Umbilical stem cells now offer an alternative to surgery for patients with injured, painful and damaged joints. We review some of the landmark literature and ask where cord blood and tissue fit in.
In 2015 Dr Robert Schwartz, an internationally-renowned practitioner of Neuromusculoskeletal, Vascular and Regenerative Medicine, published an article describing the benefits of stem cell therapy for knees. Dr Schwartz highlighted umbilical stem cell therapy as a viable, and in many cases preferred, alternative to arthroscopy or knee joint replacement surgery.
The report, based on clinical trials at Piedmont Physical Medicine and Rehabilitation, P.A. in Greenville, South Carolina, USA, showed that both autologous and placental-derived stem cells can produce outstanding results, as evidenced by the fact that 74% of his patients reported more than 80% lasting relief*.
Dr Schwartz noted the key advantages and drawbacks to using autologous or placental-derived (cord blood) stem cells:
Autologous stem cells, which derive from a patient’s own blood or marrow, typically lead to a “Eureka” day within 21 days of grafting, and seem to have a relatively faster onset of action compared to placental derived stem cells. As a result, pain relief occurs more rapidly in the majority of cases. Drawbacks include the need to harvest stem cells, and the need for a platelet rich plasma (PRP) booster one month after treatment to ensure full benefit and impact.
Placental stems cells, which are found in the placenta and collected after the blood from the umbilical cord is drawn, seem to keep working longer relative to autologous stem cells. Furthermore, the grafting procedure is simple, and an RPR booster is not required. However, they appear to work slower, which can result in the delayed onset of peak pain relief.
“We are impressed and inspired by the outcomes we are seeing for stem cell therapy for osteoarthritis in knees, as well as in hips, ankles, back, shoulders and spine,” commented Dr. Schwartz, who has been practicing medicine for 31 years, and who also serves as the Medical Director of Physical Medicine at Bons Secours Hospital in Greenville, SC.
“It is not uncommon for patients to report that their walking endurance has increased more than 700%, and that the so-called `bad’ joint or limb that had been troubling them for years or decades actually feels stronger than the `good’ one!”
* “Lasting relief” is defined by Dr. Schwartz as relief persisting more than six months after treatment. This definition is applied in order to generate more robust and credible results by filtering out any cases where a patient may report experiencing initial or short-term relief, yet later report that it has somewhat or significantly diminished.
A non-steroidal, low-risk treatment
In 2016 Regenerative Network International (RNI) began offering stem cell therapy to its patients to help avoid hip or knee replacement.
Hip and Knee replacement procedures should always be performed as an absolute last resort, since there are potential significant risks involved. With the excellent outcomes now being seen with stem cell treatments for hip and knee arthritis, the joint replacement procedures can often be delayed or even avoided.
According to the RNI, over 85% of patients receiving the regenerative treatment have achieved incredible relief and improved functionality. This may include enhanced ability to participate in recreational and elite athletics, along with simply being able to walk farther.
RNI say that the umbilical stem cell treatment has “changed the paradigm of nonoperative arthritis treatment.” While steroid injections often provide relief, they do not change the course of the condition. Stem cell treatment has been exceptional at helping with new growth of tissue along with providing relief.
Superior patient-reported outcomes
In 2017 the British Medical Journal (BMJ) published a systematic review of stem cell injections for knee osteoarthritis.
Stem cell injection for knee osteoarthritis (KOA) is an emerging new therapy, and we aimed to review its evidence of efficacy.
Five randomised controlled trials (RCTs) and one non-RCT were found. The researchers found that all the trials were at high risk of bias, resulting in level-3 evidence. All five RCTs reported superior efficacy for patient-reported outcomes (Visual Analogue Scale, Western Ontario and McMaster Universities Arthritis Index, Tegner, Lysolm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Lequesne) compared with controls at final follow-up (range 24–48 months). However, superior radiological outcomes were found, favouring stem cell injection. Superior histological outcomes and/or improved arthroscopically scored healing rates were also reported in two trials. No serious adverse events were reported.
Stem cell therapy for joint injury and osteoarthritis and osteoporosis is in its infancy and there is not yet a lot of evidence to support its efficacy. The existing evidence is positive and exciting:
- stem cell therapy can delay or even help patients avoid surgery
- as an outpatient therapy, the process is quick, relatively pain-free and has been shown to be risk-free
- stem cell therapy is non-steroidal
- patients report experiencing pain relief and greater joint functionality
- radiological findings provide evidence of joint improvement
- umbilical stem cells avoid need to ‘harvest’ cells from peripheral blood or cord marrow, an invasive process that collects older, less potent cells than those in placental derived cells