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Dr. Nizar Alsalahat

Regenerative Treatment by Mesenchymal Stem cells (MSCs) 

 

The Alternative Treatment for Knee&Hip Osteoarthritis and Sport Injuries

 
 
The following article published by Dr. Nizar Alsalahat, expounding the advanced treatment for knee&hip osteoarthritis, characterizing the principle, method and objective of this treatment.

Overview: Osteoarthritis (aka degenerative arthritis) usually affects large, weight-bearing joints such as the hips and knees. Osteoarthritis is thus strongly linked to aging-related changes in this cartilage, and also linked to other causes, such as injury, overuse and genetics.​

Physiological view: It is known that cells and tissues in the human body remains in balance between catabolic and anabolic processes. While with aging, this balance may deflected to result in decrease of anabolic process. It is also known that stem cells (aka master cells) are responsible of anabolic processes of cells and tissues in the human body.

Osteoarthritis of knee - Click to zoom

As osteoarthritis of the knee and hip is basically a stem cell (MSCs) deficiency which caused by aging or also by injuries: the gradual loss of repair stem cells is the key problem. Thus the most obvious, elegant and natural solution to a stem cell deficiency is renew and augment their numbers with fresh, new stem cells derived from the body’s SVF. We address what is a stem cell deficiency by injecting and repopulating the joint with new stem cells: cells that naturally regenerate fresh, new tissues to replace the missing stem cells, and helping the body to maintain itself.

Mesenchymal Stem Cells (MSCs):

MSCs are multipotent stromal cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells), and adipocytes (fat cells).

Methods of Extracting MSCs:

  • Bone marrow: Mainly extracted from posterior superior iliac spine PSIS​, this is the method to extract MSCs before discovering the method of extracting from adipose tissue. 
    Obtaining SVF from adipose tissue-Click to zoom
  • Umbilical cord blood: The blood that remains in the placenta and in the attached umbilical cord after childbirth.
  • Adipose tissue: Considered the richest source of MSCs from the previous methods. adipose tissue is obtained by liposuction procedure of the  abdominal wall with local anesthesia, followed by centrifugation process to separate the fat tissues, followed by dismantling process and mixture with special enzymes, and finally recentrifugation process to obtain Stromal Vascular Fraction (SVF). This SVF is very rich with MSCs which is injected in the patient's joint.

Extracting MSCs from adipose tissue is the optimal method. Why?

 1. No need for donor.
 2. There is no possibility for the body to refuse the injected cell, because it is extracted from the patient.
 3. There is no possibility for infection or virus/bacteria transaction.
 4. Cell storage or cultural are not needed. MSCs are extracted from adipose tissue of the patient within 2-3 hours, and inject it immediately​.
 5. Patient's body is rich of adipose tissue, and it is easy to obtain without making the patient facing any possible risks.
 6. Adipose tissue is very rich of MSCs. 1g of adipose tissue contains 500 times more MSCs  than 1g of bone marrow.
 7. MSCs ratio inside the SVF are approximately 3% of the entire cells, which is 2500 times more than the MSCs in the bone marrow.
 

Traditional Treatment of knee&Hip Osteoarthritis:

Traditional treatment OR Regenerative treatment?

The traditional medical treatments aim to remove damaged cartilage by arthroscopy, provide lubrication with hyaluronic acid, or use steroid to quiet pain & inflammation. Unfortunately, steroids will lead to a number of side effects with prolonged use. These treatment methods are considered “temporary” treatments, They buy time but do not restore or re-grow the damaged or injured cartilage. Sadly, most of the patients who use these traditional, temporizing methods of treatment will live to see their condition worsened, and may then be offered surgical placement of an artificial joint. Not a pretty picture…

The principle of Regenerative Medicine of Knee&Hip:

Regenerative medicine is the process of replacing and renewing human stem cell lines to enable tissues and organs to restore and re-establish optimal function. By means of simple MSCs injections for the knee and hip we can prime the body to regenerate, or functionally heal, worn, damaged or injured cartilage and bone cell lines. This SVF (Stromal Vascular Fraction) is obtained by first extracting adipose tissue (fat), and then harvesting it for MSCs which are in the SVF. The refined SVF is injected into the knee or hip joint, and later injections of Platelet Rich Plasma (PRP) activate & stimulate the differentiation of MSCs (within the SVF) into producing new cartilage. The SVF obtained from 100cc adipose tissue contains around 40 million MSCs.

Cases can be Treated with Stem Cell Injections at Puhua Hospital:

  • Osteoarthritis: Knee, Hip, Ankle and other joints.
  • Articular Cartilage Injury. Sport Injury.
  • Meniscal Injury.
  • Ligaments Injury.
  • Nonunion fractures.
  • Avascular Necrosis - AVN.

Regenerative Treatment: an Optimal & Natural Solution. Why?

​​
Knee&Hip injection process-Click to zoom

The most obvious, elegant and natural solution to a shortage of repair stem cells is to replace them, to augment their numbers with new stem cells. In treating osteoarthritis of the knee or hip with repair stem cells, patients receive a safe, relatively painless procedure that has the potential to mitigate (perhaps indefinitely) against the need for potentially risky, and relatively painful hammer and chisel surgery.

Patients who follow this relatively simple treatment program generally begin to feel symptomatic relief within ~2 weeks, followed by long-term of cartilage regeneration. We can see the new cartilage growth by MRI comparison only 3 months after the procedure. This technique can thus be seen as optimal treatment for knee & hip arthritis. This procedure is extremely safe and does not entail any surgical risks or even involve general anesthesia. Thus patients with advanced age, diabetes, hypertension and other medical issues are good candidates for this gentle & elegant treatment.

Regenerative Treatment: The Pre-SVF Arthroscopy:

Why Pre-SVF Arthroscopy for Severe OA?

In some severe cases of osteoarthritis, the articular cartilage increase its area in order to decrease pressure on the cartilage by building Osteophytes, which limit the mechanical movement of the joint. In addition, the loose bodies which fell from destroyed cartilage will be locked inside the joint and harm the articular cartilage while movement. As well as in some sport injuries which result with severe tear of the meniscus or partial tear of ligaments. In these special cases patients are advised to receive Pre-SVF Arthroscopy procedure, which considered to be the optimal solution for these cases. By this procedure, we eliminate Osteophytes and Loose bodies inside the joint which impede the joint’s mechanical movement, This procedure prolong the joint’s lifetime and aim to restore the full function of the knee/hip joint.

It is known that pain and range of motion are the only indications for joint replacement surgeries. And as long as the above mentioned regenerative treatment success in treating pain and improve the range of motion, thus there is no need for the traditional joint replacement surgery! (Except some very special cases which are around 5%).

Replacement or Injection?-Click to zoom

The Objective of Arthroscopy before Stem Cell Injection (Pre-SVF Arthroscopy):

  • Immediate improvement of the symptoms related to the joint's range of motion after arthroscopy, which caused by (Impingement + Osteophytes).
  • Removing the loose bodies which constantly harm the articular cartilage.
  • Prepare the meniscus for regeneration process by simplifying the injury which prevent a future osteoarthritis of the articular cartilage.
  • Clean the joint from the rotten tissues which may impact part of the stem cell effectiveness.
  • Provide better environment for the stem cells to regenerate the cartilage and the injuries tissues.

​Conclusion:

the advanced regenerative treatment with the use of stem cells for orthopedic disorders is considered as revolution in the world of healthcare, which always aim to provide the most advanced technologies for the patients with the least risks, also provide a better clinical results to improve the patient's quality of life. Patients who were partially (if not totallyrely on others for practicing their activities of daily living whether at home or work, now they become a productive member in the society and can practise their activities of daily living individually, without following the traditional major surgery which brings a high risks to patients.

The Pre-SVF Arthroscopy has been proven its success and effectiveness in the fast recovery time clinically after the procedure within few days, which can be seen in the improvements of the joint's range of motion ,pain relief, and returning to the previous daily life habits without rely on pain killers or other medications. It is also worth to mention that stem cells can continue the regenerative process for the injured tissues, thus patients will keep on improving not only clinically, also in tissue healing. 

Dr. Nizar Alsalahat  M.D, Ph.D

Medical Director
Orthopedic Team Leader
Orthopedics and Trauma Surgeon
 

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