In the early part of December, the Vatican issued a pronouncement, again condemning the use of embryonic stem cells for medical research and medical treatment.

While this proclamation will hinder the development of some therapies in medicine, it should not be a major stumbling block in the management of osteoarthritis.

The reason?

Current approaches using stem cells for osteoarthritis are able to make use of autologous stem cells. These are stem cells obtained from the iliac crest (hip) of the patient using a special biopsy needle.

Stem cells are located within the bone marrow. The iliac crest is an ideal site for harvesting bone marrow. Since the procedure is done using local anesthetic, the risks of the procedure are minimal.

Autologous stem cells have the ability to differentiate into other tissue cells. Previously, it was felt this trait was not possible for adult stem cells; however, it has been confirmed that stem cells harvested from an adult are capable of differentiation.

Once the stem cells are harvested, they are concentrated using a special technique. In addition, platelet rich plasma which is derived from a patient’s whole blood is also obtained. Platelets are cells that contain numerous growth and healing properties. These growth factors have the ability to fire off tyrosine kinase receptors on the surface of stem cells and accelerate differentiation and multiplication.

The knee (or hip) is then prepared by “irritating” the cartilage using a special biopsy needle. After this, stem cells and platelet rich plasma are introduced into the joint.

Calcium chloride and thrombin are also used to create a “scaffold” for the stem cells to locate themselves.

Diagnostic ultrasound is used throughout to ensure the proper location for harvesting the stem cells as well as the best location for introducing the stem cells into the target joint. The use of ultrasound is mandatory for proper anatomic placement!

So who might be a candidate for this procedure?

First, it’s important to realize that a patient must have some cartilage remaining in the knee for stem cells to do their job.

Osteoarthritis is currently graded in clinical trials using standing knee x-rays to quantify the amount of cartilage present within the knee.

The Kellgren-Lawrence classification is used. Grade 1 means the amount of cartilage is relatively normal. Stage 4 means that the patient is “bone on bone”. Patients who are Kellgren- Lawrence stage 4 are not considered candidates for stem cell treatment. Patients who are grades 1-3 are acceptable.

Patients who are grade 3 must be at or near ideal weight.

Age also plays a role. It appears that as people get older, their stem cells respond less to stem cell stimulation. At our center, we generally use 75 as the cutoff. Even then the patient must be vigorous and active.

The ideal patient is between the ages of 30-70 and is at or near ideal weight. Healthy Baby Boomers who are athletic and active are felt to be the best candidates.

What measures are assessed?

We are currently evaluating both subjective as well as objective parameters. These include a visual analogue scale of pain, a Health Assessment Questionnaire (WOMAC), 50 foot walking time, knee x-rays done using special angulation to allow precise measurements of cartilage thickness, and ultrasound measurements of cartilage thickness.

The length of recovery is highly variable depending on factors such as age, general physical condition, Kellgren-Lawrence stage, and amount of “irritation” required to prepare the cartilage.

For more information regarding stem cells for osteoarthritis, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.

Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips