by Dr. Tan Boon Cheong

MBBS (MU),. MS Ortho (MU)

Many issues ago I did very briefly mentioned about stem cell treatment in orthopaedics, but only in a few sentences. Stem Cell Therapy has gained increasing popularity in orthopaedic treatment especially in knee osteoarthritis in the last few years. Stem cells are not only used for articular cartilage regeneration, but also used for osteonecrosis, fracture healing, osteochondral defects and tendinopathies.

The two most common sources of adult stem cells for clinical application in orthopaedics are the bone marrow and adipose tissue. Bone marrow aspirate is first harvested and centrifuged, Bone Marrow Aspirate Concentrate (BMAC) which contains Mesenchymal Stem Cells (MSCs) will then be produced. When lipoaspirate has been treated by enzymes and has undergone differential centrifugation, a layer of Stromal Vascular Fraction (SVF) which contains MSCs will be obtained. With the advancement of technology today, industry players have managed to obtain better stem cell count with each centrifugation; Thus, making the cultivation of stem cells easier and faster. 

Although stem cells have been widely used in orthopaedic treatment, stem cell usage in knee osteoarthritis has interested patients more than others. With recent advancement, more research articles have been able to show the regeneration of articular cartilage in knee osteoarthritis with stem cell treatment. Even though most of these studies were small-scaled, but they have shown promising results.

Stem cell application in knee osteoarthritis can be in two ways. The first will involve a minor operation through arthroscopy of the knee. During the arthroscopy procedure, the cartilage defect on the joint surface will be identified and prepared. The stem cells will then be used to fill up the defect (implantation). The second method which is much simpler is direct intra-articular injection into the knee joint. This usually goes together with hyaluronic acid (gel).

Having said about the use of stem cells in the treatment of knee osteoarthritis, not every patient with knee osteoarthritis is suitable to be treated with stem cell as the patient must be well selected. Knees with severe osteoarthritis should not have Stem Cell Therapy performed on them as this will result in poor outcomes, for them knee replacement surgery is their only option. Do bear in mind, Stem Cell Therapy in knee osteoarthritis is not permanent. Several studies have shown that the effects only last a range of 2 to 5 years. 

One major drawback of stem cells  being widely used in knee osteoarthritis is the cost. The cost of stem cell treatment can range from RM12000 to RM 20000 (USD 3000 to 5000) per knee per treatment. Moreover, this cost will not be covered by medical insurance.

I believe that the usage of stem cells in knee osteoarthritis treatment in the years to come as more studies are conducted will be able to provide us with better evidence on the outcomes of Stem Cell Therapy. Therefore, before one decides to have this treatment, it would be great to first have a consultation with an orthopaedic surgeon as every patient differs. 

Image(s) courtesy of Freepik.com