FAQ - Stem Cell & PRP Treatment

DEFINITIONS

WHAT ARE AUTOLOGOUS MESENCHYMAL STEM CELLS?

  • Partially differentiated stem cells from your body that are active in cartilage, tendon, ligament, and bone repair
  • They are NOT fetal or embryonic

WHAT IS PRP (Platelet Rich Plasma)?

  • A small amount of a patient’s blood that has been centrifuged and processed to concentrate growth factors and cytokines from platelets

USES

WHAT ARE STEM CELLS/PRP INJECTIONS USED FOR?

  • Arthritic joints as an alternative to joint replacement
  • Tendon injuries such as partial tears of the rotator cuff, Achilles tendon, tennis elbow and patellar tendons as an alternative to surgery and cortisone
  • Bursitis, such as trochanteric bursitis of the hip
  • Ligament injuries such as occur in ankle sprains
  • Back pain that comes from facet arthritis or SI joint disease

RESULTS

WHAT ARE YOUR SUCCESS RATES USING STEM CELLS AND PRP FOR ARTHRITIS?

  • In moderate arthritis about 80% of patients respond to these treatments and do not need joint replacement
  • In bone on bone joints response is only about 50%, however this is one of the only treatment besides joint replacement that has some efficacy here, and often can be maintained for years

WHAT JOINTS DO YOU TREAT?

  • Knee, shoulder, hip, foot and ankle, Great Toe, base of thumb and a-c joint in descending order
  • For back pain we use low level laser therapy rather than stem cell/PRP can also be used for facet injection of the back

WHAT TENDONS DO YOU TREAT?

  • Rotator cuff, Achilles tendon, patellar tendon, tennis elbow, foot, and plantar fasciitis in descending order

WHAT SPORTS INJURIES DO YOU TREAT?

  • Ankle or other ligament sprains
  • Chronic muscle strains of the hamstring, gastrocnemius (calf) and others

HOW MANY TREATMENTS ARE NEEDED?

  • For stem cell 1 successful treatment will usually last years
  • For PRP treatments 1-2 injections initially (may need to be repeated annually for arthritis, usually not for tendon or sport injuries)

HOW LONG DOES IT TAKE FOR TREATMENT TO WORK?

  • For stem cell relief may occur in 2 weeks but may take months
  • For PRP relief will be maximum within a month

WHAT ARE YOUR SUCCESS RATES FOR ROTATOR CUFF TEARS?

  • For partial rotator cuff tears our success rate is well over 80%, whereas surgery is now commonly recommended for this procedure elsewhere
  • We have not had a patient go on to a full thickness tear after treatment and require surgery, whereas this can occur with cortisone injections and other treatments
  • Most full thickness tears can only be repaired surgically – which is Dr. Prodromos’ surgical specialty, but we have had success treating small full thickness tears with PRP without surgery
  • We are usually able to treat with PRP without needing stem cells

WHAT ARE YOUR SUCCESS RATES FOR ACHILLES TENDON, TENNIS ELBOW AND PATELLAR TENDON?

  • Overall about 80% of patients respond
  • To our knowledge, we have not had any patients need surgery for these problems after treatment

TELL ME ABOUT YOUR RESEARCH STUDY

  • Our patients are all followed up over time through our research foundation which has allowed us to develop powerful data as to efficacy
  • Our prospective study of PRP/Stem cell is one of the largest by an Orthopaedic surgeon and gives us cutting edge data which we can use to advise patients

DO OTHER FACTOR INFLUENCE RESULTS?

  • Yes, we have found that for knees especially, restoring motion before injection is dramatically helpful, so we will often get this accomplished before beginning treatment
  • Stopping NSAID drugs (eg. ibuprofen, motrin, aleve, diclofenac, meloxicam) also improves results since these drugs interfere with healing and also mask symptoms
  • We also prescribe nutritional supplements such as glucosamine/chondroitin, boswellic acid, collagen and MSM which can reduce symptoms and are safe – they may be found at our website under “Purchase Supplements”

AUTOLOGOUS VERSUS ALLOGENEIC

WHAT DO AUTOLGOUS AND ALLOGENEIC MEAN?

  • Autologous means it comes from the patient being treated
  • Allogeneic means it comes from someone else

DO YOU USE AUTOLOGOUS OR ALLOGENEIC?

  • We use autologous in all patients (unless they have active cancer) due to greater efficacy, safety, and lower cost

ARE AUTOLOGOUS MESENCHYMAL STEM CELLS/PRP MORE EFFECTIVE THAN ALLOGENEIC?

  • Yes, your own tissue is always more effective in you than someone else’s

Beware of advertised stem cell treatments, such as amniotic fluid, that are not from you. They do not have real living stem cells when injected into joints and tendons. They are actually a growth factor treatment like PRP but at a dramatically greater cost

ARE THERE GREATER RISKS FROMTO ALLOGENEIC TISSUE?

  • Yes, there are always greater risks from tissue from others
  • Improper processing can result in a higher risk of infection and even death

ARE ALLOGENEIC TREATMENTS MORE EXPENSIVE THAN AUTOLOGOUS?

  • Yes, allogeneic treatments usually come from pharmaceutical or other companies who will always impose additional costs from preparation and from taking their profit
  • Tissue from you eliminates this “middleman” between you and your doctor, in addition to being more effective and safer

ARE YOUR OWN AUTOLOGOUS STEM CELLS EFECTIVE EVEN IF YOU ARE OLDER?

  • Yes, in our studies age has not been a factor, even in patients in their ninth decade of life

IF AUTOLOGOUS IS MORE EFFECTIVE, SAFER AND LESS EXPENSIVE, WHY ARE ALLOGENEIC USED BY SOME?

  • There are huge potential profits in using “off the shelf” allogeneic products, therefore companies that distribute them market them heavily
  • It is much easier for any doctor to use allogeneic tissue whereas using your own autologous tissue takes significant technical expertise and an investment of time by the doctor

RISKS

ARE THERE RISKS/COMPLICATIONS OF AUTOLOGOUS MESENCHYMAL STEM CELL OR PRP INJECTION INTO JOINTS AND TENDONS?

We have had no complications after more than 3500 injections

  • No complications have been reported in the literature to our knowledge for joint injections
  • You cannot have a reaction to your own tissue and no other drugs are used

CAN I BE TREATED WITH STEM CELL OR PRP IF I AM ON BLOOD THINNERS OR OTHER MEDICINES?

Yes, patients should maintain all prior medications (except NSAIDs) for PRP or stem cell treatment. Coumadin or other blood thinners are not a problem

MECHANISM OF ACTION

HOW DO AUTOLOGOUS MESENCHYMAL STEM CELLS AND PLATELETS WORK?

  • Via growth factors that help your tissue heal (eg transforming growth factor beta, platelet derived growth factor)
  • Also via anti-inflammatory cytokines (eg. interleukin 1 receptor anatagonist) that fight inflammation
  • A substance called Lubricin that is a natural lubricant for the knee has also been recently discovered to be in PRP
  • There is new evidence that mesenchymal stem cells take root and live after they are injected and keep working long after the injection
  • Stem cells/PRP do NOT impair healing as cortisone and NSAIDs do, rather they stimulate healing directly and by inducing your own stem cells to work
  • Note that stem cells help the joint heal but no stem cell treatment has been shown to generate new tissue, despite some misleading claims that have appeared (although now an exciting new minimally invasive surgical procedure from the Netherlands called Joint Distraction Arthroplasty is offered at our clinic and has been shown to lay down new tissue)

TECHNIQUE

WHO DOES THE ACTUAL INJECTION IN YOUR CLINIC?

  • All injections are done by Dr. Prodromos, (or by Dr. Hatz DDS for TMJ injections)
  • We do not have nurses or physician’s assistants performing the injections as is the case at many clinics

DO YOU INJECT USING ULTRASOUND?

  • Yes, where needed. This allows precise placement and no use of X-rays in the vast majority of injections

DO YOU USE SEDATION OR MEDICATIONS?

  • None are used, none are needed for Stem Cell or PRP

ARE THE INJECTIONS PAINFUL?

  • The injections have some discomfort but it is minimal and usually far less than patients expect. Many patients are often surprised that the injection has been completed so easily.

CAN I COME BY MYSELF AND DRIVE HOME?

  • Yes, for PRP
  • For Stem cell it is advisable to have someone drive you

HOW LONG DO TREATMENTS TAKE?

  • PRP takes under an hour
  • Stem cell takes about 1 hour and 45 minutes

WHERE DO WE HARVEST YOUR MESENCHYMAL STEM CELLS FROM?

The back of the iliac crest bone, (this is not the hip or spine, but rather a non weight bearing readily accessible pelvic bone at waist level)

  • A small lipo-aspiration of fat (fat contains stem cells and is used for its cushioning effect) from the love handle area
  • Very little pain is involved, only a light local anesthetic is used

IS DR PRODROMOS EXPERIENCED IN REGENERATIVE MEDICINE?

  • Yes, Dr Prodromos is one of the few board certified Orthopaedic Surgeons who is also board  Certified in Regenerative Medicine
  • He is also a member of the scientific advisory board of the American Academy and Board of Regenerative Medicine

IS IT ADVANTAGEOUS TO HAVE AN ORTHOPAEDIC SURGEON SUCH AS DR PRODROMOS PERFORM THESE TREATMENTS?

  • We believe it is. Orthopaedic Surgeons are the only doctors who are specifically trained to take care of bone and joint disorders.  Proper diagnosis is key even before treatment, and only Orthopaedic Surgeons are fully trained to diagnose bone and joint disorders

With more than eight years experience and over 3500 injections performed as of mid 2019, he is one of the most experienced

  • Dr.Prodromos is also committed to only using surgery if all else fails, but his expertise as a joint preservation surgeon gives him further insight into damaged joints in regenerative medicine

COST

  • Stem cell and PRP treatments are not covered by insurance.  However, our charges however are lower than most comparable centers for each.

WHEN DO YOU USE STEM CELL VERSUS PRP?

  • Stem cell treatments have lasted far longer in our study, but treatment is more expensive
  • PRP is usually sufficient for tendon and sports injuries
  • Stem cells are usually used for arthritis, although PRP is also effective depending on the individual case

ARE X-RAYS, MRI OR OTHER TESTS NEEDED?

  • X-rays are always needed and can be taken in our clinic depending on insurance
  • MRIs are notroutinely needed but may be ordered in some cases
  • No blood tests or other tests are needed

ARE THESE PROCEDURES FDA APPROVED?

  • Yes, we perform all procedures in strict accordance with FDA guidelines
  • American Academy Regenerative Medicine
  • American Academy and Board of Regenerative Medicine
  • American Orthopaedic Society for Sports Medicine
  • isakos
  • Rush University Medical Center
  • American Association of Nurse Anesthetists
  • American Academy of Orthopaedic Surgeons
  • European Society of Sports Traumatology, Knee Surgery Academy
  • International Cartilage Repair Society