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What conditions can respond to stem cell therapy & PRP? Stem cells can help heal almost any joint in the body. The most common conditions we use this therapy for include arthritis of the knee or hip (even bone-on-bone), meniscal issues, rotator cuff, back pain, neck issues and sports injuries. If you have persistent pain in a joint or region, I would recommend that you consult a good regenerative orthopedic consultant who can evaluate the root-cause of the pain and determine if you would be a good candidate for stem cells or PRP.

Who is a candidate for Orthopedic Stem Cell Therapy? Until now, if you had a serious joint issue or persistent musculoskeletal pain, your choices were limited. You could take pain medicine, steroid shots and anti-inflammatories and suffer with it or you could have surgery to try and solve the issue (and in many cases, replace the joint). I am here to tell you that there is now another choice- you can identify what joint and structures are the pain generators and REGENERATE those structures with your own STEM CELLS. This is the new field of Regenerative Orthopedics. Many scientists and doctors agree that Stem cells are the medicine of the future. As far as orthopedic problems go, this approach is now available and for many, may very well be the treatment of choice and yield a far superior result than more conventional approaches.

What does the treatment involve and how does it work? What the treatment involves is we harvest about 60-100 cc’s from a patients own belly fat in a simple outpatient liposculpting procedure. After numbing the skin, this gentle lipoaspiration procedure is done with large syringes under low pressure and takes about 45 minutes.. We then isolate the stem cells through a special process in our lab that takes about 90 minutes. We then mix the stem cells with growth factors that are isolated from a simple blood draw (called Platelet Rich Plasma or PRP). We then inject the stem cell/PRP combo at the specific joint and ligament sites that are the root cause of the problem. The stem cells will remain alive for about 6 months and will continue to regenerate and rebuild the damaged tissues during that period. The whole therapy session is done in the office in a about four hours.

In which patients do you recommend stem cells and where do you suggest PRP? PRP (platelet rich plasma) is prepared in about 45 minutes from a simple blood draw. PRP represent natural growth factors that can activate our naturally occurring stem cells. If the damage is not too severe and has not been there too long, PRP by itself might take care of it. On the other hand if the damage or injury is more severe, stem cells with PRP may be required for faster and more complete healing. PRP usually takes three sessions to complete the healing. We usually space the visits at least two weeks apart to allow healing to occur.

What kinds of problems can stem cells treat and what is the success rate? How long do the benefits last? We have found that the stem cells have the capacity to regenerate all types of tissues, including cartilage, bone, ligaments and tendons. Moreover the stem cells can detect exactly which tissues are damaged and repair those tissues selectively. We have had an 80% success rate with bone-on-bone arthritis of the knee and hip, rotator cuff, various types of back pain and neck pain and many other chronic orthopedic issues. In fact, with an experienced Regenerative Orthopedic specialist we can almost treat any region or joint and in general, the treatment involves a single session. If the stem cell therapy is a success and the joint or connective tissue structure is regenerated, there is every reason to believe that this will be a long-term solution. Of course, there is no guarantee that the patient could not reinjure the same joint but I actually don’t see this too often.

How long before patients improve and what is the follow-up? Patients often ask how long before they feel improvement. Stem cells rely on a patients own healing response so it is impossible to predict who will heal faster. In some patients, in some joints the stem cells will ignite fast and heal rapidly and the patient may notice marked improvements even within the first week. In others the process is slower and may take six weeks befoe they notice anything. For this slower group we may do a PRP booster at about 4-6 weeks. In others, if they have significal ligament or tendon laxity we might do adjuvant Prolotherapy to tighten joints and weak connective tissue structures.

What is the importance of the “connective tissue” component of the pain? It is important to appreciate how important ligament, tendon and joint capsules are to the pain picture in many patients. These “connective tissue structures” are highly innervated and may often be the main pain generators. Conventional Orthopedics often miss these. It is also true that MRI, xray and ultrasound, while identifying anatomic abnormalities also may miss these important structures. In my opinion it is very important that regenerative orthopedic specialists develop the necessary connective tissue palpation skills to properly identify all the major pain contributors and inject them all with the stem cell solution. If we miss some of the problem, the patient may not get relief and may only achieve a partial healing.

Is stem cell therapy safe? What’s the downside? Orthopedic Stem Cell therapy is a very safe, minimally invasive procedure. Patients are likely to be a little sore after their mini-low pressure liposuction and the injections. We do ask patients to keep the joints moving without load for at least several weeks to optimize stem cell regeneration and healing. Since the stem cells are from the patients own body there is no chance of any rejection issues. The only other downside is patients have to pay for it.

How much does stem cell therapy cost and does insurance cover it? The all-in typical costs of a stem cell therapy session, including the liposculpting procedure, lab fees etc. are $7000. for a single simple joint (knee or shoulder) and $8000. for a more complex joint such as lumbar spine or hip. Many patients have two areas that require attention. In this case the second area is discounted 50%. For example two knees or a knee and a shoulder would be $10,500 etc. A third area is done for a flat fee of $1500. Unfortunately, stem cell therapy is still too new and considered experimental by the insurance industry so it is not covered. However, we expect this to change in the future, as the industry understands how effective stem cells can be and how much money the system can save by embracing this new approach. For patients who cannot afford stem cell therapy they may very well still benefit from Prolotherapy or PRP therapy and should consider it. However, these options require at least three or four sessions over a couple of months, will be slower to work and are not as powerful as stem cells.

How can people find the right stem cell doctor? I often get asked by patients how can they find and choose the right doctor for them? As with any other new field there are many dabblers who are learning about a new field. It is also important to understand that Regenerative Orthopedics is a different field from Surgical Orthopedics. While surgeons are trained and specialized in bone, cartilage and nerve problems, the regenerative specialist needs to understand cartilage problems etc. but also be very aware and capable of evaluating connective tissue structures. Connective tissue structures such as ligaments, tendons and joint capsules are highly innervated tissues that are by far the biggest pain generators in the musculoskeletal system. There is quite an art to evaluating and injecting a patient properly. In my opinion Prolotherapists who are well experienced with connective tissue problems and injections have a huge advantage in Orthopedic stem cell work. I therefore suggest that patients seek a doctor who has had good Prolotherapy and connective tissue expertise and is also properly trained and experienced with stem cell harvesting and processing procedures.

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