Knee Osteoarthritis (OA): The Key to Avoiding Joint Replacement is Hidden in the Bone!
Updated: Sep 9, 2021
With 2 groundbreaking Knee Osteoarthritis studies with long-term outcomes data (10-15 years) published in 2020, Phillippe Hernigou has ushered in the age of "biological joint replacement" as a viable alternative to traditional knee joint replacement.
What is Knee Osteoarthritis?
Knee osteoarthritis is the most commonly treated joint problem over the age of 45 and is simply defined as a loss of cartilage in the joint that is related to low-grade inflammation within the joint. All joints are composed of 3 key components: 1) bone, 2) hyaline cartilage and 3) synovium. Let's break those down.
1) Bone is the supporting structure for the joint. Think of it as the "soil" and the hyaline cartilage as the "grass." There is communication between the bone and the cartilage and into the joint space itself.
2) Hyaline cartilage is the smooth, glistening, well-hydrated ends to the bones that allows the two bones of a joint to smoothly glide past one another for frictionless motion.
3) Synovium is the inside lining of the joint capsule that keeps the joint fluid within the joint.
Osteoarthritis typically starts with an injury, large or small, to the hyaline cartilage. This sets off a chain reaction that starts as an attempt to heal the injured cartilage, and instead results in a state of chronic low-grade inflammation within the joint that leads to further cartilage breakdown, resulting in further inflammation and so on.
There are chemicals called inflammatory cytokines that get upregulated such as Interleukin-1 and TNF-alpha, which lead to increases in cartilage-munching enzymes such as matrix metalloproteinases (MMP's) that lead to further cartilage breakdown leading to a slow progression towards joint destruction. What was once thought to just be wear and tear of the joint is in fact a biological process that leads to progressive loss of hyaline cartilage. This is huge news folks!
So What Do Dr. Hernigou's Studies Teach Us About Avoiding Joint Replacement?
The big take-home messages of the 2 Knee Osteoarthritis studies he published in 2020 can be summarized as follows:
1) Subchondral (into the bone) Bone Marrow Concentrated stem cells injected into the bone under the cartilage lead to long-term outcomes roughly equivalent to total joint replacement.
2) Subchondral Bone Marrow Concentrated stem cells injected into the bone under the cartilage are vastly superior to the same Bone Marrow stem cells injected into the knee joint.
The strength of his studies are that they look at 10-15 year outcomes data for patients that needed Total Joint Replacement of BOTH knees. It involved the most common type of knee osteoarthritis involving the medial compartment, or the inner aspect of the knee joint. One knee received a Total Joint Replacement and the other knee received Subchondral Bone Marrow Concentrated Stem Cells.
In the second study, one knee received Subchondral Bone Marrow Concentrated Stem Cells and the other received "Intra-articular" Bone Marrow Concentrated Stem Cells, by injecting them into the joint.
-80% of knees treated with Subchondral Bone Marrow Concentrated Stem Cells once did not need to move onto Total Joint Replacement over an average of 10-15 years!
-Of the 20% of knees treated with Subchondral Bone Marrow Stem Cells that did need to go onto Total Joint Replacement, an equal number of knees that had Total Joint Replacement needed to move on to a Revision (2nd) Total Joint Replacement. This means both groups had similar need for further surgery.
-In knees treated with "intra-articular" Bone Marrow Concentrated Stem Cells "into the joint" but NOT into the Subchondral bone, over the same 10-15 years 70% needed to move onto Total Joint Replacement.
-Taken together these studies shows that Subchondral Bone Marrow Concentrated Stem Cell injections can lead to knee survivorship of 10-15 years, even in rather advanced cases. Likewise, they show the superiority of Subchondral injections (into the bone) to Intra-articular injections (within the joint).
-Finally and importantly, we learned which patients don't do well with these Subchondral injections- younger patients with large bone marrow lesions and with significant malalignment (knee is badly aligned and angled, like with severe knock-knees or bowlegged).
At Breakthrough Regenerative Orthopedics, we have a whole line of various treatments we can provide based on your individual situation, needs and goals. While Subchondral Bone Marrow Concentrated Stem Cell injections are certainly not indicated for everyone with knee osteoarthritis, we can help you pick the treatment that is most appropriate for your particular situation. Whether that is a couple rounds of dextrose prolotherapy, a series of platelet rich plasma injections, microfragmented fat stem cell injections or these Subchondral Bone Marrow injections, our highly trained and constantly-learning physicians can help match your particular condition with the best treatment options available today.
Simply call us at 720-463-0567 to schedule your initial consultation and we'll get you moving down the path towards a more active tomorrow.
1) Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year followup. Hernigou P, et al. International Orthopedics 23 Apr 2020. https://doi.org/10.1007/s00264-020-04571-4
2) Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study. Hernigou P, et al. International Orthopedics 02 July 2020. https://doi.org/10.1007/s00264-020-04687-7