(All of the text below was obtained from Medscape articles. Medscape credentials are presented at the end of this article)
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“Hundreds of clinics in the United States are selling stem cell treatments for knee osteoarthritis without solid evidence of their claims, researchers warn.
“People’s expectations have gotten ahead of the science,” said investigator George Muschler, MD, from the Cleveland Clinic, and orthopedic surgeons must be prepared to help their patients evaluate these claims.”
The quality of the literature is relatively sparse,” he told Medscape Medical News. In a previous study that Muschler was involved in, investigators conducted a systematic review of stem cell treatments for knee osteoarthritis and focal cartilage defects of the knee, and found only four randomized controlled trials and two well-designed controlled trials without randomization (J Bone Joint Surg Am. 2016;98:1511-1521). The other 420 reports they identified were not well-designed trials…
This has not, however, stopped clinics from offering these treatments. Muschler and his colleagues examined the current market for stem cell treatment for knee osteoarthritis, and presented their results here at the American Academy of Orthopaedic Surgeons (AAOS) 2018 Annual Meeting. The findings were previously published online (J Knee Surg. Published online July 24, 2017).
“At the 65 centers that provided pricing information for a same-day stem cell unilateral knee injection, the mean cost was $5156, but prices ranged widely — from $1150 to $12,000. Muschler and his colleagues interpreted this to mean that the prices were not related to fixed costs, but rather to the amount that the clinics wanted to charge for their labor.
Insurance companies do not reimburse for these unproven treatments, so some patients could be paying more for the treatment than for a total knee replacement, the team pointed out.”
“Two systematic reviews have questioned the quality of the studies of stem cell therapy for knee osteoarthritis, citing high risk of bias, low quality of evidence, only modest improvement reported, and possible placebo effect. Nevertheless, a survey identified hundreds of clinics in the United States that offer stem cell therapy for knee arthritis, at prices ranging from $1150 to $12,000 for a unilateral injection. In many cases these injections would consist of centrifuged blood or bone marrow aspirate rather than cultivated stem cells.”
Source: >Stem Cell Therapy
Osteoarthritis Treatment & Management
The goals of osteoarthritis treatment include alleviation of pain and improvement of functional status. Optimally, patients should receive a combination of nonpharmacologic and pharmacologic treatment.
Nonpharmacologic interventions, which are the cornerstones of osteoarthritis therapy, include the following:
Heat and cold
Unloading in certain joints (eg, knee, hip)
A physiatrist may help in formulating a nonpharmacologic management plan for the patient with osteoarthritis, and a nutritionist may help the patient to lose weight. A referral to an orthopedic surgeon may be necessary if the osteoarthritis fails to respond to a medical management plan. Surgical procedures for osteoarthritis include arthroscopy, osteotomy, and (particularly with knee or hip osteoarthritis) arthroplasty.
Several organizations have issued guidelines on the treatment of osteoarthrits, with recommendations keyed to the affected joints (ie, hand, knee, hip). An assessment of several treatments for osteoarthritis of the knee by the Agency for Healthcare Research and Quality (AHRQ) determined the following :
Home-based exercise programs and tai chi show short- to medium-term benefits for symptoms (primarily pain, function, and quality of life) but data on long-term benefits are lacking
Strength and resistance training, pulsed electromagnetic field therapy, and transcutaneous electrical nerve stimulation show mostly short-term benefits, whereas agility training shows both short- and long-term benefits.
Weight loss and general exercise programs show medium- and long-term benefits.
Intra-articular platelet-rich plasma, balneotherapy, and whole-body vibration show medium-term benefits.
Glucosamine-chondroitin and glucosamine or chondroitin sulfate alone show medium-term benefits with no long-term benefits for pain or function.
Mesenchymal stem cell therapy continues to be a promising investigational approach to knee osteoarthritis. However, the improvement reported with stem cell therapy has been modest, a placebo effect remains possible, and the quality of the supporting evidence has been questioned. In addition, the variability in mesenchymal stem cell injection, including timing, frequency, and culturing mode, warrant further research, as does the possible long-term risk.”
More details of each treatment found at Source: >Osteoarthritis Treatment & Management
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