I am an active 75 year old who does not want a knee replacement. Are stem cells an option for me?
David N. Woznica, MD discusses when does a patient get too old for stem cell therapy?
This is a more typical email than you think. “I am 75 years old, I am still playing tennis and running but I have a lot of pain. The Medicare doctor says I have advanced arthritis, and I will need a knee replacement. My doctor told me there was nothing else to offer me except pain medications and pain management until I can no longer tolerate the pain or I become a fall risk. I can also wear a knee brace to help keep me stable. I do not know if there are alternatives for me, can you help?”
Why would the doctor say there was nothing else but knee replacement? Because according to that particular doctor, THERE IS NOTHING ELSE!
Treatments that are useless for the elderly patient with degenerative knee disease.
We know, 75 year olds do not like to be spoken of as elderly, in the medical literature they are. Now why would the doctor say there was no alternatives to our tennis player above? Because for those who resist the knee replacement option, the only other treatment suggestions are to therapies that are noted for their ability to ONLY prolong or delay the need to have a knee replacement. Not help avoid it.
These treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, Hyaluronic Acid Injections. Here is the big statement: These treatments are useless for the elderly patient. This is not just our opinion, it is the opinion of a team of researchers publishing in the medical journal American Health and Drug Benefits. (1)
These researchers insist:
- That there is only one realistic option for elderly or older patients with knee osteoarthritis, knee replacement.
- Delaying or prolonging the inevitable knee replacement is a waste of time, a waste of money, and a waste of health industry resources.
- The only people who should not get knee replacement are those with other health issues.
- The need for blood thinners to prevent blood clotting and possible prolonged recovery stay in a nursing home. Should be considered.
The very active elderly patient in the nursing home
There are likely not many active 70 and 80 year olds who are ready for a nursing home, but why would an active 70 or 80 year old need to be in a nursing home after knee replacement? The causes are many.
Jun 2016, published in the journal Anesthesia & Analgesia: “Elderly patients are at risk of increased length of hospital stay, postoperative complications, readmission, and discharge to destinations other than home (nursing homes) after elective total hip replacement and total knee replacement.”(2)
- “I had a knee replacement and it fractured my shin bone.”
- Post-surgical/implant fractures after total knee replacement are an increasing problem and challenging to treat. (Published BioMed Central musculoskeletal disorders September 2018) (3)
- “I developed blood clots.”
- Blood clots – Venous thromboembolism is an important complication to monitor following total knee replacement. (Published BioMed Central musculoskeletal disorders September 2018) (4)
- “I lost too much blood during the procedure”
- Blood management after joint replacement has become a serious problem. (Published in the journal Medicine September 2018) (5)
We did not mention infection or malpositioning of the new knee or the many other complications a more mature patient may face because we cover this is our article Problems after knee replacement | Finding help for prolonged pain
Research then has been somewhat shocking in its recommendations that aging or elderly patient proceed directly to total knee replacement. Why not find a non-surgical alternative especially now that the science of joint repair focuses on healing the elderly patient with biomedicine, namely those components of stem cells, blood platelets, and comprehensive Prolotherapy
“I researched stem cells – I went to a seminar at a hotel. They gave me lunch”
For those who did not trust that joint replacement was their only option, alternatives including stem cell therapy were explored.
Here is another typical email: “I researched stem cells, I did a lot of reading. I went to a seminar at a hotel. They gave me lunch. The presenters, I am not sure if they were doctors, told me that my stem cells were too old and weak to help fix my knee, I needed to explore amniotic, placenta, or umbilical cord stem cell therapy.”
Understandably – the science surrounding stem cells for the treatment of osteoarthritis in the elderly is still somewhat in its infancy, as such researchers are still questioning the potential of the elderly stem cell to provide a healing response. This is the argument supported by advocates of allogenic stem cells (from donors) or those who endorse culturing stem cells in overseas clinics, or from those who suggest amniotic/placenta stem cell treatments are needed in the elderly.
In stem cell therapy practiced in the United States, a patient’s stem cells are taken from bone marrow or from the fat from their abdominal area as in a liposuction procedure. The stem cells are then reintroduced into the damaged joint to create a healing environment from a diseased joint environment. They are not cultured or expanded.
In amniotic/placenta/umbilical cord blood treatments there are NO STEM CELLS, only stem cell activators that activate your stem cells. For these “stem cell therapies” to work you need your own stem cells to be very active and very potent.
Question: Is there enough of my own stem cells, are they vital enough? Answer: Look at the synovial fluid, you will find a high presence of native active stem cells in your knee
Doctors at Tokyo Medical and Dental University published their research in the Journal of Orthopaedic research. In it, they looked at patients with mild to severe knee osteoarthritis, obvious problems found in the elderly. They took some of the synovial fluid from the knee joint and found there was a high presence of stem cells in those knees. The researchers speculated that the stem cells were responding to a diseased joint environment and that doctors should investigate what are they doing there and can they be harnessed or signaled action.(6)
In another supportive study published in the World Journal of Stem Cells researchers also found viability and potency even in stem cells from patients with advanced osteoarthritis and agreed that diseased and damaged cartilage have a high number of repair cells, that could also be exploited.(7)
The researchers here are saying that there is a potential to use these extra/native stem cells to heal the knee and doctors need to be aware how to use them. One method is through Signalling – where stem cells tell other stem cells to “wake up and go to work.” – please see our article on Avoiding knee replacement | Effectiveness of stem cell therapy and bone repair in knee osteoarthritis.
In signaling, doctors believe that the numerous stem cells present in the aging joint are confused and have lost their healing instructions. The introduction of stem cells from the pelvic bone or patient’s fat “reboot” these stem cells to start healing again.
Can stem cell injection therapy in ultra-octogenarians stimulate self-repair? Elderly stem cells should not be dismissed as having limited potency
Doctors have presented research in the medical journal Current opinion in rheumatology that stem cell injection therapy in ultra-octogenarians can stimulated to self-repair in Degenerative Joint Disease.
This study says elderly stem cells should not be dismissed as having limited potency, “Mesenchymal stem cells (MSCs) from elderly patients with osteoarthritis may still display significant chondrogenic potential…”(8)
Caring Medical’s Published Research starts with a young man of 63 and continues on with a young woman of 76 years of age
In our own research that we published in the Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, we documented 7 patient outcomes using bone marrow Prolotherapy / stem cell therapy.
- The patients included a 69-year old male with knee pain,
- a 69-year old female with knee pain,
- a 76-year old female with pain in both hips, and
- a 63 year old man with pain in the hips – you can read about their case histories in our article Bone Marrow Stem Cell Prolotherapy.
While we are always hesitant to define anyone as elderly especially patients in their 60’s and 70’s, the research we spoke about earlier in this article set the line of knee replacement at age 70. Once you get to 70, it should only be knee replacement according to that research. But as we have found, 70 is too young NOT to explore stem cell therapy.
The determination of the effectiveness of stem cell therapy in the elderly needs to be made during a consultation. As mentioned above if determined that success will be good, stem cell therapy may be utilized on its own or within the comprehensive prolotherapy program.
If you have questions about stem cell therapy, You can get help and information from our Caring Medical staff
1. Pasquale MK, Louder AM, Cheung RY, Reiners AT, Mardekian J, Sanchez RJ, Goli V. Healthcare utilization and costs of knee or hip replacements versus pain-relief injections. American health & drug benefits. 2015 Oct;8(7):384. [Google Scholar]
2. Pitter FT, Jørgensen CC, Lindberg-Larsen M, Kehlet H; Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group. Postoperative Morbidity and Discharge Destinations After Fast-Track Hip and Knee Arthroplasty in Patients Older Than 85 Years. Anesthesia & Analgesia. 2016 Jun 1;122(6):1807-15. [Google Scholar]
3 Schreiner AJ, Schmidutz F, Ateschrang A, et al. Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue. BMC Musculoskeletal Disorders. 2018;19:323. doi:10.1186/s12891-018-2250-0. [Google Scholar]
4 Lu X, Lin J. Low molecular weight heparin versus other anti-thrombotic agents for prevention of venous thromboembolic events after total hip or total knee replacement surgery: a systematic review and meta-analysis. BMC musculoskeletal disorders. 2018 Dec;19(1):322. [Google Scholar]
5 Wang F, Zhao K-C, Zhao M-M, Zhao D-X. The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: A meta-analysis. Palazón-Bru. A, ed. Medicine. 2018;97(36):e12270. doi:10.1097/MD.0000000000012270. [Google Scholar]
6. Sekiya I, Ojima M, Suzuki S, Yamaga M, Horie M, Koga H, Tsuji K, Miyaguchi K, Ogishima S, Tanaka H, Muneta T. Human mesenchymal stem cells in synovial fluid increase in the knee with degenerated cartilage and osteoarthritis. J Orthop Res. 2012 Jun;30(6):943-9. doi: 10.1002/jor.22029. Epub 2011 Dec 6. [Google Scholar]
7 Eslaminejad MB, Poor EM. Mesenchymal stem cells as a potent cell source for articular cartilage regeneration. World journal of stem cells. 2014 Jul 26;6(3):344. [Google Scholar]
8 Diekman BO, Guilak F. Stem cell-based therapies for osteoarthritis: Challenges and opportunities. Current opinion in rheumatology. 2013;25(1):119-126. doi:10.1097/BOR.0b013e32835aa28d.[Google Scholar]