Current approaches using stem cells for osteoarthritis are able to make use of autologous stem cells. These are stem cells obtained from the patient’s blood and fat tissue using a special biopsy needle. Since the procedure is done using local anesthetic, the risks of the procedure are minimal.
Autologous stem cells have the ability to differentiate into other tissue cells. Previously, it was felt this trait was not possible for adult stem cells; however, it has been confirmed that stem cells harvested from an adult are capable of differentiation.
Once the stem cells are harvested, they are concentrated using a special technique. In addition, platelet rich plasma which is derived from a patient’s whole blood is also obtained. Platelets are cells that contain numerous growth and healing properties. These growth factors have the ability to fire off tyrosine kinase receptors on the surface of stem cells and accelerate differentiation and multiplication.
After this, stem cells and platelet rich plasma are injected into the damaged area of the foot or ankle using special stem cell injections.
Calcium chloride and thrombin are also used to create a “scaffold” for the stem cells to locate themselves.
Diagnostic ultrasound is used throughout to ensure the proper location for harvesting the stem cells as well as the best location for introducing the stem cells into the foot or ankle. The use of ultrasound is mandatory for proper anatomic placement!
So who might be a candidate for this procedure?
First, it’s important to realize that a patient must have some cartilage remaining in the foot or ankle for stem cells to do their job.
Osteoarthritis is currently graded in clinical trials using foot or ankle x-rays to quantify the amount of cartilage present within the area.
The Kellgren-Lawrence classification is used. Grade 1 means the amount of cartilage is relatively normal. Stage 4 means that the patient is “bone on bone”. Patients who are Kellgren- Lawrence stage 4 are not considered candidates for stem cell treatment. Patients who are grades 1-3 are acceptable.
Patients who are grade 3 must be at or near ideal weight.
Age also plays a role. It appears that as people get older, their stem cells respond less to stem cell stimulation.
The ideal patient is between the ages of 30-70 and is at or near ideal weight. Healthy Baby Boomers who are athletic and active are felt to be the best candidates.