| Osteoarthritis (OA) is the most common form of | | | | these procedures has been used extensively for |
| arthritis and is the one typically associated with aging. | | | | osteoarthritis. In addition, long term data regarding |
| According to data compiled by the National Institutes | | | | efficacy has been mixed. |
| of Health (NIAMS), OA affects more than 20 million | | | | So the problem remains... What can be done to |
| Americans. | | | | restore cartilage? |
| OA is a disease due to abnormal cartilage metabolism. | | | | The most promising approach appears to be the use |
| Cartilage is the connective tissue that lines the ends | | | | of autologous stem cell transplantation. In this |
| of long bones. It is tough gristly material consisting of | | | | procedure, bone marrow harvested from the |
| a matrix of proteoglycans and collagen. Within this | | | | posterior iliac crest of the patient is concentrated to |
| framework, cells, called chondrocytes, manufacture | | | | isolate stem cells. Then using a combination of |
| the matrix. | | | | platelet-derived growth factors, subcutaneous fat, |
| OA can be a result of genetics (there is often a | | | | and a few other ingredients, the stem cells are |
| family history), injury to the joint, and aging. | | | | reapplied in a regional manner to treat the |
| Weight bearing areas such as the spine, hips, knees, | | | | osteoarthritic joint. |
| and the base of the thumb are the most common | | | | It must be mentioned that the pain of OA is not due |
| areas affected. | | | | directly to cartilage loss. Rather the pain is a result of |
| Symptoms of OA include joint pain, swelling, limited | | | | several factors including irritation of the joint capsule |
| range of motion of the joint, and stiffness. | | | | due to bony spurs, called osteophytes, as well as |
| Treatment of this disorder has been largely aimed at | | | | inflammation of the synovium, the lining of the joint. |
| symptom reduction. Among the various treatments | | | | However, there are significant barriers when it comes |
| used have been analgesics (pain killers), non-steroidal | | | | to the used of stem cells. First, patients need to be |
| anti-inflammatory drugs (NSAIDS), which help reduce | | | | at or near ideal weight. Second, they must be in |
| swelling and inflammation, injections of corticosteroid | | | | good physical condition. And lastly there are |
| and viscosupplements (lubricants), physical therapy, | | | | biomechanical factors that must be considered. For |
| and eventually joint surgery. | | | | instance, the knee is not just a hinge joint that bends |
| Different types of alternative therapies such as | | | | back and forth. There is also a gliding component as |
| chiropractic, acupuncture, herbal medicines, and | | | | well as a rotation component with normal knee range |
| supplements have also been used. | | | | of motion. |
| These treatments, while helpful for symptoms, do | | | | The hip is a joint that is capable of significant range |
| nothing to restore cartilage. The end result is that | | | | of motion. Most osteoarthritis develops in the |
| patients end up needing joint replacement. | | | | superior portion of the joint and that also makes the |
| More recently, there have been attempts to heal | | | | treatment approach difficult since there is a |
| cartilage defects. Procedures that have been | | | | tremendous amount of load strain that accompanies |
| employed include: | | | | weight bearing. |
| 1. Autologous chondrocyte implantation. In this | | | | The upshot is that with cartilage deterioration, there |
| procedure, cartilage cells are removed from a | | | | are altered biomechanics that need to be taken into |
| non-weight bearing part of the joint, arthroscopically, | | | | account when treating an osteoarthritic joint, |
| grown in a lab, and then re-implanted into the | | | | whether it's the knee or the hip. |
| cartilage defect. | | | | Limited weight-bearing after the procedure is critical |
| 2. Mosaicplasty. Multiple cartilage plugs are harvested | | | | and an early program of directed physical therapy is |
| from a non weight-bearing part of the joint and | | | | also required. |
| inserted into the cartilage defect. | | | | Attempts to normalize the abnormal biomechanics are |
| 3. Microfracture. The cartilage defect has multiple | | | | critical. |
| small holes drilled into it to allow blood and a few | | | | While the early data for stem cell transplantation |
| stem cells escape into the defect and ostensibly | | | | looks promising, longer term data, and continued |
| grow cartilage. | | | | improvements in techniques should improve the long |
| While these procedures have been used for small | | | | term outlook for patients. |
| isolated cartilage defects- mostly in athletes- none of | | | | |