Stem cell therapy in the elderly osteoarthritis patient. Are your stem cells too old and too weak? No

Dr. David Woznica ProlotherapistDavid N. Woznica, MD discusses when does a patient get too old for stem cell therapy?

Prolotherapists see a number of patients who believe or were told that they were too old for any type of knee repair outside of knee replacement.

For those who resist the knee replacement option, they are also told about other therapies that are noted for their ability to prolong or delay the need to have a knee replacement. These include nonsteroidal anti-inflammatory drugs (NSAIDs)corticosteroid injectionsHyaluronic Acid Injections.  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)

Please see our article on Research on Alternatives to Knee Replacement for more and similar research.

It is medical studies like that above which shows that the current concepts of managing knee pain in the elderly is lacking. Further, total knee replacement is not the right answers for many elderly patients as attested by numerous research papers including this one published in the journal Anesthesia & analgesia lead by Copenhagen University which warns:

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)

The question one has to ask is: “Does a very active 70 year old want to go to a nursing home?”

Research then has been a somewhat shocking in its recommendations that aging or elderly patient proceed directly to total knee replacement  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. This can be attested to by the numerous research studies that are now examining stem cell therapies as an alternative for joint repair in elderly patients and are examined below.

Stem cell therapy in the elderly. Too little stems left, too late? Not so

For those who did not trust that joint replacement was their only option, alternatives including stem cell therapy were explored. Some of these patients were told that their stem cells were too old and weak to help them, they needed to explore amniotic or placenta tissue treatments.

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.

Mesenchymal Stem Cells

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 treatments there are NO STEMC CELLS, only stem cell activators that activate your stem cells.

So are there sufficient resident stem cells in the elderly? Look at the synovial fluid

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 that there were 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 signalled into action.(3)

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.(4)

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 The Paracrine Effect and Inflammation in our article on Stem cell therapy for bone repair in osteoarthritis. Also see our article Osteoarthritic Bone repair.

In signalling 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.

Stem Cell Differentiation

Aging and Reduced Potency Questioned

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…”(6)

Let’s stop for a second here and point out that stem cells in older patients may be part of a comprehensive Prolotherapy program including dextrose and Platelet Rich Plasma. It may be more effective combined with treatments than as a stand alone treatment.

So clearly there is remaining power in the stem cells drawn from the elderly suffering from advanced osteoarthritis.

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.

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. 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]

4 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]

5. 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]

5. Labusca L, Zugun-Eloae F, Shaw G, Botez P, Barry F, Mashayekhi K. Isolation and phenotypic characterisation of stem cells from late stage osteoarthritic mesenchymal tissues. Curr Stem Cell Res Ther. 2012 Sep;7(5):319-28. [Google Scholar]

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