Stem Cell Therapy for Knee Arthritis is Controversial
I treat a number people at any one time with osteoarthritis(OA) of the knee. It is a very common problem in Western society and with aging baby boomer population knee pain from arthritis is going to be become even more prevalent. Over several decades the science behind the treatment of this condition has evolved. What we know is that exercise is probably the single best treatment for OA of the knee. Other treatment options that can help reduce pain and lead to functional improvements include the use of over the counter or prescription NSAIDs, physical therapy, bracing, corticosteroid injections, possibly the injection of hyaluronic acid “lubricants” and finally total knee replacement.
But wait there is more. What about the newest and greatest treatments? I get asked all the time about PRP and of course stem cell injections. It seems that everyone knows someone that had stem cell injections and it helped when nothing else did. So, what do we know about the role of stem cells in OA of the knee. We know very little. The reason being is that very little research has been done in this area.
This is from an ad for stem cell therapy for osteoarthritis of the knee. The outcome demonstrated in the after drawing is a very unlikely outcome.
A Study of Clinics Offering Stem Cell Therapy
From the recent American Academy of Orthopedic Surgeons annual meeting there was this statement.
“Hundreds of clinics in the United States are selling stem cell treatments for knee osteoarthritis without solid evidence of their claims, researchers warn.”
Here is an excerpt from a presentation by Dr. George Muschler from the Cleveland Clinic.
“People’s expectations have gotten ahead of the science,” said investigator George Muschler, MD, from the Cleveland Clinic, and orthopedic surgeons must be prepared to help their patients evaluate these claims.
“The quality of the literature is relatively sparse,”
In a previous study that Muschler was involved in, investigators conducted a systematic review of stem cell treatments for knee osteoarthritis and focal cartilage defects of the knee, and found only four randomized controlled trials and two well-designed controlled trials without randomization (J Bone Joint Surg Am. 2016;98:1511-1521). The other 420 reports they identified were not well-designed trials. Although the results from the six trials were positive, the placebo effect could not be discounted, the team concludes.
This has not, however, stopped clinics from offering these treatments.
The authors investigated to see what was going on in the current marketplace for stem cell clinics for patients with OA of the knee. At the 65 centers that provided pricing information for a same-day stem cell unilateral knee injection, the mean cost was $5156, but prices ranged widely — from $1150 to $12,000. Muschler and his colleagues interpreted this to mean that the prices were not related to fixed costs, but rather to the amount that the clinics wanted to charge for their labor.
Insurance companies do not reimburse for these unproven treatments, so some patients could be paying more for the treatment than for a total knee replacement, the team pointed out.
So, without any proven benefit should a patient really pursue this form of treatment? Personally, I cannot recommend to my patients that they pay for this ridiculously expensive and totally unproven treatment. To me, this is just another example of the age-old snake oil salesman willing to prey on the desperate and in this case the desperate who have money.