Osteoarthritis (OA) is the most common form of arthritis and affects more than 20 million adults. It’s been estimated that by the age of 70 almost all individuals will have OA to some degree.

OA is a disease of articular cartilage, the gristle that caps the ends of long bones. Cartilage is a complex substance consisting of two basic materials: collagen and proteoglycans and one type of cell- the chondrocyte. Proteoglycans are mixtures of proteins and sugars. The chondrocyte actually produces the ingredients that go into making cartilage. Cartilage provides shock absorption as well gliding functions.

With OA, there is premature wear and tear that occurs because of a metabolic abnormality that causes the chondrocyte to produce destructive enzymes. There is a complex interplay involving the cartilage, the synovium (lining of the joint), and the subchondral bone (the bone that lies underneath the cartilage. The result is premature wear and tear as well as local inflammation.

OA is primarily a condition that affects weight-bearing joints such as the neck, low back, hips, and knees.

Risk factors for the development of OA include genetics, trauma (injury to the joint), and weight in the case of weight-bearing areas such as the low back and knees. There is less evidence that weight plays a role in inducing OA of the hips.

Once injury occurs to cartilage, it is difficult to heal since cartilage has no blood vessels to carry nutrients.

Treatment for OA is symptomatic until either intolerable pain or loss of function results in joint replacement.

That is why the recent developments in regenerative medicine techniques are so exciting. There are abundant anecdotal reports as well as small studies indicating the relative success of mesenchymal stem cells derived from either bone marrow, adipose tissue (fat), or both to help with cartilage healing and possibly cartilage regeneration. While early reports that surfaced discussed positive results in animal models, there are now multiple communications indicating success in humans as well.

The question then is how successful is stem cell therapy? As for any medical procedure, the term “success” must be defined. Is it relief of pain, delay of joint replacement, improvement in cartilage growth, patient satisfaction, enhanced functional capacity, or a combination of the above?

At our center, we have patients undergo a battery of measurements before they have the procedure and then approximately every three months after the procedure. Since a number of our patients travel a long way, we have had to modify this schedule in many cases.

That being said, using our combination of measurements, we have seen the success rate for OA of the knees at 97 percent. Unfortunately, the success rate for OA of the hip is substantially lower, generally 25-30 per cent. Why such a discrepancy? The answer appears from a recent report from Duke University that the cartilage in the hip is different from the cartilage in the knee. Knee cartilage is capable of impressive regeneration when provided the right materials. Hip cartilage is much less able to regenerate itself.

What this means is that the technique for hip OA needs to be modified to account for this. We are currently working on new approaches for the hip.

Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html Arthritis Treatment and http://arthritistreatmentcenter.com

Author Bio: Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Category: Advice
Keywords: arthritis treatment, osteoarthritis knee, osteoarthritis hip, stem cells, success rate