Stem Cell Rich Bone Marrow Concentrate
Cartilage damage and joint pain
Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber. Damage to this tissue is common and occurs mainly following sudden twists or direct blows, such as falls or heavy tackles playing sports such as football and rugby, but can also develop over time through gradual wear and tear or due to conditions such as Hip Impingement. Damage to the articular cartilage (chondral defects) does not heal when injured, leading to exposure of the bone itself, this may increase in size over time leading to increased pain and disability. Untreated, chondral defects may eventually lead to osteoarthritis and patients may ultimately require joint replacements to relieve symptoms.
What are stem cells?
Stem cells are your body’s own reparative cells. They have the ability to divide (mitosis) but also to form various structures such as cartilage, bone and many more through the process of ‘differentiation’ and this is a part of the natural regenerative process.
Are stem cells safe?
There are two basic forms of stem cell - the embryonic stem cell and adult stem cell. Adult stem cells, which are also known as Mesenchymal Stem Cells or MSCs are of great interest to researchers, scientists and surgeons alike. MSCs are free of the controversy that surrounds the embryonic stem cells and yet have the potential to form new tissues. At Oxford Hip we use the MSCs. This gives us the ability to repair and regenerate tissues such as cartilage and bone more effectively.
The stem cells are harvested autologously - directly from the patients. Consequently, there is no risk of disease transmission, rejection or ethical controversy that can exist using cells from an unrelated donor. All of us have a supply of MSCs in various tissues and these can be harvested using specialised techniques.
What does the procedure involve?
The procedure is in the form of arthroscopy (keyhole surgery) of the hip. Patients often ask whether stem cell therapy involves surgery on two separate occasions. For the techniques that we use, only a single operation is normally required. This is normally carried out as day-case procedure for most hip arthroscopy patients will have one night’s stay in hospital. Once the patient is under general anaesthesia, an aspirate of their blood and/or marrow is taken with a special needle. The aspirate is then processed in the operating theatre, and while the patient is still asleep, in order to harvest the stem cells. At the same time the keyhole operation (arthroscopy) is commenced to access the hip joint. The surgeon uses specialist arthroscopy techniques to prepare the tissue bed so that it is ready to receive the stem cells. The harvested stem cells, alongside a suitable scaffold, are then injected through the same keyholes that are routinely used for the arthroscopy.
What are the side effects?
The risks of undergoing surgery are the same in both groups and are related to any ‘keyhole’ procedure. There is a small risk of bleeding or instrument breakage when taking the bone marrow from next to the hip joint. This is less than 1% risk.
What is the evidence for stem cell therapy?
Stem cell therapy is a relatively new procedure. However, it has created so much interest worldwide that extensive research has been taking place in this field. Animal and human studies have been published that have suggested a safe and favourable response to stem cell therapy in hips, knees and even ankles. Our practice routinely collects data on almost all patients who undergo surgical treatment under our care; assessment questionnaires are periodically sent to those who have undergone surgery. This is an invaluable source of information that helps us to inform our patients, publish in the literature, and to train others who are interested in the techniques we undertake. To date we have performed this procedure in more than 400 patients. We are also running one of the first trials worldwide on this technique.