The treatment of osteoarthrosis with autologous bone marrow cells is included in Traumatology and Regenerative Medicine. It is based on administering “progenitor” cells (stem cells) in the injured joint in order to repair the damaged cartilage and recover function. These cells are found in the bone marrow, which is where the progenitor cells of blood, connective tissue, adipose tissue, bone and cartilage, among others, are found.
Why does osteoarthrosis appear?
Cartilage has an extremely low regenerative capacity, so any injury (traumatic or degenerative) will hardly recover spontaneously, especially in patients of a certain age. The reason for this low regenerative capacity is that cartilage does not have, like other tissues, its own progenitor cells and also has a very poor vascular supply. This leads us to the need to consider the use of cells from other locations (cell therapy), in this case bone marrow, since this is where the cartilage’s own progenitor cells are found.
Treatment with autologous bone marrow cells
Regenerative medicine is not the same as treatment with so-called “growth factors” extracted from peripheral blood, which have anti-inflammatory rather than regenerative power.
A standard therapy for isolated cartilage lesions is the so-called “microfracture”, in which small perforations are made in the injured cartilage. This is done to put the lesion area in contact with the underlying bone and bone marrow, making possible the migration of progenitor cells to the lesion area and favoring the regeneration or repair of the cartilage. However, this therapeutic alternative alone is not very effective since the amount of bone marrow cells migrated to the joint lesion, especially after a certain age, is very low.
The treatment of osteoarthrosis with autologous bone marrow cells consists of a single procedure (arthroscopy) during which the cells are obtained and administered. The collection of bone marrow cells from the iliac crest is performed under anesthesia. The iliac crest puncture is performed in the upper buttock, above the insertion of the buttock, next to the spine. This puncture does not take more than 10-15 minutes, since it is a simple intervention and without risk for the patient.
Once the sample is obtained, it is processed in the operating room, with the necessary sterility measures and under a strict protocol approved by the health authorities, in a small laboratory prepared for this purpose while the arthroscopy is being performed. The process allows a high number of cells to be obtained, reaching sufficient concentrations for therapeutic application without the need to resort to culture.
The objective of arthroscopy is to clean the articular cavity where the degenerative affectation is greater, eliminating necrotic tissue or abnormal regeneration in the ulcerated and eroded areas. Once this cleaning is completed, selected bone marrow cells are administered, with special attention to the areas of greatest involvement.
What happens after regenerative treatment?
There is evidence of almost immediate symptomatic improvement in treated patients, since there is an initial anti-inflammatory and analgesic effect. The clinical improvement is very noticeable from 8 months after the intervention. To date, no data on long-term efficacy are available, as the treatment has been in place for five years. Nevertheless, long-term positive effects are expected to substantially delay or eliminate the need for prosthesis implantation.
Is it possible for patients to reject autologous bone marrow cell transplantation?
For the most part, patients usually tolerate autologous bone marrow-derived cell applications well. Even so, there is the possibility of suffering side effects or complications, which are only those inherent to the surgical process (arthroscopy), as in any intervention and not directly attributable to cell therapy. Since it is the administration of the patient’s own cells, i.e. autologous cells, this process does not entail any foreseeable risk of rejection or other complications.