For bone and joint patients, avoiding surgery can sound attractive. But physicians say stem cell therapy, which is coming to be known as orthobiologics, is not a cure-all.
For people whose joint disease has them heading toward replacement surgery, stem cell therapy looks like an attractive alternative. Yet physicians who perform the therapy caution that sometimes enthusiasm may be outpacing science.
“This has tremendous potential, but the research is in its infancy,” says Dr. Jason Hurst, an orthopedic surgeon with JIS Orthopedics.
Dr. Joseph Ruane has seen improvements in patients at OhioHealth’s McConnell Spine Sport & Joint Physicians, where he is medical director. “But what we desire from a scientific standpoint we don’t have now. The evidence is still weak.”
The appeal of stem cell therapy is that it uses the body’s own cells without introducing synthetic materials, such as steroids. The commonly held theory has been that stem cells produce new generations of cells with a wide range of capabilities such as growing cartilage or bone. In practice, however, data have yet to demonstrate that, says Dr. Michael Baria, co-lead of orthobiologics in sports medicine at Ohio State University Wexner Medical Center.Stay up to date with the region’s movers and shakers, top employers, philanthropic causes, real estate developments and thriving creative and startup scenes. Subscribe to Columbus CEO’s weekly newsletter.
“The science has changed,” Ruane says. “It’s a major paradigm shift.” In fact, bone and joint physicians say they are being advised to avoid the term “stem cell therapy,” referring instead to orthobiologic injection therapy or cellular regenerative therapy. Baria says it now appears the stem cells serve as signals instructing existing cartilage to grow stronger and healthier.
Specialists say they feel a duty to temper expectations in patients eager to avoid surgery by using the treatment. Patient education and selection are critical. “The best patient is one who knows all the options,” Ruane says. “In some cases, surgery is the best option.”
Orthobiologic therapy should not occur in a vacuum but as part of a comprehensive plan that includes weight management, physical therapy and other medications when needed.
“It’s only one tool in the toolbox, and it needs to be surrounded by other tools,” Ruane says.
Orthobiologic therapy, also known as mesenchymal stem cell therapy, is a new way of treating osteoarthritis or tendinitis. While not intended as a substitute for joint replacement, it may delay the need for surgery and be an alternative to treatments such as steroid injections.
During the procedure, physicians extract bone marrow from the pelvis, or fat from the belly or buttocks. The material is spun in a centrifuge to concentrate the cells, which then are injected into the affected joint.
Costs vary widely but can reach upwards of $7,000 and are not covered by insurance.
Another orthobiologic treatment with a bit more scientific support behind it is platelet rich plasma. It uses concentrated platelets from a patient’s blood. Those activated cells also are injected and stimulate cell repair. Cost is a fraction of stem-cell treatment, but benefits might not be as long-lasting.
Ruane says one promising piece of research showed changes in MRI results after one year of biotherapy that wouldn’t otherwise be expected. Going forward, the medical community needs randomized, controlled clinical trials to compare orthobiologics to existing therapies and determine who is most likely to benefit, for example.
Meanwhile, the lack of data and industry regulation makes stem-cell therapy an easy target for false advertising. “If you get a flyer in the mail inviting you to a steak dinner and a stem cell presentation, don’t go,” Baria says.
Prospective patients should ask thorough questions about a physician’s education, certification and credentialing and steer toward programs affiliated with respected medical practices or hospitals. Ask if they are part of a patient registry.
Those living with chronic, unyielding pain can fall prey to practitioners promising a miracle, Hurst says.