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 osteoarthritis. 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.
Stem cell therapies are a cutting-edge 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 treatments. First, there’s Bone Marrow Aspirate Concentrate, or BMAC for short. BMAC is obtained from bone marrow and is usually harvested from the patient’s iliac crest in the pelvic bone.
Next we have adipose stromal vascular fraction also known as SVF. SVF is derived from fat tissue and is harvested through liposuction. Last, there are stem cells from umbilical cord which are ethically sourced and processed for clinical use.
Each stem cell treatment, whether it's BMAC, SVF, or umbilical cord-derived, shares a common goal. They utilize mesenchymal 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 1 year.
The results showed that there was no difference in pain scores between any of the stem cell therapies when compared to cortisone injections. In addition, no treatment groups saw any notable improvement in MRI scores. This suggests that none of the 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?
Some critics would argue that a one-year study may not be sufficient to evaluate the long-term benefits or structural 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 treatments 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 presents 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 injections. I've covered the risks of corticosteroid injections in a separate video, which I'll link for further details.
Ok 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 controlled 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 arthroscopic 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.
For those considering orthobiologic therapies and regenerative medicine, I generally recommend against stem cell injections. They tend to be more expensive and invasive, without necessarily offering better results than cortisone injections. Instead, I advocate for Platelet Rich Plasma injections, which I suggest to my patients as a more viable option.