Do Stem Cell and PRP injections help advanced arthritis: AAHKS official position

I just opened my local Sunday paper today to find a full page ad touting PRP and Stem Cell injections to treat pain and disability from arthritic hips and knees. It had pictures, testimonials, and the credentials of the doctors who would perform the injections. As I continue to flip through “section A”, I found another full page ad now advertising Laser therapy to treat “pain from muscle, nerve and joints, like that associated with chronic knee pain” again accompanied with testimonials and now X-ray images of a normal knee and a severely advanced arthritic knee. Finally, a smaller ad appears again showing a normal knee and a severely arthritic knee and encouraged people to call for an appointment with a particular physician who can fix their knee arthritis with “only his hands”, no surgery or injections.

Ads like these are appearing on billboards, in newspapers, digitally on the web, in TV spots.Clinics are popping up throughout America as well as in many other places in the world.  Buyer beware. Many of these treatments are “under the radar” because they are not directly regulated by our Food and Drug Administration (FDA) and the costs are not paid by health insurances, so a lot of money is being made by practitioners. Fortunately, these practices are beginning to be shut down.

I frequently meet patients who have had many of these alternative treatments as well as others, prior to meeting me and then undergoing a hip or knee replacement. I feel bad for my patient because the treatments didn’t stop the arthritic disease process or relieve their symptoms in any lasting way and that patient still needed a joint replacement. They spent their time, personal money and invested their hopes and beliefs on these treatments, when to someone knowledgeable, it was obvious their treatment was no more than a “noble effort on their part” and could not have possibly changed the natural progression of their disease and obviated joint replacement in their future.

Unfortunately, in some patients not only are hopes dashed and money wasted but injury from these treatments can occur. This can greatly complicate caring for them with well-accepted and predictable treatments such as joint replacement. Infection or nerve injury can be devastating.  I applaud and encourage everyone to get involved in their own health and to proactively try to help themselves with conservative treatments prior to having a joint replacement. I think it’s a normal and healthy human response to want to fully exhaust conservative treatments prior to capitulating and having a joint replacement. Nobody wants surgery. Sadly, this desire is being exploited by many individuals.

The American Association of Hip and Knee Surgeons (AAHKS) is the largest association of hip and knee surgeons in the world, and closely associated with our American Academy of Orthopedic Surgeons (AAOS), The Hip Society, The Knee Society and American Joint Replacement Registry (AJRR).  The AAHKS is a highly respected organization whose mission is to “advance hip and knee care through education and research.” They have recently issued a position statement regarding biologic therapies including stem cell and PRP intraarticular injections for advanced arthritis of the hip and knee. It very much mirrors what I believe and have been telling my patients.

Biologic therapy refers to therapies derived from living organisms (cells can be harvested from the patient who will be receiving the treatment or some other person (a donor) or another organism). Stem cell and PRP injections are a form of biologic therapy and I believe have great promise to treat a variety of orthopedic conditions.  Some evidence suggests that PRP can have an anti-inflammatory effect and temporarily improve symptoms from mild or moderate knee osteoarthritis, such as pain and stiffness. It will not change the natural progression of the arthritic process.  There is very little evidence to suggest any benefit in advanced osteoarthritis (bone on bone). Stem cells injections are often advertised as being able to repair damaged tissue including cartilage, bone and ligaments. There is no data to support these claims.

Injected stem cells cannot sense the environment that they are injected into, magically transform themselves into different cell types and repair and replace the damaged tissue. Recognize that we are very early on our learning curve. Basic science and clinical research has only just begun to understand which conditions, if treated, will have the best chance of benefiting, the best timing of treatment, and what the most optimal rehab protocols are after injection. Science and study will help us learn what the optimal sources are for cells (blood, bone, and fat, amniotic) and for what conditions and at what concentration.  And the optimal way to procure, and then prepare these injections. Well-controlled, validated studies will help us then quantitate and define best practices. Unfortunately, now it’s The Wild Wild West with very little or no oversite or standards. Anecdotal success and testimony from great athletes should be tempered against good judgment and risk vs. benefit. Out of pocket cost must also be part of the calculus.

I have attached link to the AAHKS position statement. I would encourage you to read it if your considering one of these alternatives.

http://www.aahks.org/position-statements/biologics-for-advanced-hip-and-knee-arthritis/

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