Osteoarthritis

Stem Cell Treatment for Osteoarthritis

What are stem cells?

Stem cells can divide and change into different types of specialized, mature cells. There are 2 main types of stem cells:

Adult stem cells that are found in bone marrow, fat, blood, in joints and in many other tissues.
Embryonic stem cells that are found in embryos (but not used in the treatment of osteoarthritis).

Can stem cells be used to treat osteoarthritis?

Many clinics offer stem cell treatments for osteoarthritis, but treating osteoarthritis with stem cells is still experimental. More research is needed to find out how best to use stem cells and how useful stem cells are to treat osteoarthritis before they become a standard treatment for osteoarthritis.

Most stem cells used for the treatment of osteoarthritis are adult mesenchymal stem cells (MSCs). Research shows that MSCs release anti-inflammatory factors that help in healing and lessen pain. MSCs can be easily collected from fat or bone marrow. MSCs are able to turn into cartilage, bone, muscle, tendon, ligaments, or fat, depending on the type of tissue that surrounds them. This is why MSCs are used in stem cell treatments for osteoarthritis.

Most clinics that offer stem cell treatments for osteoarthritis will suggest that you try other ways to manage the disease before you try stem cell treatment. This may include a change of diet, exercise, physiotherapy, bracing, orthotics, anti-inflammatory or other pain medicines, or non-cell joint injections.

How do stem cells treat osteoarthritis?

Research shows that injections of stem cells into a joint may help relieve symptoms of osteoarthritis including pain, swelling and loss of movement in a joint. Stem cells can also be used to make an artificial tissue in a lab (tissue engineering) and then put into a joint. This approach may also help rebuild (repair) damaged bone, ligaments, cartilage in a joint.

Are stem cell treatments safe for the treatment of osteoarthritis?

Research to date shows that stem cell treatments using a patient’s own cells tend to be safe for the treatment of osteoarthritis. Most injection-based treatments use a patient’s own MSCs (called autologous MSCs) taken from bone marrow or fat.

Some stem cell treatments use stem cells donated from other people (called allogeneic MSCs). When donor stem cells are used, there are possible risks that include developing an infectious disease or an unwanted immune reaction where your body attacks the donor cells. If you have a stem cell treatment for osteoarthritis you will have follow-up to watch for signs of unwanted side effects.

The safety of a stem cell treatment also highly depends on the standards used to prepare the stem cells before they are given and making sure they are given in a clean and sterile setting.

Do stem cell treatments work to treat osteoarthritis?

Because people don’t respond the same way to stem cells, we don’t yet know if stem cell treatments work well for all patients to treat osteoarthritis. Research so far doesn’t show that stem cells alone cure osteoarthritis or rebuild a damaged joint. The patients who report the treatment works tend to be those who have improved symptoms, especially pain relief. But not all patients have pain relief. Some have long-term pain relief lasting more than a year, but others only report short-term pain relief of a few weeks to a few months. It’s not yet known why some people have pain relief and why others don’t. This may be related to the number or quality of the stem cells or a placebo effect. More research is needed to learn if stem cell treatments are a useful way to treat osteoarthritis.

We strongly support research to better understand the outcomes of stem cell treatments for osteoarthritis. Clinics who offer these treatments can collect data from their patients to see how well treatments worked or didn’t work. They can also use information about a person who had the treatment such as their sex, age and personal and family health history to study how these factors may be linked to how well a stem cell treatment works.

Can I get stem cell treatment for osteoarthritis in Alberta?

There are private clinics in Alberta that offer stem cell treatments for osteoarthritis. At this time the Bone and Joint Health (BJH) Strategic Clinical Network (SCN) does not list or endorse any of these clinics.

The Alberta College of Physicians and Surgeons has Standards of Practice for Stem Cell Regenerative Therapies that doctors and medical clinics who offer these treatments need to follow.

Is treatment funded by public health insurance in Alberta?

No, stem cell treatments for osteoarthritis are not a publicly funded healthcare service in Alberta. Private clinics offer stem cell treatments for osteoarthritis. They set their own prices and the consumer pays out of pocket for the service. Some third-party health insurers may cover the cost of these treatments. If you have third-party health insurance, review your policy or contact the insurance company directly to find out if these treatments are covered.

What should I know before getting stem cell treatment for osteoarthritis?

Stem cell treatment for osteoarthritis is still under study and is considered an experimental treatment. It is an emerging treatment for osteoarthritis but is not a standard treatment. You may want to think about the following before you decide to have a stem cell treatment:

Provinces in Canada may have different guidelines for clinics and providers who offer stem cell treatment for osteoarthritis.
Guidelines for clinics and providers outside of Canada may have different standards than those in Canada.
Look for treatments offered by a regulated healthcare professional who belongs to a provincial regulatory body that protects public safety.
Research the provider and clinic to make sure they are trained to give stem cell treatments for osteoarthritis and they are certified by the appropriate regulatory body.
Look for a clinic that is properly set up to do stem cell treatment and is up-to-date in their operations and guidelines.
After the stem cell treatment, the clinic or provider should give you information about what to expect and follow-up care instructions. This information may not be the same at all treatment centres because stem cell treatments for osteoarthritis are still considered experimental.

Please be aware there are treatments called regenerative therapies that are sometimes called stem cell treatments, but don’t use stem cells. These include platelet rich plasma (PRP) treatment, which is more correct to describe as a “cell therapy” since it uses a type of blood cell called a platelet.

Questions to ask about stem cell treatment

If you are thinking about a stem cell transplant for osteoarthritis you may want to ask the following questions to help educate yourself about safety and quality of care of the clinic or provider.

Am I a good candidate for stem cell treatment?
How much does the treatment cost? What does the cost include?
What are the payment options?
Does private or public health insurance cover any of the costs?
Does the clinic (or provider) also collect and prepare (process) the stem cells?
Where are the stem cells prepared before they are used in the treatment? Do you have equipment at the clinic to do this?
What are the possible risks or side effects of the treatment?
Is the clinic able to handle any complications or emergencies that may happen during the procedure?
How many stem cell treatments has the clinic (or provider) already done for osteoarthritis?
How many people at the clinic have had complications after the treatment? How many people didn’t respond to the treatment?
What can I expect in the days and weeks after the treatment?
What is the follow-up after the treatment?
Do you collect my data to track good or bad outcomes?

You may want to ask the following questions if you want to know more about the details of your treatment:

What stem cells will you use for my treatment? Are they from fat or bone marrow?
Do you plan to use my stem cells or someone else’s stem cells?
Will you inject anything else along with the stem cells?

If you would like to learn more about research on stem cells for osteoarthritis in Alberta, contact the Scientific Office of the Bone and Joint Health (BJH) Strategic Clinical Network (SCN) at BJHSCN_SO@ahs.ca.

Current as of: June 22, 2018

Author: Bone and Joint Health Strategic Clinical Network, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.