Osteoarthritis, commonly known as degenerative arthritis is an auto-immune disease in which mainly joints are affected due to external trauma, deficiency of calcium, damage in the cartilage. The factors responsible can be developmental, hereditary, metabolic, mechanical deficits that may initiate process leading to loss of cartilage.
The diagnosis includes radiological findings like X-rays and MRI, blood tests and joint fluid analysis. Surgical options include cortisone shots, lubrication injections, realigning bones and joint replacement. Above mentioned all surgical procedures have risk of infection and blood clot. There is not any cure for osteoarthritis but treatments can help reduce pain and help in joint movement. The symptoms can slowly subside by variety of medications like Acetaminophen, Nonsteroidal anti-inflammatory drugs (NSAIDs) and Narcotics.
The target organs are hips, knees, neck and lower back; it also affects hands, feet, and spine. It starts with pain causing loss of ability with stiffness in affected organs. The pain becomes worse after exercise or putting weight on it and is relieved by rest. Over a period of time pain is still present even after rest and there is grating of joints with motion. Other symptoms also include swelling of joints, limited movement and Muscle weakness around arthritic joints.
Stem cell therapy, a non-surgical procedure, offers an alternative to total hip replacementt. The goal of treatment is to reduce joint pain and inflammation while improving and maintaining joint function.
Stem cells are classified as Adult stem cells and embryonic stem cells, which are further classified according to the way they are derived and sources tissues like, Mesenchymal stem cells(MSC’s), Haematopoietic stem cells(HSC’s) and induced pluripotent stem cells(iPS)cells are the major types of stem cells.
Autologous stem cells are derived from patient’s own body and can be obtained from bone marrow, adipose tissue and Peripheral blood.
We use Mesenchymal stem cells derived from bone marrow, adipose tissue, which are self renewing cells derived from adult tissues that can from a number of cells or tissues that are usually restricted to a particular germ layer.
The major advantage of using MSC’s is the ease of harvest and lack of immunoreactivity since they are derived from autologous sources.
These are then processed in tissue culture lab to isolate stem cells which are then used for the therapeutic purposes and are then given epidurally, intrathecally, intradiscally or intravenously depending on the type of disease.
A male patient with 56 years of age had come with complaint of osteoarthritis with diabetes, hypertension and lumbar canal stenosis
Chief complaints: pain in right leg, right hip joint, and knee joint stiffness and pain, numbness in right palm.
Associated complaints: Mild stiffness in all joints and weakness, constipation and polyuria.
Past illness: K/C/O DM/HTN, N/H/O TB
Past Surgery: Epigastric hernia in Sep 2012
Past trauma: H/O fall on lumbar in1978, no major trauma.
Radiological findings: Mild disc bulgness in L2-L3, L5-S1, facetal arthropathy, ligamentum layer, hypertrophy at multiple levels, mild supra patellar, pre patellar and knee joint effusion noted.
Treatment Plan: In OA two major factors are responsible for disease
- Age related
The stem cell plays a major role for cure due to their basic correctors of Angiogenesis & Differentiation, so the below protocol was adopted for treatment.
Hip-joint lock and bilateral knee stem cell transplant.
- Mesenchymal Stem Cell Transplant:
Bone Marrow & Adipose Tissue derived Stem Cells with Stromal Factor Transplanted
- Intra Articular Transplant in B/L knee Joint under Image Intensifier guidance around both the knees.
- Intra Articular transplant around the bilateral hip-joint under C-arm
- Intravenous route.
- Infusion dose.
- Local PRP Injection for Ligament Injury
- Epidural dose.
- Supplementation of deficient vitamins like D3, B12 and minerals like zinc, calcium; amino acids like glutathione, argenine and proteins so as to maintain the micro environment needed for stem cell to differentiate and maintain the potency.
- Physiotherapy exercise, Hinged Knee Caps, Left limb active exercises given.
He is very happy as he has started getting movements in his hip-joint which was lock for past 2-3 years, pain relief, all stable.
The patient is still under observation and follow up for full recovery.