It's a scenario I see all too often in my line of work: A new patient in his late 30s comes in to see me, suffering from painful osteoarthritis in his knee. The soft articular cartilage, which cushions the ends of his bones, has been damaged and is worn away. The bones are grinding against one another, causing inflammation, swelling and stiffness.
He's tells me a familiar story. He had been injured skiing in his early 20s and while he thought his injury had been fixed, his knee had begun hurting again a few years ago. He recently had been diagnosed with osteoarthritis and had been told that it's likely to get a lot worse and that he'll eventually need a knee replacement. He'll have to wait until he's at least 60 for that operation. (Knee replacements don't last long, so people delay getting them to avoid having them replaced twice.)
In the meantime, he's been on medication to ease the pain and take down the swelling, which counterproductively allow him to use the joint and damage it further. He's also been instructed to modify his activity (no more skiing), and lose weight. Essentially, he's been told to change his lifestyle and "suck it up" for 20 years until he can get the joint fixed permanently by removing it.
"Is this the only option?" he asks me.
I shake my head.
"No, it is not."
I explain that unfortunately his arthritis treatment is focusing on the symptoms of his condition but is not addressing the underlying causes. Instead, there is something we can do right now, to repair the damage to the cartilage. The Stone Clinic, among others, is pioneering groundbreaking therapies using adult stem cells, meniscus transplantation and other biologic procedures with the goal of addressing the cause of arthritis and reversing its symptoms.
With an advanced procedure called the articular cartilage paste graft, we can fill the hole in the cartilage that's causing the arthritis. By filling the hole, we can halt and reverse the symptoms. Think of it like having a dentist fill a hole in your tooth. You'd rather have a filling to catch the decay early on than get a set of dentures right? It's the same with cartilage damage. A joint is a little more complicated than a tooth since the hole in the cartilage is more difficult to fill but it's the same concept: fill the hole to stop it getting bigger and causing further painful damage.
With a paste graft, a small amount of the patient's own bone, adult stem cells (from the patient's bone marrow) and cartilage are taken out of the knee, crushed into a paste and compressed back into an arthritic defect in the joint. From there, the knee grows its own replacement tissue, right inside the joint, taking full advantage of the healing ability of the patient's own stem cells. It's an arthroscopic, outpatient surgery.
In some cases, osteoarthritis may be the result of a missing or damaged meniscus cartilage. The meniscus is the natural shock absorber in the knee. Without it, the unprotected femur and tibia bones grind together. Our goal is to save the meniscus cartilage when possible by bringing new blood supply into damaged tissue, often adding growth factors, stem cells and clot materials to help the healing process. In some cases, I would recommend replacing all or a portion of the meniscus with donor cartilage. A meniscus transplant can reduce pain and improve function even in people with severe arthritis.
Osteoarthritis is a silent, insidious disorder that ruins far too many lives. We are determined to put an end to it. It's not just an older person's disease, it can start young. After a joint injury at any age, or for another reason such as an imperfect joint alignment, your cartilage can begin the process of wearing away. If you catch it early, you can stop it in its tracks. We've done this procedure on people from 15 years old to 70 with positive results, our patients return to sport and resume their busy lives. You don't have to compromise your activity or suck up the pain until you're a knee replacement candidate.
As I explain all of this to my patient, I see a sense of relief wash over his face. He smiles for the first time. However, I know that this smile will pale in comparison to the huge grin he's going to be wearing when, after his cartilage is fixed and his knee feels ready to go, he's once again back on the ski slopes.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments. For more info, visit www.stoneclinic.com.Our new columnist
Beginning today, Dr. Kevin Stone will be writing about cutting-edge procedures regarding biologic joint repair and related fields. He has experience with world-class athletes and has spoken at the TED conference. His column will run on the first and third Sundays of each month.