While the gold standard for Osteoarthritis and Osteoporosis treatments since the late 1970’s has been Hyaluronic Acid, also referred to as Hyalgan in the medical industry, recent research has shown a growing trend towards the experimental nature of stem cell therapy as an alternative that some are boasting have superior clinical effects for the reintroduction of cartilage and synovial fluid in the joints of the knee where the condition is most common. But first we must understand what is Hyaluronic Acid, and how does it help treat these conditions.
So what exactly is Hyaluronic acid? According to Web MD, “Hyaluronic acid is a substance that is naturally present in the human body. It is found in the highest concentrations in fluids in the eyes and joints. The hyaluronic acid that is used as medicine is extracted from rooster combs or made by bacteria in the laboratory.” This is administered, in many cases, as an injection in the knees to rebuild worn down cartilage and refill the synovial fluid that surrounds and lubricates the joints in conditions like Osteoarthritis and Osteoporosis. While there are significantly more proven clinical trials using Hyalgen on these conditions for treatment, more physicians presently seem to be shifting their preference to regenerative medicine, that being stem cells and platelet rich plasma.
This of course then begs the question, what do we know about existing studies incorporating Stem Cell Therapy and its applications on Osteoarthritis? Dr. McDonald from Texas Orthopedics Sports & Rehab uses some very interesting statistics to help create a bedrock of understanding on the topic. “The best data about stem cells for arthritis comes from Asia. There are multiple studies that show injection of stem cells into an arthritic knee may induce new cartilage formation. These results were verified by surgical arthroscopy (with a camera) to look at the cartilage. Some caveats with the study: It took 100,000,000 fat derived stem cells in one injection to obtain these results and the number of patients treated was small (12). We don’t have the ability to obtain this amount of fat derived stem cells in this country through simply harvesting from the fat pad in the knee.”
It is obvious, based on the evidence above, that clinical research and efficacy from stem cell therapies utilization for Osteoarthritis and other conditions is still lacking, that is why CMS Medicare still refers to the therapy as experimental in nature. Despite that realization, clinicians nationwide continue to want to be on the cutting edge of science and offer these treatments. Both PRP (Platelet Rich Plasma), which involves drawing of the blood and spinning it through a centrifuge to create platelets that are then injected to the treatment area, and Mesenchymal Stem Cells which are traditionally harvested from bone marrow are the leading contenders as an alternative to Hyaluronic acid. All of these treatment applications are ultimately intended to do the same thing for the patient; that is to reintroduce cartilage and synovial fluid to the ball and joint areas in the knee. The debate is not whether which works and which doesn’t as much as which works better and faster for the patient.
From a financial standpoint, insurance companies reimburse for Hyalgan injections but not currently for stem cell therapy. Why is that important? The cost to the patient is substantially higher when pursuing PRP or Stem Cell options as a means of treatment, as payment out of pocket, i.e. cash will be necessary, whereas Medicare and private insurance can cover most of the bill for Hyaluronic acid.
Hyalgan injections done in an Interventional pain practice or surgical center performed by a C-ARM or digital ultrasound for needle guided procedures are still considered widely as the safest, most cost effective option for helping specifically with conditions such as Osteoarthritis and Osteoporosis. However that reality is likely to change in the near future, as Stem Cell Therapy continues to gain momentum in the medical community and as more clinical trials and research is conducted to substantiate its clinical efficacy.
For more information and to discuss treatment options, protocols and equipment for your practice please call 561-408-8138 to speak to a specialist.
You can also read about our Osteoarthritis program.
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