Stem-cell therapy shows promise in orthopedic treatment

Single treatment costs several thousand dollars and is not covered by insurance

By Peggy O'Hare
San Antonio Express-News

SAN ANTONIO (AP) - Three San Antonio doctors are bringing the science of stem-cell therapy treatments to orthopedic injuries, a burgeoning field that caters to patients seeking to have joints or tendons rebuilt without undergoing surgery.

The physicians at The Stem Cell Orthopedic Institute of Texas - a recently created division of the long-standing South Texas Spinal Clinic - said they are among the few providers in San Antonio doing the procedures on an outpatient basis.

Dr. Ajeya Joshi, Dr. David Hirsch and Dr. John Hall are performing the services at their office, which they said significantly reduces the costs patients would face compared with having it done at a surgical center or a hospital.

The group began performing the procedures more than a year and a half ago; they launched the institute this month.

Another medical practice, The San Antonio Orthopaedic Group, offers the same stem-cell treatments for orthopedic injuries but typically does that work at outpatient surgical centers, often in conjunction with other surgical procedures, said one of its physicians, orthopedic surgeon Frank J. Garcia. He expects his practice eventually will offer the procedure in-house on a more frequent basis as well.

The practice of using a patient's own stem cells, derived from bone marrow, to rebuild cartilage, collagen, tendon or bone is flourishing in orthopedics, physicians said. The procedure also can reduce pain and inflammation.

Stem-cell therapies have great potential for the increasing numbers of people who are running and working out to keep fit, said Hall, an anesthesiologist and pain-management doctor.

"There's a lot of younger people getting severe joint damage," he told the San Antonio Express-News. "Now there's an alternative for them to surgery."

In the past, such procedures were "a little bit cost prohibitive to someone other than a professional athlete," Hall said. "Now, we've got the price down to where it's actually affordable for the everyday athlete - the guy that's out running 5 miles every morning."

A single treatment still costs several thousand dollars - and is not covered by health insurance at this point. But because Joshi, Hirsch and Hall do the procedures at their office, they said, their prices are $1,500 to $2,000 less than what a patient would pay at a hospital or surgical center.

The therapy involves withdrawing a patient's bone marrow stem cells from his or her hip, concentrating those cells and injecting them directly into the damaged joint or tendon, using musculoskeletal ultrasound technology to reach the most severely affected areas. Once preliminary exams are out of the way, the stem-cell therapy can be done in one doctor's office visit, typically lasting an hour, while the patient is under mild sedation.

The process does not involve the controversial use of embryonic stem cells, the doctors said.

"This is a very straightforward application of cells from your own body," said Joshi, an orthopedic spine surgeon. "You're minimally manipulating them, and you're returning them back to the patient."

The stem-cell application may be an attractive option for a patient wanting to avoid surgery or who is deemed too young, too old or not medically stable enough to undergo a total knee or hip replacement, doctors said.

"Surgery is pretty invasive, can be disruptive and has a known set of complications," Joshi said. "Stem cells represent a powerful, natural option . that can reduce inflammation, reduce pain and maybe make it unnecessary to go through surgery."

"The applications are tremendous," agreed Garcia at The San Antonio Orthopaedic Group, "not just for arthritis, but for tendinitis, for things like degenerative disc disease."

Before forming The Stem Cell Orthopedic Institute, the doctors conducted an unpublished study assessing how 15 patients with severe joint damage fared with the treatments. Those patients, ranging from their 40s to their 80s, saw significant pain relief and improved function after six months, they said. One of the 15 patients still required surgery after the treatment, Hirsch said.

"The results were pretty fantastic," said Hirsch, a specialist in physical medicine and pain management.

The procedures do not yield immediate results. If treatment is successful, the benefits are seen over time. Pain relief might become evident in a few weeks, but the formation of new tissue is likely to take six months, Hirsch said. Medical literature indicates the greatest effects likely will be seen three to four years after the injection is given, he said.

Not everyone will benefit from such treatments. For patients who have bone grating against bone or severe wearing down of their joints, the doctors won't profess "that we're going to just magically grow a healthy cartilage," Joshi said.

"Most people aren't candidates," Hirsch said.

The doctors said they also will perform the stem-cell treatments on two knees or two hips at no additional cost beyond what a patient would pay for a single knee or single hip procedure.

Published: Wed, Apr 22, 2015


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