Knee replacement vs signaling cell treatment explained in this presentation. This will allow you to take a considered decision between the two

1. Knee replacement vs Signaling
cell treatment India
A comparison of both in same patient
Dr.A.K.Venkatachalam
www.kneeindia.com
Knee replacement vs Signaling cell treatment
India

2. Knee replacement versus signaling cell treatment for osteoarthritis in same patient
Case report- A 72-year-old gentleman suffering from osteoarthritis of both knees was treated
with a total knee replacement in one leg and signaling cells in the other. He has obtained pain
relief in both legs and has regained full function. The rationale for doing a knee replacement
in the right knee was correction of severe deformity, pain relief and restoration of normal
gait. The rationale for performing a biological treatment in the left knee was pain relief
without correction of a less severe deformity. Both the treatments were chosen by the patient
after inputs by the surgeon.

3. Discussion— Osteoarthritis of the knee is a very
common condition in India. It causes pain, deformity
and affects mobility. The permanent treatment after
exhausting all conservative measures is surgical, usually
a total knee replacement. Other surgical treatments
include a high tibial osteotomy and partial knee
replacement. A new modality of treatment is now
available with the help of medicinal signaling cells. This
is an interventional treatment which doesn't involve a
scalpel.

4. Total knee replacement is a routine surgical procedure done under anesthesia that involves
hospitalization. The surgeon amputates the worn out portion of the joint and cements in a
prosthesis. After discharge the patient undergoes physiotherapy for about three months in
order to squat on the floor and regain full function. Although it is a common-place
operation, some patients are skeptical or fear a major surgery under anesthesia. Others have
comorbidities like heart, lung, kidney disease or neurological complications, diabetes which
may increase their risk for this surgery. Very elderly patients often are afraid of surgery.
Often times the patient is very young to undergo a knee replacement. The longevity of a
standard knee implant is about 10 to 15 years. Durable implants that last 30 to 35 years are
also available. Young patients undergoing a knee replacement are likely to need one or two
revisions in their lifespan. Total knee replacement is a tested operation and it has a 95%
success rate. It can correct the deformity and provides a good quality of pain relief. It is
invaluable in young patients who have got very severe post traumatic arthritis stemming
from a road traffic accident. In those patients are medically fit and are willing to undergo
knee replacement it is the operation of choice due to its sanction by usage and success rate.

5. Biological treatments are an emerging treatment for
orthopedic conditions. They involve no metal prosthesis.
They are performed with the help of a needle, need no
anesthesia and hospitalization.
They utilize platelet rich plasma (PRP) and
undifferentiated cells known as medicinal signaling cells
(MSC’s). PRP is obtained from peripheral blood and MSC's
are obtained from bone marrow. These are then placed
within the joint in the same session under local
anesthesia.

6. They have the capacity to provide pain relief without
surgery. These signaling cells and platelet rich plasma
supply growth factors to the arthritic joint boosting its
natural repair capacity by several mechanisms. They
alleviate pain and enhance quality of life. The duration
of pain relief lasts for months to years. Biological
treatments may be valuable for the young, very elderly
and those with co-morbidities.

7. Biological treatments have been proven to be safe in studies.
They are still considered investigational. Careful case
selection, expert treatment, evidence, objective evaluation,
maintenance of case records, follow-up and publications are
needed to change their status from investigational to valid.

8. In this case, objective measurements of pain relief and
function were recorded by the patient prior and post
treatment. He has been followed up for two and half
months after knee replacement and three weeks after
biological treatment. Further investigations will be
performed later to record the course
Objective scoring and investigations are essential to
record the post treatment course.
In summary, biological treatments are an emerging
alternative to the time tested joint replacement for knee
osteoarthritis.