Osteoarthritis of the hip (or coxarthrosis) andosteoarthritis of the knee (or gonarthrosis) are unfortunately very common diseases that afflict two of the most important joints in the human body; therefore, today, research channels much of its efforts into trying to establish a close correlation between knee and hip healing and Regenerative Medicine.
When Regenerative Medicine is applied in Orthopedics, it takes the name Orthobiology, a discipline that aims to avert joint degeneration by using the patient’s own tissues and cells.
But let’s go in order.
REGENERATIVE MEDICINE: let’s get some clarity.
When we talk about regenerative medicine, we mean that branch of medicine that aims to repair a damaged tissue through cellular regeneration and not through metal replacement of the joint.
The “birth” of mesenchymal cells
It is based on the use of a particular type of cells, called Mesenchymal Stem Cells (literally mesenchymal stem cells). This term was coined in 1991 by the American scientist Arnold Caplan: he envisioned a class of human bone cells that could be isolated and multiplied in culture while retaining the ability to differentiate into different tissues such as bone, cartilage, adipose tissue to others.
This ability of theirs is called multipotent, and it mistakenly became the evidence for calling them precisely stem cells.
Today after hundreds of clinical trials, the regenerative ability of these so-called stem cells (Mesenchymal Stem Cells) has been greatly scaled down.
In fact, it has been shown from the numerous clinical studies that these cells are unfortunately not stem cells, thus endowed with differentiative and regenerative capacity.
The positive clinical results are due to the fact that these cells, usually obtained from bone marrow (from the iliac crest of the pelvis) or from the patient’s subcutaneous fat, are pericytes (cells derived from small vessels) that, when injected into a new environment (hip or knee), are activated by releasing molecules that reduce inflammation: this causes the joint environment to return to its physiological function, decreasing pain.
Therefore, they are mainly used for injuries involving cartilage, such as, indeed, coxarthrosis and gonarthrosis.
Recently, Prof. Caplan expressed his willingness to change the term he coined (Mesenchymal Stem Cells), replacing it with Medicinal Modulating Cells (Medicinal Signaling Cells).
In fact, as mentioned earlier, it has been shown that these cells, released into the joints, have the sole ability to “modulate” the damaged environment by “talking” to their surroundings.
This communication allows the slowing of cell apoptosis (the physiological cell death) of chondrocytes and promotes the synthesis of collagen, the building block of “cartilage.”
This occurs especially in moderate arthritic conditions.
It is possible to date to say that these are safe procedures; but then how effective are they?
THE APPLICATION IN ORTHOPEDICS: ORTHOBIOLOGY
We mentioned thatOrthobiology is that discipline that combines Regenerative Medicine and Orthopedics; its goal is to try to recover what is damaged at the joint level rather than proceeding immediately with surgery.
Obviously, this type of choice is made when faced with the early stages of joint degeneration.
ORTHOBIOLOGY: HOW IT WORKS
When the first symptoms of hip or knee osteoarthritis begin to appear, cell precursors are harvested from adipose tissue, bone marrow, and subcutaneous tissue.
These particular cells are then introduced by infiltration inside the damaged joints; thus, the concentration of precursor cells in the hip or knee increases.
the benefits of orthobiology
By introducing precursor cells into the joints, cells already present in the cartilage are “reactivated”; this promotes their regeneration, allowing them to be blistered and reduce hip or knee joint pain. The result is also long-lasting.
hip, KNEE and REGENERATIVE THERAPY: THE LIMITS
As we have already seen, so-called “regenerative therapies” are designed to stimulate cartilage tissue regeneration but, in fact, they seem rather to reduce joint inflammation.
The results, which were once classified as positive, are due to the fact that, the material taken from the patient’s bone marrow or adipose tissue and then injected where cartilage damage is present, is rich precisely in pericytes: these cells, when injected into a new environment, (hip or knee), lower the inflammation, and thus also the pain, and communicate to the damaged environment to slow cell apoptosis (the physiological cell death) of chondrocytes, creating collagen repair.
Indeed, it is not possible to regenerate cartilage where the irreversible process of tissue degeneration has begun; much less in cases where wear and tear has reached the bone. However, we know that if the damage is not advanced, the mesenchymal cells can form a cartilage-like tissue that integrates properly with the surrounding tissue through type 2 collagen.
INFILTRATIVE THERAPIES: an effective solution
What we have said, however, should by no means discourage: the results of infiltrative therapy in the orthopedic field for the early stages of osteoarthritis are obvious.
We will need to identify the Patient’s characteristics to use the most sensible treatment approach, choosing the use of infiltration, or surgical options such as hip arthroscopy or hip replacement.
Infiltrative therapies are completely safe and have the ability to reduce pain, improve joint function, and consequently increase quality of life, and can be combined with conservative surgical options such as hip arthroscopy.
If you would like to learn more about hip osteoarthritis and imnfiltrative therapies, please feel free to contact me.
