Stem cell and platelet rich plasma (prp) injections for the treatment of osteoarthritis have garnered significant attention as a potential therapeutic option. However, their status remains contentious due to several factors, including the lack of FDA approval, the absence of standardized cell types, limited clinical evidence supporting cartilage regeneration, and the high cost associated with the treatment.
One of the major concerns surrounding stem cell injections for osteoarthritis is the absence of FDA approval. Despite ongoing research and some promising results in animal models, the FDA has not yet granted formal approval for these treatments. This lack of regulatory endorsement raises questions about the safety and efficacy of the procedure. Indeed, stem cell injections are not without risk including the possibility of infection, rejection, and the generation of malignancy. PRP injections are from autologous blood so the risks are less, but FDA approval for the treatment of osteoarthritis is still lacking.
The lack of standardization of cell types used in stem cell injections also poses a significant challenge. Stem cells can be derived from various sources, such as adipose tissue, bone marrow, or umbilical cord blood, and each type may have different regenerative capabilities. The lack of consistent protocols and guidelines for selecting the most appropriate cell type for osteoarthritis treatment adds to the uncertainty surrounding the therapy's effectiveness.
While some patients have reported positive outcomes and pain relief following stem cell injections, there is still a dearth of robust clinical evidence supporting their ability to regenerate cartilage effectively. Many studies conducted so far have been small-scale, lacked control groups, or had limited follow-up periods, making it difficult to draw definitive conclusions about the long-term benefits of stem cell therapy for osteoarthritis. Similarly, PRP can offer short term pain relief, but most studies show no more durable pain relief than traditional therapies like corticosteroids or viscosupplementation and there is no in vivo evidence of a regenerative cartilage effect.
Additionally, the high cost of stem cell and prp injections is a significant factor that limits accessibility and widespread adoption. As a relatively novel and experimental treatment, uncovered by insurance, stem cell therapy can range from three to five thousand dollars per injections. PRP injections range for five hundred to two thousand dollars. This cost burden places the therapy out of reach for many patients, making it a less viable option for managing osteoarthritis compared to more established treatments.
Osteoarthritis is a complex disease. The pathogenesis is much more than chondrocyte death. Eventually cell therapy will likely come from several cell lines and include growth factors and cytokines that mitigate the risk that new cells will succumb to the enduring “injury” environment that led to osteoarthritis in the first place. Current recommendations for treatment involve symptom alleviation and functional improvement, not cure. Acetaminophen, NSAIDS, weight loss, and low impact cardiovascular exercise are first line treatments. Bracing and intraarticular injections including corticosteroid and/or viscosupplementation may have a role in more advanced disease. Ultimately, joint replacement surgery is one of the more predictably successful operations for alleviating pain and restoring quality of life in patients with advanced disease and severe symptoms.
