Vinh Medical University Hospital: Treating knee osteoarthritis with platelet-rich plasma combined with stem cells
(Baonghean.vn) - Vinh Medical University Hospital has implemented the project: "Research on the treatment of knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue-derived mesenchymal stem cell transplantation".
With the desire to treat, bring health to people, reduce the burden of disease and prolong life, with the permission of the Ministry of Health and the Science Council of Nghe An province, in the past 2 years, at Vinh Medical University Hospital, the topic has been implemented: "Research on the treatment of knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue mesenchymal stem cell transplantation".
CAUSES, SYMPTOMS
Knee osteoarthritis is a condition of damage to articular cartilage, subchondral bone, ligaments and tissues around the joint, and is the second leading cause of disability in the elderly after cardiovascular disease.
In Vietnam, according to statistics over 10 years (1991-2000) on inpatients treated at the Department of Musculoskeletal, Bach Mai Hospital, osteoarthritis ranked third (4.66%) in the group of diseases with joint damage.
In osteoarthritis, knee osteoarthritis accounts for 56.5%. Knee osteoarthritis affects motor function the most. Severe knee osteoarthritis is the cause of disability for many patients, increasing medical costs for families and society.
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Separating platelet-rich plasma, mixing stem cells and platelet-rich plasma. Photo: PV |
Knee osteoarthritis is divided into 2 types: Primary knee osteoarthritis, due to the aging process, the disease often appears late in people over 60 years old, in many locations, progresses slowly, increases with age, and is not severe.
Because cartilage cells age over time, the ability to synthesize substances that make up collagen fibers and mucopolysaccharides will decrease and become disordered, the quality of cartilage will gradually deteriorate, especially elasticity and endurance, moreover, cartilage cells of adults do not have the ability to reproduce and regenerate.
Secondary knee osteoarthritis: Due to mechanical causes, occurs at all ages (usually under 40 years old), localized in a few locations, severe and progressing over an area of the joint surface and disc. Due to congenital deformities, secondary deformities after trauma, causes of increased load such as excessive weight gain due to obesity, increased load due to occupation, due to habits.
Symptoms of knee osteoarthritis: Clinically: Mainly pain, pain that increases when moving, more pain in cold weather. There are signs of crackling, rumbling in the knee joint, sometimes there is swelling and heat due to inflammation or joint effusion. Late stages can limit movement due to deformation, misalignment of the joint axis.
Paraclinical: X-ray shows images of bone spurs, narrowed joint space, misaligned joint, and subchondral sclerosis; Ultrasound shows joint effusion; Arthroscopy shows lesions more clearly; MRI fully assesses lesions such as bone spurs, cartilage and ligament damage.
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Mixed product of abdominal fat tissue, stem cells extracted from abdominal fat tissue. Photo: PV |
Treatment of knee osteoarthritis: Internal medicine: Use pain relievers, non-steroidal anti-inflammatory drugs: Such as Diclofenac, Mobic, Acorxia, Celebrex... Anti-osteoarthritis drugs: Such as Glucosamine, Condroitin, Atrodar. Intra-articular corticosteroid injection when there is effusion.
Physical therapy: Ultrasound, shortwave, light therapy, hot compresses... Joint lubricant injection: Hyaluronic acid depending on the type can be injected once every 6 months, 9 months. Platelet-rich plasma: Take the patient's blood to separate the platelet-rich plasma, platelets are increased 5-10 times, injected into the joint to increase cartilage growth.
Stem cells: Using autologous stem cells from extracted adipose tissue to inject into the joint to replace and regenerate new cartilage, increase cartilage growth, reduce degeneration and compensate for damaged cartilage, creating conditions for easier joint movement. Combination therapy of platelet-rich plasma and autologous adipose tissue mesenchymal stem cells. This treatment is considered a promising strategy for the treatment of articular cartilage damage and osteoarthritis.
At the same time, this therapy has platelet-rich plasma (platelet extract) that stimulates cartilage proliferation and adipose tissue stem cells that replace old cartilage cells with new cells, helping joints recover from damage caused by degeneration.
EFFECTIVE, SAFE, FEW COMPLICATIONS
After more than 2 years of implementing the project: "Research on the treatment of knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue mesenchymal stem cell transplantation", despite the Covid-19 pandemic outbreak worldwide, including Vietnam, with difficulties in equipment and patient travel, but with the determination of the Director of Vinh University of Medicine and Pharmacy Hospital, who is also the project manager, along with the efforts of the research team and scientists, the project has completed the following goals: Receiving the technique of separating mesenchymal stem cells from adipose tissue and platelet-rich plasma on the ADI-25-01 ADIPOSE PRCEDURE PRAK Kit and PRP, APC 30 PRP PRCEDURE PRAK from the United States.
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| Platelet-rich plasma is separated from autologous blood. Photo: PV |
Under the guidance of technicians from Terumo Medical Equipment Company of Japan, the research team established a team to perform abdominal fat extraction techniques. The research team received and used the equipment of the abdominal fat extraction kit: ADI-25-01 ADIPOSE PRCEDURE PRAK to extract stem cells and PRP, APC 30 PRP PRCEDURE PRAK to extract platelet-rich plasma. In particular, the research team proactively performed the technique of extracting and isolating stem cells from abdominal fat tissue and actively used and operated the Harvest stem cell separator.
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| The leaders of Vinh Medical University Hospital directly directed the injection of a mixture of stem cells and platelet-rich plasma into the knee joint. Photo: PV |
During the implementation process, the research team injected platelet-rich plasma on 30 patients, 26 female, 4 male, average age 58.63 ± 11.11, average disease duration 5.3 ± 4.6 years.
The research team conducted follow-up immediately after injection, in the first week, after 1 month, 3 months and 12 months. The results showed that: The injection therapy of platelet-rich plasma combined with autologous adipose tissue mesenchymal stem cells is safe: Shown through 30 patients - 60 injected joints, 45 joints were painless, 4 joints had pain gone after 6 hours, 3 joints had pain gone after 6-12 hours, 2 joints had pain gone after 12-24 hours and only 6 joints were still painful after 24 hours and pain gone after a few days.
No patients had joint or periarticular infections. There were no complications during liposuction, no external bleeding, or secondary subcutaneous hemorrhage.
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| Injecting a mixture of stem cells and platelet-rich plasma into the knee joint. Photo: PV |
After 12 months of treatment, the VAS pain score of the right knee decreased from 6.0 to 1.91; the VAS score of the left knee decreased from 6.34 to 2.25, a statistically significant difference.
The patient's mobility increased significantly, pain decreased, and signs of joint stiffness decreased. Articular cartilage thickness on MRI is an important indicator to evaluate the treatment results and the cartilage regeneration ability of stem cells. After 12 months of treatment, the cartilage thickness in all locations increased significantly. After 12 months of treatment, 96.3% of patients were satisfied and very satisfied with the treatment results.
The process of implementing the topic has mastered the technique of treating knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue-derived mesenchymal stem cell transplantation at Vinh Medical University Hospital. Thereby, it is affirmed that the method of treating knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue-derived mesenchymal stem cells is effective, safe and has few complications.
Steps to implement the technique of treating knee osteoarthritis with platelet-rich plasma combined with autologous adipose tissue mesenchymal stem cell transplantation in Nghe An:
Step 1: Screening selection, clinical examination to assess pain and mobility levels (30 patients).
Step 2: The patient is given X-rays, ultrasound, blood counts and necessary tests to assess the damage and to rule out.
Step 3: MRI to assess damage.
Step 4: Extract mesenchymal stem cells from abdominal fat tissue using the ADI-25-01 ADIPOSE PRCEDURE PRAK Kit from the United States.
Step 5: Separate platelet-rich plasma.
Step 6: Mix stem cells and platelet-rich plasma.
Step 7: Inject a mixture of platelet-rich plasma and autologous adipose tissue-derived mesenchymal stem cells into both knee joints by a surgeon or rheumatologist.
Step 8: Monitor the patient during the first day and week.
Step 9: After 1 week of monitoring, if there are no complications, the patient is sent home and continued to be monitored after 1 month, 3 months, 6 months and 12 months.