Am I going to get arthritis in my other knee and have to have it replaced too?

This is a question we get asked frequently, and it makes sense to be concerned. Total knee replacement is a serious surgery that requires a long time to recover from, and results are often not what the patient or surgeon expected.

The use of concentrated mesenchymal stem cell products like we engineer in the setting of knee arthritis has been investigated for over two decades in Europe. These treatments' clinical success has led some authors to propose cell therapy as a first-line treatment for patients facing total knee replacement. That's good news for patients who have already had a traditional knee replacement in one knee.

Specifically, orthopedic surgical pioneer Phillippe Hernigou MD examined a group of patients over 15 years and found that using techniques similar to ours, they could put off total knee replacement 80% of the time. Inferior methods used by 99% of the clinics offering cell therapy with injection into the joint alone don't cut it. In that group, only 20% of patients avoided total knee replacement for a significant period.

These procedures are expensive, and patients need to know what they are paying for, short of any hype. Patients need to understand why they are being offered the treatments and what to expect for their money. Many studies have demonstrated short-term to intermediate-term relief from injections into the joint alone that lasts about 1-3 years, with results reaching a plateau at about one year. Subchondral injections (injection into the bone underneath the cartilage) are superior, and cost differences are negligible.

The chances are that if you have one knee with arthritis, the other one has seen the same impacts and has the same basic pathology. That doesn't necessarily mean you'll need another total knee replacement or that you will have a problem with the other knee, but there's a good chance it will bother you at some point. Based on orthopedic surgical studies, the other knee's likelihood of needing replacement is about 40% within ten years.

It is known that the degree of disease by radiographic staging is predictive of the need for the other knee to be replaced and, in combination with clinical findings and symptoms, we use that criterion when making recommendations to patients. We also know from studies that the worse off a knee is before cell therapy, the smaller the degree of sustained improvement on validated outcomes scores. Patients who have had one knee replaced already may be ideal for cell therapy intervention.

Arthritis is a disease of the subchondral bone and does not progress until it has lost its modulus of elasticity, called 'Young's Modulus.' Subchondral bone condition is easily assessed with MRI, and involvement is an independent risk factor for the progression of arthritis, leading to total knee replacement. As the disease progresses from the joint's concave side to the convex side of the joint, it proceeds in a predictable fashion, also known as 'stages.' At the point that the subchondral bone has become stiff, the overlying cartilage is degraded into nanoparticles that stimulate the inflammatory cells lining the knee. This makes up about 20% of cells in the knee lining and produces inflammatory molecules perpetuating a sinister cycle of catabolic destruction in the joint. At this level, we see the merge of our body as a physical machine and biological organism.

When we started using cellular biologics in 2006, the goal was to improve knee joint fluid condition and convert catabolic inflammatory protein storm into a more stable, anabolic microenvironment. Most clinics are offering real bone marrow concentrated stem cell treatments now align with this process. The product must come from bone marrow. Fat stem cells aren't bioavailable unless the fat is enzymatically digested off of them, a practice forbidden by the FDA. That's why reputable clinics are now adopting a process we have used for over a decade; the evidence shows that our approach was the most effective.

It became evident that we were missing part of the picture as most of our patients had excellent initial relief, but it did not last more than 3-5 years typically. We've upgraded our treatments by seven generations since that time, and that lets us continue to offer the real most advanced concentrated stem cell treatments in the world.

Subchondral decompression is not new in orthopedic surgery and has been used for decades for hip pathology when the bone loses its blood supply. A similar process is present in the subchondral bone of the knee. What makes the knee a better candidate for the methods is that it is easy to offload in the coronal plane, changing the mechanical axis to a more favorable one that doesn't continue to degrade cartilage and stiffen the bone underneath. It's just about impossible to do that with the hip, and we did not have good luck with the hip using our techniques and very rarely recommend the procedure to patients with hip pathology. One example would be someone who had intractable pain but was not a candidate for surgery. In addition, total hip replacement is one of the best procedures in medicine in terms of patient outcome success. We did not feel like we had a better option for the hip. We do have a better chance of knee replacement.

At the time of our nanoplasty procedure, which we call our subchondral bone injection, the patient's subchondral bone is cored and decompressed, followed by subchondral marrow exchange with our cell therapy product. We complete this step at the same time as an injection into the joint of the same product. We have a few steps unique to our process that other clinics have not yet adopted, making our treatment unique, and we think that leads to the best clinical results achievable.

In the event that third party insurers paid for the procedure, it's likely that every patient would opt for cell therapy before committing to total knee replacement. All of our patients who have had a total knee replacement on one side have been pleased with the results in their other knee when choosing the cell therapy option for their second knee. There's no comparison in the recovery times or intensities. So if you've had a total knee replacement on one side and know what's required, it may be worthwhile to look into cell therapy options for the other knee. Patients need to know about this option. Sadly, orthopedic surgeons who are not familiar with the techniques or the literature continue to overlook them. Find one who doesn't.x