Joint Regeneration As An Alternative to Joint Fusion Surgery

Image Credit: Orlin & Corbin Orthopaedic Group 

Authors: Gordon Slater| Tandose Sambo 

“Give a man health and a course to steer, and he’ll never stop to trouble about whether he’s happy or not.” – George Bernard Shaw

What is Joint Fusion Surgery?

The discomfort of arthritis can be dealt with in a multitude of ways via the advent of medical technology and innovation. If you are experiencing the symptoms of arthritis pain, joint fusion surgery is a treatment that is often administered. As a surgical process, the joint fusion procedure results in the fusion or welding of the bones in your affected joint. As the bones are now one, the joint stability will be increased, and you’ll experience less pain. 

Arthritis is a degenerative disease that can cause severe damage to your joints. Surgical procedures are often administered as treatments of last resort, and where possible, your orthopaedic surgeon will make an effort to ensure that all other methods of treatment are exhausted before the joint fusion procedure is administered. The joint fusion recovery process is also quite extensive, and can last up to several months after the procedure is completed. 

If you’re the candidate who is able to cope with the long recovery times of the Joint Fusion Surgery, the procedure may be a great solution to your arthritis pain. For those who are seeking an alternative to joint fusion surgery, regenerative medicine is able to provide you with the appropriate solution of joint regeneration. Utilizing your own healing cells, there are a myriad of ways that you can restore your joint health without the advent of surgery. 

CARTILAGE RESTORATION 

One of the physical signs of arthritis is the degeneration of the bone cartilage as the joint degrades. Cartilage is a soft, lubricating tissue that enables the smooth operation of the joint as you are moving. Various medical studies have found that it is indeed possible to regenerate cartilage. Research conducted at Stanford University’s School of Medicine has identified a method that has restored the joint cartilage of both humans and mice. With nearly twenty five percent of the adult population suffering from arthritis, the ability to increase the comfort level of these individuals and reduce their joint pain and inflammation, is a worthwhile medical cause. 

The Stanford methodology of articular cartilage restoration involves a slight injury to the joint tissue. Once the tissue injury is initiated, the next steps involve the utilization of chemical signals to guide the growth of stem cells through the healing process. Stem cells are the regenerative cells in the body. They have the ability to not only reproduce themselves, but have the ability to create the relevant cells for a site. If cartilage repair cells are needed, the stem cells are intelligent enough to differentiate themselves into cartilage repair cells, and facilitate the healing of the joint. The ability to catalyze the regenerative ability of the cartilage is critical to the restoration of arthritic joints. Cartilage can’t regenerate readily because the joints are limited in terms of vascular blood flow. By bringing the healing cells to the site, the joint can then restore itself. The stem cell utilized in the healing of the joint is the skeletal stem cell. This stem cell has the ability to restore and regenerate bone, cartilage and blood cells. 

The treatment of the cartilage via the microfracture process, involves the drilling of tiny holes into the joint surface. The microdamage triggers the body to create new tissue in the joint. The new tissue is often a softer version of cartilage. According to the Stanford team 

“Microfracture results in what is called fibrocartilage, which is really more like scar tissue than natural cartilage,” “It covers the bone and is better than nothing, but it doesn’t have the bounce and elasticity of natural cartilage, and it tends to degrade relatively quickly.” [2] 

The discovery of the Stanford team is an indicator that adult cartilage can indeed regenerate, after it was previously believed that this was not possible. With an understanding of the factors that induce healing, the ability to regenerate joints is now a possibility. At the smaller scale, the study was initially conducted in mice. With the understanding of healing mechanisms in mice, the therapy was then scaled up to human patients and proved to generate similar results. 

Osteoarthritis (OA) is one of the most common health conditions that affects adults, particularly the elderly population. While the underlying treatment conditions for Osteoarthritis are still being investigated, we are approaching a point where the critical healing mechanisms are being elucidated by the medical research community. 

Types of Stem Cells Utilized in Joint Regeneration Therapy 

The human body generates a multitude of stem cells. While the Stanford study has utilized the skeletal stem cell, adipose tissue derived stem cells are alternatives that are utilized in the healing of joint arthritis. These adipose tissue-derived stem cells are a type of mesenchymal stem cell, and they have proven to be effective in the treatment of cartilage regeneration. Fused with platelet rich plasma, there have been successful trials that are able to treat osteoarthritis. In clinical trials, there have been instances where great efficacy was proven. No serious side effects were experienced by patients. 

ALTERNATE JOINT REGENERATION THERAPIES 

Platelet Rich Plasma (PRP)

One critical enhancer to human joint restoration is platelet-rich plasma. This plasma is generated from the body’s own blood supply, and enables the natural growth factors embedded in the plasma to heal relevant tissues in the body. This tissue can include cartilage, a critical component of human joint systems. 

How Is The Plasma Obtained?

The human circulatory system consists of an ever flowing blood stream. The plasma is the liquid portion of the blood. Other constituents that are suspended in the blood include red blood cells, white blood cells, and platelets. The platelet, as a component of the blood, is a type of blood cell that is able to facilitate healing of the body. When there is a cut, the platelets are what accumulate in order to generate the clot, that finally heals into the renewed skin. The significance of the platelets then, cannot be underestimated. The platelet activation process is key to the body’s healing mechanisms. The protein growth factors are also embedded in the platelet structure. 

Via centrifugation extractive processes, the plasma (known as protein rich plasma or PRP) can be obtained. With a higher concentration of platelets than the blood, the healing abilities of the PRP can be optimized from 5 to 10 times the normal healing mechanisms. The healing process is therefore catalyzed. 

Mechanism of Activation

With the PRP extracted from the patient’s blood, the extracted components are then injected into the sites of healing, in order to accelerate the healing of those sites. For patients who are experiencing injuries in their tendons, ligaments, muscles and joints, PRP injections are one of the primary methods that the therapy can be applied to heal the body. Many athletes are actually the recipients of PRP injections, and they have proven to be very effective in the process of restoring musculoskeletal problems. 

According to the severity of your condition, PRP injection treatments may take up to one or several tubes of your platelets. When applied to the body’s injured tissues, the growth factors then start the process of catalyzing healing, and increasing the production of the body’s healing mechanisms. 

During the process of administering the injection, ultrasound imaging is often utilized in order to gain a picture of what is happening in the internal system. With the ultrasound image, your orthopaedic surgeon will be able to see directly into the tendon, and facilitate the guidance of the plasma to the appropriate site in the joint. A variety of ailments have been relieved via the PRP mechanism, particularly for persons with conditions such as tendonitis. 

With the ability of the body to heal itself naturally, the utilization of medication such as anti-inflammatory agents or opioids can be eradicated. As an agent that is produced by your own body, the PRP is one product that your body will readily accept because it is natural to your own system.

With the ability to treat your osteoarthritis in a multitude of ways, your orthopaedic surgeon will opt for surgery as a last resort. Via joint restoration therapies, it will be possible to avoid surgeries where possible. Talk to your orthopaedic surgeon about joint restorative therapies. 

References: 

  1. Joint Fusion: https://www.webmd.com/osteoarthritis/guide/joint-fusion-surgery
  2. Stanford Medicine: https://med.stanford.edu/news/all-news/2020/08/Researchers-find-method-to-regrow-cartilage-in-the-joints.html
  3. The Spine And Sports Center: https://www.thespineandsportscenter.com/blog/4-regenerative-medicine-therapies-that-can-remedy-joint-pain

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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