Orthopedics. Cartilage can be regenerated using cells from the body's own blood. The method is safe, comparatively inexpensive, and is increasingly being used in Austria.
Vienna. Osteoarthritis, the wear-and-tear related degradation of cartilage in the joints, is a widespread disease accompanied by severe pain, swelling, and restricted movement. Hundreds of thousands of people are affected, especially in older age. A new method, which has been successfully used in countries like South Korea, Japan, and the USA for about 15 years, is slowly gaining traction in Europe and Austria. It involves the use of stem cells and other cells from the patient's own blood. The success rate is remarkable – especially compared to prostheses, where complications such as bleeding, loosening, and infections are not uncommon, as these are major surgical interventions.
How does the use of stem cells from one's own blood work?
In this method, blood is taken from a patient's forearm vein, from which stem cells and platelet-rich plasma are extracted. Stem cells are so-called pluripotent cells, meaning they can transform into other cells. This includes cartilage cells, so that the cartilage in the joints regenerates after the stem cells (together with the supportive platelet-rich plasma) have been injected. Stem cells can be obtained not only from blood but also from adipose tissue and bone marrow (from the iliac crest with local anesthesia, making it painless). The ability to transform is one of two effects of stem cells; the second is the so-called paracrine effect. This means that they can produce growth factors
(exosomes). These growth factors are released by centrifugation (using ultrasound) and also injected into the affected joint – they inhibit inflammatory processes in the joints. "Every cartilage injury leads to an inflammatory reaction, so-called inflammation," says Viennese orthopedic surgeon Patrick Weninger, who is the pioneer of this method in Austria. Together with Dr. Angelika Reich and Dr. Murat Özcelik, he founded the Avancell practice network (www.avancell-joint.com) to make it accessible to more patients with other orthopedic surgeons. "By using stem cells and exosomes, these painful inflammations, which are also associated with swelling and restricted movement, can be reduced to a minimum. We also work with radiofrequency ablation to eliminate pain." This involves heat waves that reach and deactivate pain nerves via small electrodes. They do not heal the cartilage damage but alleviate the pain.
What are the advantages of this method, which is currently being established?
Firstly, the speed of treatment. Blood collection, as well as the extraction of stem cells from blood, adipose tissue, or bone marrow, including the injection into the affected joint, takes place on the same day, usually in less than an hour. According to Weninger, practically all patients report a noticeable improvement in their condition, meaning pain relief and greater freedom of movement, within hours afterward. This effect intensifies in the following days and, as international studies show, lasts for at least seven years. Weninger himself evaluated data from 39 patients from Austria – 100 percent of them reported significant pain relief on the same day (if they rated their pain before the procedure on a scale of zero to ten as eight to ten, it was two to three after the treatment), which also persisted a year later. There are no longer observation periods because this method has not been used in Austria for as long. Another advantage is the low complication rate, practically zero. "With prostheses, about 20 percent of patients are dissatisfied afterward, and they also have a limited lifespan. However, I am not criticizing prostheses. We do not see ourselves as opponents of artificial joints but as a sensible complement to them," says Weninger. "I only want to point out that in countries like South Korea, where stem cells have been widely used for years, the prosthesis rate is very low because the advantages of this method outweigh the disadvantages. It is not without reason that it has also been used by athletes such as tennis player Rafael Nadal, soccer player Cristiano Ronaldo, and the late basketball player Kobe Bryant." Patients are allowed to put weight on the joint immediately after treatment, but running and jumping sports should be avoided for four weeks.
How high are the costs and how much do health insurance funds cover?
This method can be applied to all joints, but it is most commonly used for the knee. For mild cartilage damage (osteoarthritis grade I to II), the costs amount to 1900 Euros, for moderate damage (III) to 3500 Euros, and for severe damage (IV) to 4500 Euros. Subsequently, no further treatment is usually necessary for at least seven years, after which another treatment can be performed. For comparison: inserting a prosthesis costs an average of 40,000 Euros. According to Weninger, stem cells will be used even more in orthopedics in the future, for example, for ligament injuries, muscle fiber tears, and meniscus tears. "Stem cells have played a very important role in medicine for decades, for example, in cancer therapy," he says. "Now they are gradually gaining ground in orthopedics too." Nevertheless, the costs for the use of stem cells are not yet covered by health insurance funds in Austria. "From the perspective of social insurance, there are currently no clear results for long-term effectiveness or superiority to other treatment options," stated the Austrian Health Insurance Fund (ÖGK) in response to a "Presse" inquiry. "The Austrian Health Insurance Fund is following the application and results in international literature with interest. At present, such methods should primarily be provided in the clinical setting with appropriate data collection." It should also be noted that, for example, the cell types that currently yield the best results, namely laboratory-grown cells, are not available in Europe. The prerequisite for good results also depends on the individual lifestyle, exercise habits, and body weight of the treated persons.
(c) Article by Köksal Baltaci