How Long Will Stem Cell Therapy Last?
Patients rightfully ask this question. Here is some evidence to show that this is not a short-term solution, but hopefully a long-term solution. First, many of the studies using stem cells for arthritis have results at 2 years and some as short as 6 months. However, this does not mean that the treatment stopped working at this interval. This merely means that the study was designed to stop at this point. If you look at some of these studies, there are some promising results showing positive structural reversal of the arthritic disease. For example, Koh et al in his arthroscopic second look study revealed reversal of the arthritic changes on visual inspection of the knee through arthroscopy. This finding was confirmed by the South Korean dosing study. In addition, Khanh Hong-Thien Bui and colleagues found positive structural changes on serial MRI’s.  Thus, we can conclude that this is not just a band aide type of treatment, but this evidence helps point us in the direction of positive reversal of the underlying destructive process of arthritis. This is unlike many other current treatments available in orthopedics.
Some more recent studies from Iran show further long term success. Eighteen patients were treated with a bone marrow concentrate in multiple joints including knee, ankle and hip and followed for 30 months with careful laboratory, radiographic and MRI studies. The research team reported the “All” patients received therapeutic benefits confirmed by pain and function scores and were confirmed by MRI. Researchers at the University of Paris followed 534 patients up to 18 years after a bone marrow stem cell treatment for avascular necrosis of the hip which is an arthritis caused by the lack of blood supply to the hip. This long-term study revealed that only 15.7% of the patients went on to receive a total hip after this treatment and many of the x-rays and MRI’s of the hip stabilized.
We also have a “white paper” result from a very interesting long term study comparing bone marrow stem cell therapy to our traditional total knee replacement in elderly male patients. A white paper is a study which is not yet published and thus it has not been peer reviewed and one must be careful in using this data because it has not yet been validated. However, this same researcher, Philippe Herniguo, M.D., PhD, has published hundreds of peer reviewed studies and is a very respectable source. This study took 60 elderly male patients all 85 years old or older. Group A was treated with the standard total knee replacement for both knees. Group B was treated with the bone marrow stem cells to both knees injected directly into the bony part of the knee next to the joint. Group C had one knee injected with the stem cells and the other knee replaced. After an average of 6 yrs. (ranging from 2 to 15 yrs.), the patients in Group B (stem cell group) had the following:
- Improved knee function scores (Knee Society Scores)- A 16.3-point improvement for the stem cell group vs. only an 8.9-point improvement for total knee group.
- Faster Functional Recovery- At 9 months, the stem cell group had faster recovery than the total knee group.
- Lower Complication rates- Blood clots occurred in only 2% of the stem cell group compared to 12% in the knee replacement group. None of the stem cell patients required a blood transfusion and 29.3% of the total knee group required blood transfusions. Higher use of analgesic medications such as narcotics were used in the total knee group.
- Lower Re-operation rate- None of the stem cell patients required further surgery or conversion to a total knee. However, 5% of the total knee patients required further surgery.
- Higher Overall Satisfaction- When patients were asked to point to the knee which they preferred, 70% of the patients pointed to the stem cell therapy knee.
A large multi-national, multi-center study evaluating patients of all ages with all levels of severity gives us some further evidence that this is a longer term treatment for arthritis. In the study by Michalek J, et al. entitled “Autologous adipose tissue-derived stromal vascular fraction cells in patients with osteoarthritis,”(Cell Transplant, 2015 Jan 20. doi: 10.3727) followed 1128 patients for up to 54 months (over 4 yrs). A majority of these patients (63%) had at least 75% improvement of pain and function and 91% had at least 50% improvement. However, obese patients and patients with more severe arthritis took longer to respond. This is one of the largest and longest term study showing promising positive results in the longer term. Our own experience confirms this result. Our own unpublished evaluation of pain and function using a visual analog scale and the WOMAC on hundreds of patients receiving a similar procedure for over 3 years reveals similar results with an excellent safety profile and no serious adverse events.
Although some of these studies are not controlled, blinded, or randomized, but they do show a common pattern of:
- This is a safe procedure with very low rates of complications.
- Consistent reduction of pain.
- Consistent restoration of function.
- High rate of patient satisfaction.
- Improved MRI or physical findings (microscopic or arthroscopic).
- Midterm and long term relief of symptoms
- Superior results to other orthopedic conditions such as hyaluronic injections and even joint replacement.
Advanced Orthopedic Specialists offers this state of the art care in a friendly environment with skilled surgeons and staff. Dr. Loniewski has developed a simple questionnaire to determine if you may benefit from cell based therapies. This only takes about 3-5 minutes to complete. You can read more and download the questionnaire at: http://www.advancedortho.net/candidate-stem-cell-therapy.php
If you would like to schedule an appointment , please call our office at 810-299-8550.
 Koh YG et al, Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy, 2013 Apr; 29(4) 748-55.
 Khanh Hong-Thien Bui et al , Symptomatic knee osteoarthritis treatment using autologous adipose derived stem cells and platelet-rich plasma: a clinical study, Biomedical Research and Therapy, 2014 (1):02-08
 Emadedin M., et al, Long-Term Follow up of Intra-articular Injection of Autologous Mesenchymal Stem Cells in Patients with Knee, Ankle or Hip Osteoarthritis, Arch Iran Med. 2015, Jun;18(6): 336-44
 Hernigou, P, et al, Cell Therapy of hip necrosis with autologous marrow grafting , Indian J Orthop.2009 Jan-Mar; 43(1): 40-45
 Michalek J et al., Autologous adipose tissue-derived stromal vascular fraction cells in patients with osteoarthritis, Cell Transplant, 2015 Jan 20. doi: 10.3727
Hour Top Docs 2016 - Laith Farjo MD
We are pleased to announce that Dr. Laith Farjo has been selected as an Hour Magazine Top Doc for 2016, his fifth year in a row to receive this honor! Every year, Hour Magazine polls physicians in Southeast Michigan and asks them to rate physicians they feel are exceptional - the highest ranking of these doctors are rated a Top Doc by the magazine.
Hip Incision Used by Dr. Loniewski:
Plastic Surgery Hybrid Hip Incision Combines Minimally Invasive and Safe Approach Along with Stem Cells for Best Outcome
Some patients will call about what type of incision or approach used for hip replacements. Most of these calls come from patients who were told by another friend or family member that there is a newer, less invasive approach from the front or anterior aspect of the hip. Here are some facts about this anterior or front approach:
- The anterior approach is not new. Many orthopedic surgeons used a similar longer incision called the Smith-Peterson approach over the same area in the 1960’s and 1970’s but abandoned it due to an increase in complications.
- The anterior approach is not without potential complications associated just with the incision choice alone. This includes increased blood loss; nerve damage and loss of sensation over your thigh; and a higher fracture rate of the femur.
- The anterior approach normally requires the use of intra-operative x-rays exposing the patient and the staff to increased risk.
- There is normally a greater length of time required, and a higher incidence of need for blood transfusions during this longer and bloodier surgery.
- Studies comparing most of the popular surgical approaches has shown no difference in function, pain or outcome 6 weeks after the surgery.
Dr. Loniewski normally use a hybrid incision for total hips with a proven track record and an excellent safety record. This utilizes the benefits of an anterior approach, but with a better safety profile.
Dr. Loniewski use a minimally invasive anterior-lateral approach. This mini incision allows the surgeon to enter into the hip with minimal damage to any muscles or tendons. There is no use of skin staples or removable sutures. This is a plastic surgery type of closure. It also allows complete access a larger area of the hip allowing for proper visualization of the important parts of a hip replacement. The result of this improved visualization and lower surgical time is a lower rate of complications such as fractures of the bone, nerve damage, and bleeding. The anterior-lateral approach allows for a quicker operative time and no need for x-ray radiation. Many of our patients get up and walk the same day of surgery and an overwhelming majority of our patients are able to be discharged one day after surgery to the care of their families. In addition to this minimally invasive approach without any visible sutures or staples, Dr. Loniewski uses the patient’s own stem cells to heal the wound quicker and reduce the chances of infection. Bone marrow is aspirated at the same time of the surgery and this is concentrated down into a special paste used at the time of closure to promote healing, and reduce complications.
Regenerative Medicine At Advanced Orthopedic Specialists
The National Institute of Health (NIH) defines regenerative medicine as the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects. This field holds the promise of regenerating damaged tissues and organs in the body by stimulating previously irreparable organs to heal themselves.
Osteopathic medicine tends to fit perfectly within the concept of regenerative medicine. Andrew Taylor Still founded the first college of osteopathic medicine in Kirksville, Missouri in 1892 when he declared that there must be a better philosophy of medical care. Dr. Still felt physicians needed to trust the body’s innate ability to heal itself and to avoid toxic and misdirected treatments aimed to treat the effects rather than the cause of the disease.
Thus, the tenants of regenerative medicine fit well within the philosophy of an osteopathic physician and surgeon. Our Comprehensive Arthritis and Recovery and Education program otherwise known as the C.A.R.E. program utilizes these basic principles to help your body heal itself. We use an ancient concept of homeostasis that is still used today to treat chronic diseases such as heart failure, calcium metabolism and arthritis. Ancient Greek philosophers such as Heraclitus (540–480 BC) first described this concept when he theorized that static, unchanging states of the human body was not natural, and that ability of the human body to undergo constant change and to respond to the change was “intrinsic to all things.” Hippocrates (460-375 BC), considered to be the father of medicine, further refined this concept and compared health to the harmonious balance of the elements, and illness and disease to the systematic disharmony of these elements. We have simplified this into modern terms of damage and repair.
We can simplify your arthritis into a mathematical formula. Every day, your joint makes cells and every day, your joint looses some cells. Over time, your joint has just lost more cells than what it can make and the net result is the loss of cartilage. This loss of cartilage is the definition of arthritis. When we lose cartilage, we have pain, swelling, and deformities ultimately causing a dysfunctional joint. If you want to think of this in a practical manner, consider the City of Detroit. For years, they spent more money than they took in. They barely survived for years limping along, but the truth was that they spent more than what they made. This eventually led to a declaration of bankruptcy and a long process was started to reduce the spending and increase the revenues. This is not usually enough. The bankruptcy court also corrects any underlying functional deficiencies to keep the city functional and out of bankruptcy. Most of the times, this means facing reality and making some dramatic, yet helpful changes. This eventually led to a balanced budget and the emergence out of bankruptcy.
When we look at your joint, we use the same concept to get your joint out of bankruptcy. We need to lose less cells and make more cells while correcting some underlying deficiencies. We look at both ends of the formula helping you identify why you are losing so many cells and we correct these deficiencies. We can also look at what you need to do to increase the production of cells. We look at weight control, shoe wear, joint alignment and muscle or ligament deficiencies and correct all that we can correct. On the other end of the formula, we encourage the correction of some nutritional deficiencies, and supplement these deficiencies. We can also increase gentle range of motion exercises that can stimulate repair and have a discussion about cell-based treatments.
Cell-based treatments include using your own body’s cells to help in this reparative process. Some examples of this include platelet rich plasma (PRP), bone marrow concentrate (BMC) and adipose derived stem cells (ADSC). Each one of these has specific indications and, most importantly, contra-indications. Not everyone responds the same way to these treatments, so it is very important that the physician treating you understands who and what conditions are best treated with these treatments. We have the most experience using these treatments in the area. Dr. Loniewski has been using PRP since 2005 and has performed this on thousands of surgical and non-surgical patients. Dr. Loniewski has conducted research on PRP and presented the results at scientific meetings. He was also one of the first physicians in the Midwest to utilize adipose derived stem cell (ADSC) for hip and knee arthritis since 2013 and he has since performed this on nearly 100 patients. This experience helps us understand the best methods and the best patient selections for these treatments. It also helped us identify patients who may not respond as favorably, which is sometimes more important.
We just don’t offer these treatments, we help correct the underlying deficiencies and customize what type of treatments may offer the best overall outcome with the greatest chance for success while reducing the risks of treatment. Thus, Dr. Loniewski has followed the basic tenants of Andrew Taylor Still and Hippocrates by restoring homeostasis while reducing harm to the patient.