Could stem cell injections delay the need for joint replacement?As a knee and hip replacement specialist, Simon Bridle is always keeping abreast of developments within the industry that could benefit his patients. One area that is developing and gaining a lot of attention recently is that of stem cell research, and the benefits this could bring to healing patients who are in the early stages of hip and knee problems.

There are thousands of people each year who develop osteoarthritis in their knee or hip joints, and it can be a painful, debilitating condition, causing the joints to stiffen and be sore and tender. Although there are treatments available such as total knee and hip replacements, treatments for the early stages of this condition vary in effectiveness, as they can only really help patients deal with the condition, rather than reverse the problem or restore the worn connective tissue around the joints.

Understanding stem cell research

Stem cell research is something that a lot of people have heard about, yet many people still have lots of questions about it. What is it? How does it work? Is it available now?

Stem cells are human cells that are able to develop into other types of cells as they are forming. This means that they are being explored as being able to offer healing properties, as they could potentially create more cells that can be used beneficially in a damaged area of the body. The exciting fact about these cells is that when a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell.

This research could mean that people who are suffering with the very early stages of knee or hip joint arthritis may be able to help lessen or reverse the progress of the condition. It is important to recognise the limitations of stem cell treatments, for example it is likely to be that younger patients with isolated small areas of articular cartilage damage are most likely to be those who could benefit from stem cell treatment as a means of delaying the need for joint replacement surgery.

The treatments that are undergoing research at the moment involve extracting mesenchymal stem cells (MSCs) and platelet-rich plasma directly from the patient. As the cells come from the body, the expected benefit is that the patient’s immune system should not reject the new cells.

Patience required

There are companies that are already talking about “regenerative” or “bio-restorative” medicine as an alternative to joint-replacement surgery, but Mr Bridle warns that although these technologies sound exciting, they are still in their medical infancy. It is likely to be many years before this kind of treatment could be available more widely.

Nevertheless, it is through research such as this that we keep progressing medical knowledge, so although this is still in the early stages of research at the moment, this is likely to be something that we hear a lot more about in years to come.

recent joint replacement studiesTwo studies on the effects of joint replacement have hit the news recently – one, from the University of Oxford, examined the long term benefits and limitations of knee replacement surgery.

The second study, which gained a lot of media coverage, came from the University of East Anglia and looked at activity levels in patients before and up to one year after hip replacement surgery.

Studies like these are very useful to help improve the practice of orthopaedic surgeons, such as London hip and knee surgeon Mr Simon Bridle, but there is often a danger when they are reported in the mainstream press that the results can be taken out of context.

Here, we will look at each of these studies objectively and examine the results in more detail.

The knee replacement study

This piece of research has not received much general press coverage, but was reported by Arthritis Research UK, who have provided a neat summary of the results for patients.

The study looked at the long term benefits of knee replacement surgery, as well as investigating factors that can affect the effectiveness of treatment. A group of 1,980 people receiving total knee replacement surgery were assessed by the research team both before the procedure and again ten years post op, to find out more about their individual outcomes.

Researchers found that both pain and function of the knee joint improved over the ten-year period, although pain significantly more so, showing that while knee replacement surgery is shown to be effective in relieving knee pain, the less satisfactory functional results suggest that improvements in implant design and surgical techniques will further improve results.

A number of factors were identified which were associated with less good results. Patients who are overweight and who have had previous operations on their knee tend to do less well other patients.

Consultant hip and knee surgeon Simon Bridle welcomes studies such as these, which allow him to give more accurate information to patients considering knee replacement surgery, as well as providing a catalyst for the improvement of surgical techniques and technology.

The hip replacement study

This study, conducted by researchers from the University of East Anglia, is equally useful to orthopaedic surgeons like Mr Bridle. Unfortunately, however, media coverage such as this piece in the Sun has misled the general public and caused concern amongst many hip replacement patients.

The study itself looked at the activity levels of patients, both before and up to one year after hip replacement surgery. Rather than researchers assessing patients themselves, this paper was a review of 17 different studies on the subject, carried out between 1976 and 2016.

Having analysed the results of all the different studies, researchers found that there was “no significant statistical difference in physical activity levels before and up to one year after unilateral primary total hip replacement.”
Does this mean hip replacement doesn’t work?

Articles like the one in The Sun have claimed that the study shows that hip replacement surgery is unnecessary. However, it is always important to analyse all aspects of a study.

As Mr Martyn Porter, Medical Director of the National Joint Registry, explains:

“Joint replacement surgery offers significant benefits – getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility. Of 91,760 patients surveyed in 2013, 92% described themselves as being either ‘excellent’, ‘very good’ or ‘good’ six months after surgery.
“The main reason for doing hip replacement is to improve pain and there is overwhelming evidence that hip replacement is a wonderful success at improving pain dramatically for the vast majority of patients.”
Mr Porter goes on to say that the overwhelming majority of hip replacement patients report a marked improvement in functionality after the procedure, something that is reflected in Mr Bridle’s own London hip replacement clinic.

To read Mr Porter’s full response to the media furore surrounding the study, click here.

To find out more about how hip replacement surgery could improve your hip problems, contact us to book a consultation with Mr Bridle.

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PA to Mr Bridle: Adriana Espinel-Prada
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