self-renew, they can be guided into specialized muscle, tendon, cartilage, or bone cells and implanted in any of those areas to promote healing.
The stem cells we use at Philadelphia PRP and Stem Cell Institute are autologous adult stem cells, which means they’re derived from the patient who will be using them. We source them from the bone marrow of the hip bone.
Some clinical trials have been done to study the efficacy of stem cells derived from fat tissue, called adipose stem cells. Although the technology has shown promise in the treatment of some issues, it is inherently more dangerous than other forms of stem cell treatments. The isolation process involves the use of collagenase, which if not removed before injection can actually cause cartilage damage, rather than heal it. Due to the processing risks and other qualities of adipose-derived cells, the FDA has clearly stated that it is illegal for physicians to use this type of stem cell for the treatment of orthopedic conditions.
Speaking of isolation, it’s the second of three steps in our minimally invasive process of a stem cell therapy treatment, after extraction. First the doctor uses a needle to withdraw bone marrow aspirate from your hip, which is then spun in a centrifuge. This concentrates the stem cells in the bone marrow, producing what’s called bone marrow concentrate (BMC). This powerful material full of growth factors is then inserted via injection--the third step--into the shoulder, back, knee, or other area of pain. The FDA also views this method of extraction, processing, and use of bone marrow derived stem cells as a fully compliant part of the practice of medicine.
The entire process takes less than an hour and results may be seen as early as within days, but usually patients show improvement between two and six weeks later.
Platelet-Rich Plasma - A Stem Cell Therapy Alternative
Platelet-rich plasma (PRP) therapy is similar to stem cell therapy in that the treatment involves extraction, minor processing, and re-injection of healing material from your body. The main difference is in the material itself. Instead of concentrated bone marrow, healing comes about by relocating platelets—which are full of growth factors and vital to cell health—to damaged areas where platelets aren’t found in substantial numbers.
Like stem cell treatments, PRP treatments are minimally invasive, take less than an hour, and can be used to treat illnesses that are marked by inflammation, such as arthritis, bursitis, carpal tunnel, tennis and golf elbow, and even partial ligament tears. They are not the same as cortisone shots, which can actually cause joint and cartilage damage.
While there is no hard-and-fast schedule for PRP treatments, most patients begin to see improvement between 2 and 6 weeks after their office visit. Additional treatments may be necessary, depending on the patient’s condition.
PRP treatments are not covered by insurance at this time, but it may be possible to use a health sharing plan or health savings account to offset at least some of the cost.
IRAP and Alpha 2 Macroglobulin Injections for Arthritis
Arthritis comes in many different varieties, but there are two main classes: inflammatory and noninflammatory arthritis. Rheumatoid arthritis is a common form of inflammatory arthritis. Even though it can cause joint inflammation through wear and tear on cartilage, regular osteoarthritis is considered noninflammatory arthritis.
Therapies like Alpha 2 Macroglobulin (A2M) and IRAP (Interleukin-1 Receptor Antagonist Protein) injections seek to inhibit the underlying proteins that trigger the body’s inflammatory response. Now, inflammation is actually a helpful, built-in mechanism for fighting infection and stimulating healing. The trouble is, this mechanism can become out of control and self-damaging, resulting in various forms of arthritis.
The process for both treatments is similar to PRP injections—healing material is extracted and moved to a damaged area where it’s not normally found—except A2M utilizes a special, multi-phase centrifuge system to concentrate it for re-injection. Although all PRP injections will naturally include small amounts of A2M and IRAP, they won’t contain nearly as much as an injection designed to concentrate the two proteins.
IRAP is strictly intended to reduce pain and inflammation, making it a good fit for chronic knee pain and osteoarthritis. A2M has been shown to have more regenerative properties and able to help tissue and cartilage recover from breakdown, making it an applicable treatment for a wide variety of joint, disc, and soft tissue problems.
Prolotherapy for Joint Pain
It may sound futuristic, but prolotherapy is a natural, non-surgical technique that’s been in use for decades. A natural irritant like dextrose (a type of sugar) is injected into the damaged joint or ligament, with the goal of kick-starting the body’s healing response in that area. Then the body can react on its own to heal the damaged tissue.
Prolotherapy has some drawbacks, including higher costs compared to PRP, the need for as many as 15 doses per treatment series, and the fact that it may not be optimal for patients with more than superficial tissue damage. It is unlikely to provide permanent relief, though patients may experience improvement lasting months or even years in certain cases. For patients who respond, pain should dissipate as the joint is strengthened, stability and overall function should improve, and re-injury risk should diminish.
Prolotherapy has been used in treating the back, knees, shoulders, hips, and other joints. But some studies indicate a low response rate and short duration of relief with this type of intervention.
Regenerative Medicine + Surgery
Although in many cases regenerative medicine can help you avoid surgery, it can also be paired with surgery as an effective means of recovering faster and reducing the risk of re-injury. It can also reduce the pain and inflammation common after many surgeries.
For example, rotator cuff surgery has suffered for years from a failure rate of upwards of 50%. But many patients who underwent the surgery and augmented it with BMC therapy have shown complete healing after six months. And studies tracking the results over a ten year period have found only a 13% risk of re-injury when the surgery is paired with stem cells, versus 44% for those who received surgery alone. That means almost half of patients not receiving stem cells experienced a re-tear within a decade. And close to 9 of 10 patients who received stem cells with their surgical repair did not.