What Is Stem Cell Therapy?
Stem cells are cells that have the ability to transform into other cell types under certain conditions. They are primarily found in bone marrow and adipose tissue. In various branches of medicine, stem cells are used to repair damaged cells with new ones. They are particularly common in hematological diseases, neurological disorders, and dermatology. In orthopedic cases, stem cells can also be used, especially for cartilage issues and muscle-tendon injuries.
The application of stem cells generally follows a process where a group of cells taken from the body is isolated and multiplied in a laboratory environment, converted into the desired cell types for damaged tissue, and then transplanted to the target tissue. This method is quite expensive and is typically performed on a select group of patients.
In daily orthopedic practice, stem cell applications involve injecting cells obtained from the patient’s adipose tissue or bone marrow into the damaged area after undergoing specific procedures in an operating room.
These damaged areas are usually large joints like the knee and hip. Due to their constant load-bearing nature, the cartilage in these joints can become damaged over time or due to trauma. This can lead to pain and restricted movement, necessitating an evaluation by a specialist.
Patients undergo examinations, and the results of X-rays and MRIs are assessed. If surgical intervention is deemed necessary for lesions in the cartilage, the patient is evaluated accordingly. If no additional intervention is required, stem cell therapy can be performed simultaneously in the operating room.
Orthopedic stem cell applications can be derived from the “stromal vascular fraction” (SVF) obtained from adipose tissue or aspirated from hip bone marrow.
Generally, samples taken from the adipose tissue around the abdomen contain more stem cells compared to those taken from the bone marrow. Additionally, the adipose tissue has a higher presence of accompanying cytokines that aid healing, making it a safer option.
Stem Cell Application from Adipose Tissue
In this method, the adipose tissue around the abdomen is commonly used as a source. After the patient receives anesthesia, the abdominal area is prepared sterilely. A special solution is injected to reduce potential bleeding and pain in the subcutaneous adipose tissue. After waiting for about 3-5 minutes, adipose tissue is extracted through a small incision using special cannulas. The size of the extracted tissue depends on how many joints will be treated. This tissue is then processed using enzymes or mechanical filters to reduce it to very small cellular sizes and filtered. The final filtered solution is placed in syringes and injected into the damaged joint.
Patients are usually discharged the same day or after one night in the hospital.
After the procedure, swelling and edema may occur in the treated joint for about a week. This is due to the inflammatory response elicited by the injected stem cells. Patients are advised to rest for a few days post-procedure before returning to their normal activities.
Who Is an Appropriate Candidate for Stem Cell Application?
Stem cell applications are particularly beneficial for active individuals under 60 years of age with traumatic cartilage injuries that have a high biological healing potential. The number of stem cells in the extracted tissue decreases with age, making the procedure potentially less effective. Additionally, in cases of muscle tears and ligament sprains where surgical intervention is not required, stem cell applications can accelerate healing.
Especially in cases of avascular necrosis (a condition affecting the blood vessels to the bone) frequently seen after the COVID-19 pandemic, stem cell applications are recommended for patients in stages 1 and 2 after surgical intervention. These applications can enhance the speed of recovery and slow disease progression.
Who Is Not Suitable for Stem Cell Applications?
Stem cell applications may not be effective for elderly patients, those with narrowing joint spaces, or those with extensive cartilage injuries, as well as cases with improper leg alignment and load distribution.
Is Stem Cell Application an Alternative to Surgery?
Generally, stem cell applications serve as an adjunct therapy to enhance healing. If a patient has an anterior cruciate ligament injury or a meniscus tear causing mechanical symptoms, the underlying mechanical issue must be resolved for the treatment to be beneficial. However, when applied during the repair of ligaments, cartilage, or menisci, it can enhance the healing process.
A common misconception is that stem cell applications are appropriate for patients with advanced osteoarthritis in their knees or hips who require joint replacement. While these applications may provide temporary relief due to the lubricating effect of the adipose-derived tissue, the underlying disease may persist or worsen afterward.
Additionally, stem cell therapy should not be performed in patients with rheumatological diseases. In such cases, the stem cells may carry genetic defects, and the patients’ immune systems could react adversely, causing increased pain.
The final group to avoid stem cell applications includes patients with oncological diseases. In these cases, there is a risk of inadvertently spreading cancer to other tissues through stem cell treatment.
