Osteoarthritis remains the most common joint disease in the world, representing a major cause of disability and an enormous financial and economic burden. Oftentimes, those with degenerated joints end up needing surgical repair or joint replacement. Regenerative medicine is growing in popularity in the medical world as an alternative to surgery. Since surgery comes with many disadvantages, regenerative treatments, like Stem Cell Therapy, offer a way to alleviate pain and restore cartilage providing an exciting way to repair joints in a non-surgical manner.

<strong>Osteoarthritis: The Disease and its Progression</strong>

Osteoarthritis is a chronic disease that debilitates the articular joints. It occurs through a sequence of events that has at its core, a loss of joint cartilage, and is characterized by chronic pain, joint stiffness, structural damage and bone remodeling through the progressive loss of cartilage. The disease process affects other joint structures, and eventually will lead to joint space narrowing and bony overgrowth, progressing until joint movement becomes noticeably restricted. Bony overgrowth with the appearance of bone spurs or osteophytes, detected by x-ray, has become the criterion for diagnosing advanced osteoarthritis or radiographic osteoarthritis.

Many people do not realize what occurs before the cartilage loss. Osteoarthritis almost always begins with unresolved ligament weakness or injury. The weakened and lax ligaments allow for abnormal motion in the joint. With each movement the joint makes, time after time, the joint wears down and becomes damaged.

Joints are composed of two bones covered with articular cartilage. Healthy cartilage allows the joint to slide, because it has a smooth lubricated surface. Healthy ligaments hold the bones together, and along with the cartilage enable the bones to glide evenly over one another when the joints are in motion. When the ligaments are weak, the bones will glide over one another in an uneven manner, causing one area of bone to bear additional weight on the articular cartilage when the joint is stressed. This uneven distribution expands with ongoing joint stress, weakening the ligaments further, and causing instability of the joint. The increase in abnormal weight distribution inside the joint causes a breakdown of the articular cartilage. Without this surface, the joint loses its smooth gliding motion and becomes limited in its movement. With the ligaments unable to stabilize the joint, the muscles and their tendons will tense in an attempt to stabilize the weakened area, but they too will eventually weaken, producing “knots” and eliciting painful trigger points. The unstable bony surfaces continue to rub roughly and unevenly, causing bone loss. This bony loss leads to joint space narrowing, exposure of the underlying subchondral bone and precipitating a process of bone remodeling, in which the subchondral bone thickens. This accumulated or thickened bony overgrowth is called osteoarthritis.

Articular cartilage has no blood supply, and therefore tends to heal slowly and imperfectly. Cartilage also lacks a neural network and does not elicit pain itself. The pain in osteoarthritis occurs from the pressure on the subchondral bone after the loss of cartilage tissue and from the stress on the tendons and ligaments of the joint.

<strong>Treatment for Osteoarthritis</strong>

There are many medications and procedures that have been tried over the years for relief of pain and treatment of osteoarthritis, but there is still no cure. Exercise, medications, physical therapy, and lifestyle modification may provide symptom relief, but they do nothing to regenerate the joint. Icing the joint and the use of nonsteroidal anti-inflammatory medicines to decrease the swelling, will unfortunately inhibit the natural inflammatory response and normal healing mechanism of the body for soft tissue repair. As such, NSAID’s reduce the body’s ability to repair and hasten the osteoarthritic process. There are however, treatments available that stimulate the regenerative processes in the joint to facilitate the restoration of degenerated cartilage to a healthy state. One regenerative technique that has shown success is Stem Cell Therapy, a non-surgical treatment supplying the affected joint with chondrogenic (cartilage forming) bone marrow-derived mesenchymal stem cells (BMSC). Stem cells have been shown in research to speed up and enhance bone and cartilage repair in osteoarthritic joints.1 Injecting these cells into the degenerated joint supports chondrogenesis, or the process by which cartilage is developed. Since surgery comes with many disadvantages, Stem Cell Therapy to repair defects of articular cartilage provides an exciting alternative. Another fascinating research finding involves evidence of the reduction in the usual progressive destruction of articular cartilage in arthritic disease by mesenchymal/bone marrow stem cells.  Bone marrow stem cells appear to suppress inflammation and release growth factors that combat arthritis and the degenerative process, enabling healing mechanisms to repair articular cartilage and relieve the chronic pain of arthritis. 2

<strong>A Combination Treatment Far Above the Rest</strong>

<span lang="en">In our practice, we </span><span lang="en">use the Gold Standard in Stem Cell Therapy, which combines several different regenerative treatments </span><span lang="en">to effectively repair </span><span lang="en">osteo</span><span lang="en">arthritic joints. </span><span lang="en">The treatments are non-surgical, requiring basically no down time, and allowing the patient to stay active. </span> <span lang="en">There is also no</span><span lang="en"> extended time off of work</span><span lang="en"> necessary. </span><span lang="en">Regenerative Orthopedic Therapies are reparative and effective non-surgical alternatives</span><span lang="en">.</span> Dextrose Prolotherapy is a technique that is used to aid the body in healing by prompting it to create new collagen. Various trials and studies have shown the effectiveness of Dextrose Prolotherapy in treating osteoarthritis, as well as ligament and tendon injuries.<a href="#sdendnote1sym" name="sdendnote1anc">i</a>,<a href="#sdendnote2sym" name="sdendnote2anc">ii</a>,<a href="#sdendnote3sym" name="sdendnote3anc">iii</a> Since these regenerative treatments are effective at repairing ligaments and tendons, treatment earlier on in the process has the potential to prevent damage and help with avoidance of the lifestyle adjustments that often transpire with the disease. <span lang="en">In </span><span lang="en">many</span><span lang="en"> cases, Prolotherapy alone is sufficient to bring the pain relief and repair needed. When cases of degeneration are advanced</span>, we turn to the Gold Standard in Stem Cell Therapy, which combines Prolotherapy with components of blood, fat, and bone marrow. Many clinics use only one or two of these procedures, but we have discovered that this combination acts as an amazing regenerative solution to reverse the damage of osteoarthritis on the joint. We comprehensively treat the entire joint with multiple injections of the Platelet Rich Plasma portion of the blood, progenitor cells from a lipoaspirate, and bone marrow aspiration. These regenerative treatments, along with Dextrose Prolotherapy in and around the involved joint offer benefits in terms of pain relief, regenerative properties, and cartilage repair for people affected by musculoskeletal disorders such as osteoarthritis. Dextrose Prolotherapy involves the injection of a hypersmolar dextrose solution into an injury site to elicit localized inflammation, which is the first step in healing the damaged area. The dextrose solution acts as a proliferant via the induction of local inflammatory and wound healing cascades, including fibroblast cells that make collagen. With the addition of the Gold Standard in Stem Cell Therapy, the goal is to enhance the effects of hypertonic Dextrose Prolotherapy and improve treatment outcomes in patients with advanced arthritic conditions. All solutions are centrifuged and concentrated to get a solution with the most concentration of stem cells.  In our experience, we have discovered that these stem cells act as great proliferant solutions for regeneration. We utilize this style of treatment because it addresses the whole joint and not just the effect. That is why it is considered the Gold Standard.

<strong>What is the Expected Outcome?</strong>

Patients treated with the Gold Standard in Stem Cell Therapy report significantly decreased pain and significant gains in function and quality of life, exercise ability, range of motion, as well as losses in stiffness and crepitus. These regenerative therapies in conjunction with Dextrose Prolotherapy are a safe and effective treatment for osteoarthritis, one that has the potential to slow down the progression of osteoarthritis and one that promotes the regeneration of articular cartilage. The treatment is essentially a new paradigm in the treatment of osteoarthritis, and one that decrease the need for surgical joint repair and replacement.

<strong>Not a One Shot Magic Cure</strong>

All Stem Cell Treatments are not alike, so it is important to do your homework. Treatments are advertised that may involve just one injection of stem cells, and one injection is most likely insufficient to adequately repair the injured joint. Without comprehensive repair of the joint, sufficient pain relief may not occur. The joint injury that eventually results in osteoarthritis, as noted earlier, involves multiple joint structures. The ligaments that were injured and began the cycle of abnormal joint motion all need to be treated. The degeneration and breakdown of cartilage that is present in arthritis transpires over time. If one ligament is injured, there’s a huge likelihood that other ligaments or soft tissue are also injured. A comprehensive treatment is necessary to strengthen, repair and stabilize ligaments and structures of the joint to prevent destructive forces from continuing the breakdown of cartilage common in osteoarthritis. A single injection is simply not comprehensive enough to reverse the damage affecting the entire joint. In our practice, we address these unnatural hypermobile forces with a multi-injection technique called Comprehensive Regenerative Orthopedics.

Osteoarthritis is a challenging condition to treat, but Regenerative Injection Therapies offer an effective way to meet the challenge and have been proven to work well to effectively activate cells for regeneration and repair in degenerated osteoarthritic joints and offer the potential for enhancing the quality of life of individuals with the disease.

<strong><a href="https://www.drfields.com/Articles/Prolo-News">Click here for more articles by Dr. Fields</a></strong>

1. Wakitani S, Goto T, Pineda SJ, Young RG, Mansour JM, Caplan AI, Goldberg VM. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage J. Bone Joint Surg. Am. 1994;76:579-92.
2. Burke J, Hunter M, Kolhe R, Isales C, Hamrick M, Fulzele S. Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and translational medicine. 2016 Aug 10;5(1):27.
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<a href="#sdendnote1anc" name="sdendnote1sym">i</a> Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Health Med. 2000; 6(2):68–80.

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<a href="#sdendnote2anc" name="sdendnote2sym">ii</a> Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. Apr 18, 2007; (2): CD004059.

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<a href="#sdendnote3anc" name="sdendnote3sym">iii</a> Rabago D, Zgierska A, Fortney L, et al. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Altern Complement Med. 2012;18(4): 408–14.

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