Nathan Wei’s Blog

More questions and answers about stem cells and PRP… September 10, 2009

There have been many more questions asked since we released the latest information on stem cells and PRP.  I have attempted to consolidate some of the questions and hope my answers make sense…

Question: Do Blue Cross and Blue Shield cover doctor visits and stem cell therapy?

Answer: Most likely not.  If you have any insurance questions you can call the office and ask to speak with an insurance person at (301) 694-5800.

Question:  How many patients had this procedure done last year?

Answer: 23.  Of these, 17 were knees, 2 were shoulders, 4 were hips.

Question: How many decided to have a total knee replacement afterward?

Answer: 1

Question: What is the average regrowth after 6 months, 12 months, 18 months, 36 months?

Answer:  Since we’ve only been doing this procedure for little more than a year, I can say that we have no data for 18 months and 36 months.  The parameters we chose to measure include patient visual analogue scale, physician visual analogue scale, WOMAC 9a measure of quality of life), 50-foot walking time.  All these measurements are subjective.  We also included  ultrasound measurement of patellofemoral compartment thickness at 7 points (objective).

We’ve collected data on 10 patients so far at eight months.  All 10 patients have had objective improvement in cartilage thickness at the patellofemoral joint.  The increase reaches statistical significance at the p<.001 level.  One person had a poor result subjectively but had objective increase in cartilage thickness.  He may have a total knee replacement (he hasn’t decided yet).  One person has had a fair result subjectively.  The other eight have had a good to excellent result. I realize these are small numbers.  However, the objective findings are encouraging.

I also must mention that we have been very selective in our choice of candidates for this procedure.   Only one patient with stage 4 disease (“bone on bone”) underwent this procedure and he actually had an excellent result both subjective and objective.  All others were turned away.  Patients exceeding a certain body mass index (too heavy) or who had any type of angulation deformity were also rejected.  Roughly only 1 out of every 7 patients who called in about this procedure were accepted.

The ideal study of effectiveness of stem cell therapy would involve arthroscopic digital images of cartilage damage pre and post treatment.  Unfortunately, such a study would be expensive and I don’t see this type of funding being available to us in the near future.

Question: What other materials are being used?

Answer: Advanced Biosurfaces has a metal/plastic component that can be inserted.  It requires an open incision.  Other types of pastes consisting of ground up cartilage and growth factors are also being evaluated. Osteochodral grafting, microfracture, and other cartilage transplant techniques are being evaluated.  These require a significant invasive approach and the recuperation is about a year or more.

Question:  Any infection or rejection?

Answer:  No infection or rejection.  We would not expect rejection with our technique which uses autologous stem cells… the patient’s own stem cells.  Problems may occur with allogeneic stem cells (donor stem cells).  Our technique is done in an operatory… strict sterile technique.

Question:  Is anyone doing accelerated cell growth outside the body and implantation similar to what is done for racehorses?

Answer: A center in Denver is doing this.  I’m not sure what their data is.  They claim that growing cells outside the body is better. I’m not sure I agree with them.  And I do know the FDA frowns upon removal of human cells and stimulation with factors outside the body.  Because of this FDA regulation, I doubt whether any study will be done in the near future comparing their method with ours.

Question:  Can you recommend a doctor in Pennsylvania who has this expertise.

Answer: No one I’m aware of.