Stem cell knee therapy

kiwimatt

I wondered if anyone had looked into this? (as a fix for lack of cartilage/degeneration in the joint).

Still at the 'experimental' phase and a few different protocols involving injections or arthroscopy, and cells just taken from bone marrow, spun out then fired straight in or alternatively taken out and grown for 6-8 weeks first. Arthritis UK appears to be halfway through a 5 year trial and another one ongoing at Southampton. A few private UK hospitals offering if you want to pay but £££ though.

keef66

I've only seen the supervet doing it on small animals. Extracted, grown up and just squirted into the joint. Certainly appeared to have done something visual to the areas where articular cartilage had gone missing, and the patient looked a lot happier.

I hope it can be made to work in humans because I'll be needing new knees some time in the next 20 years...

kiwimatt

keef66 wrote:

I hope it can be made to work in humans because I'll be needing new knees some time in the next 20 years...

That's the bit I'm currently pondering - whether to pursue just now in the hope the intervention wards off further degeneration - with all the attendant costs/risks (another round of surgery on previously operated knee)/experimental aspects - or 'manage' it for as long as possible while the tech develops.

I know the usual rationale is to put off as long as possible but this feels a bit different since we're talking about possible regeneration of the cartilage.

keef66

I've had 3 lots of meniscal cartilage surgery. Left knee is increasingly painful again so I hoped the orthopod could tidy it up a bit. The new MRI scan showed that the remaining medial meniscus is torn virtually the whole way round, which would explain why the pain seems to move about, but there's too little left to make further trimming a viable option if I want a stable knee joint. So I'm just being careful, avoiding the things that I know aggravate it (luckily cycling is fine) and hitting the ibuprofen and resting it when it flares up. He's still telling me I'll need knee replacements at some point...

kiwimatt

Interesting thanks. I had a full on butcher job done on my meniscal cartilage when I was 16, old fashioned open knee job due to the mess arthroscopy couldn't cope. Nearly 30 years later cycling is similarly fine and I studiously avoid any impact running etc but it has flared up. I will see if I can get sent for an MRI and see exactly what the current state of play is.

mouth

keef66 wrote:

I've only seen the supervet doing it on small animals

And they say animal testing is bad.............

FWIW not necessarily my opinion - vanity products, yes, medical intervention, not so much.

Cartilage doesn't naturally grow inside the body, but once extracted it can be convinced to grow under certain conditions. As an operation, it's been going around for quite a few years but I couldn't comment on the availability, or success rate.

keef66

Mouth wrote:

keef66 wrote:

I've only seen the supervet doing it on small animals

And they say animal testing is bad.............

FWIW not necessarily my opinion - vanity products, yes, medical intervention, not so much.

Cartilage doesn't naturally grow inside the body, but once extracted it can be convinced to grow under certain conditions. As an operation, it's been going around for quite a few years but I couldn't comment on the availability, or success rate.

I'm not getting into the rights and wrongs of animal testing since I work for a global agchem company. But we'd save a fortune if we weren't compelled to do them...

I seem to be running out of all the body parts that don't naturally repair themselves very well. Teeth, eyes, hair, cartilage...

kiwimatt

Mouth wrote:

keef66 wrote:

I've only seen the supervet doing it on small animals

And they say animal testing is bad.............

FWIW not necessarily my opinion - vanity products, yes, medical intervention, not so much.

Cartilage doesn't naturally grow inside the body, but once extracted it can be convinced to grow under certain conditions. As an operation, it's been going around for quite a few years but I couldn't comment on the availability, or success rate.

Getting the cartilage to regrow like bone must be the ultimate aim of these stem cell related therapies? Or have I misunderstood. I suppose not going too far and triggering tumour type uncontrolled growth must be one of the big challenges. I could do with a new lot anyway...!

lochindaal

I have a colleague at work who had it done in the US and swears by it. Think it was about $5K per knee

kiwimatt

lochindaal wrote:

I have a colleague at work who had it done in the US and swears by it. Think it was about $5K per knee

Do you know which version he had was it the same day injection thing or the extract and grow and then back in? (the second version I think they only do at a Cayman Islands clinic as far as I can see) And done once and fixed?

Always the slight problem which is impossible to reconcile that paying big $$ of your own for something has a sort of validation bias as to the success or otherwise - bit like the transformational effect of that carbon stem and titanium bolts...

Matthewfalle

I've just been quoted 2 year post operative rehab for my knee (as it's utterly buggered and has had a couple of procedures on it before) so quite interested in all of this....

US$5k - £3,500? Steep but not massively over ridiculous if they get the procedure to work well.....

thebikerdude93

:0 Why not just use a decent knee support instead of risking surgery and emptying your bank account?

https://nuovahealth.co.uk/shop/open-patella-knee-support-brace/

kiwimatt

thebikerdude93 wrote:

£3,500 wow im actually quite surprised at how cheap that is.. thats like the price of getting yuor teeth done.

UK looks more like £7,500 to £10k - but it's hard to tell
https://www.highgatehospital.co.uk/gene ... l-therapy/
This looks like a bit of a different procedure with a full arthroscopy under a general rather than just injecting the stem cells into the knee. Off to the physio today to try and get the inflammation down a bit and then need to get that MRI organised

meanredspider

Given my daughter has had donor stem cells recently with an aim to cure her leukaemia (seemingly reasonably successfully so far), getting some of your own to do this sounds like a great idea. Quite how they persuade them to become cartilage rather than head back to bone marrow, their natural home, I have no idea. Clever stuff.

Matthewfalle

meanredspider wrote:

Quite how they persuade them to become cartilage rather than head back to bone marrow, their natural home, I have no idea. Clever stuff.

Which is why all the bankers, brokers, accountants etc who all walk around thinking they are clever get zero respect from me for their jobs.

Doctors. They are kinda clever. I am fortunate to have worked/currently work with some people who do the most amazing stuff everyday and are just so cool about it and chilled about it. Not an ego in sight.

Come the revolution, I know where my pick elf is headed.

keef66

There's some amazing stuff being discovered in almost every field of science and technology, stuff that could save the planet, improve lives and stop people dying. But for the most part, scientists are undervalued, under paid, and on short term contracts.

So in order to attract continued funding and raise awareness they put out press releases. Which are invariably misconstrued or dumbed down by the Daily mail as / Frankenfoods / Designer babies / They've grown a human ear on a mouse! That and things like the BSE crisis and Chernobyl, and vast swathes of the population are suspicious of scientists and evidence based decision making in general. Nobody wants to wade through the results of scientific research, they'd rather see what's trending on Twitter. Everybody is looking for a quick fix for something. Every week there's a new must-have superfood, and as soon as Waitrose sell out of Goji berries it'll be something else. And don't get me started on extreme / celebrity diets and clean eating...

Politicians claim to take advice from scientists, but only when it suits them and if somebody else is paying, and they won't be treading on the toes of big business or adversely affecting tax revenues. Take the current fiasco about air quality.

Meanwhile the fat and greedy bankers fcuk things up by risky lending and convoluted investment products, and plunge the rest of us into a decade long financial crisis and years of austerity and pay freezes.

And all of which might mean sweet FA since we're at the mercy of a tangerine buffoon with a Twitter habit, who's picking a fight with a delusional dictator with nuclear ambitions.

svetty

The NHS - through NICE - does fund expensive treatments where there is a clear evidence base of efficacy. This is because the cost of treating these problems with conventional treatments often works out more expensive in the long run so innovations can be cost effective as well as clinically beneficial.

In this case the fact that there is no current NHS provision may say something for the lack of independent evidence of benefit over existing treatments......

kiwimatt

Svetty wrote:

The NHS - through NICE - does fund expensive treatments where there is a clear evidence base of efficacy. This is because the cost of treating these problems with conventional treatments often works out more expensive in the long run so innovations can be cost effective as well as clinically beneficial.

In this case the fact that there is no current NHS provision may say something for the lack of independent evidence of benefit over existing treatments......

Or it may be that it just takes a considerable number of years to gather that evidence. It's not like you can be 'cured' of this or demonstrate quickly for instance that the therapy delays the need for knee replacement for say a further decade (which I would view as a decent outcome for me).

(As an aside physio was very negative on one of the existing therapies microfracture which he says he has never seen work properly in anyone who is active - any coating that develops on the end of the bone from the fracturing just gets sheared off again)

Agree totally about the misery of short term funding and contracts for scientists - leaves the best and brightest constantly worrying about what happens in 18 months etc

svetty

kiwimatt wrote:

(As an aside physio was very negative on one of the existing therapies microfracture which he says he has never seen work properly in anyone who is active - any coating that develops on the end of the bone from the fracturing just gets sheared off again

Yea microfracturing was the previous great hope and was going to revolutionalise knee meniscal injury management........

DeVlaeminck

I know a guy who has had several major knee ops. First one they drilled the bone to encourage cartilage growth, second one was the cartilage grown in the lab and imported back into the knee, third one was a knee replacement which tells you how successful the first two procedures were. He's since ridden his first 200k so as far as cycling goes the knee replacement seems to be working.

DeVlaeminck

I know a guy who has had several major knee ops. First one they drilled the bone to encourage cartilage growth, second one was the cartilage grown in the lab and imported back into the knee, third one was a knee replacement which tells you how successful the first two procedures were. He's since ridden his first 200k so as far as cycling goes the knee replacement seems to be working.

LittleMate1

After 3 arthroscopies; years of research; trials of alternatives (like apostherapy) I came to the conclusion in 2014 that the only viable option was to have a replacement knee at the age of 50. This is what led me back to cycling after a 30 year absence. The easy answer around all such treatments are that there are no cures - everything out there really only slows down the deterioration in the knee joint.

Advances in knee technology mean that there appears to be a knee out there that is, effectively, a "Duracell" knee. Its made of Oxinium (Oxidised Zirconium) by Smith and Nephew. I have one - and its believed it will last 25 years. It actually has plasticised pads inside that can be changed if wear occurs (the big problem with knees is that for a second replacement to take place they have to smash the first one out). Knee's are like tyres and surgeons are like stockists in that they only tend to use 1 type of tyre. When done privately, all types of knee cost the same (2014 - c.£11k) and so it pays to (a) research which type of knee you want and (b) what surgeon you want to do it. No sense in having a poor workman use good tools.

If someone had said there was a lasting cure for £100k, or spending £25k would buy me 5 years with my old knee then I would have done it without hesitation. For me, replacing the joint was the best thing I could have done. This year I have upped my mileage on the bike and will do just under 5,000 miles; last year was 3,000.

There are downsides - but when you start looking for therapies or miracle cures then they are still upsides by comparison. The only negative thing I can think of for having a replacement is age. I waited for 3 years, until I hit 50, to go ahead. If I were 45 then I'd have to think much harder about the options.

molteni_man

Hi. I've had two operations on my right knee similar to some of the other operations noted above.After the 2nd operation the surgeon told me that he was shocked by the state of my knee when he operated on it and that' I would need a knee replacement for sure. That was five years ago when I was 48. Since then I have taken both glucosamine sulphate and cod liver on a daily basis and it's made a huge difference. My knees no longer seize up in the evening or give me great pain. I can kneel on them too easily now.For sure cycling helps massively too and I know that the knee can't be repaired this way but just wanted to share that the glucosamine and cod liver have given me a new lease of life and meant having to take ibruprofen after heavy days walking in the hills. I'd say you need to take them for some time for the effect to kick in . Hope this might help some of you.

kiwimatt

Another new technology
http://www.dailymail.co.uk/health/artic ... laced.html
Anyone had this done?
Reinforces my first principles idea that the longer you can hold off intervention the more options/better tech the solution is likely to be.