New Knees (Stem Cells)

[John “Jay” Menna]

I mentioned that I had stem cells put into my 58-year-old knees a little while back and I’ve gotten a lot of private messages and questions about it so I thought I would let as many details as I can here. I am rather tongue in cheek placing this in the gear forum as  it is replacing worn parts on very critical gear…

First of all by way of profession I must tell you that I spent 20 years in the medical malpractice insurance business. A good percentage of my practice involves covering clinical trials. As you can imagine I’ve seen a number of very ‘interesting’ things and my quack radar has become highly highly sensitive. If you Google stem cells you will see a lot of quacks pushing the miracle cure of stem cells. From cancer to autism.

I am not going to get into the medicine behind the stem cell procedures, I simply don’t have the medical depth to ethically represent this.

In July 2019, I hiked the 100 Mile Wilderness in Maine. I knew that arthritis was really nipping at my knees before the hike began. And I became a bit overly dependent on Meloxicam to keep things from going bad. But by mile 70 at the hundred mile wilderness my knees were shot. I had to goose-step the last 30 miles.

Upon my return I consulted with an orthopedic surgeon who suggested that it was time to get my knees replaced. I did not like the sound of that. Through the grapevine I heard that a number of late stage clinical studies are being done with stem cells on knees. Most of the safety studies it already been done and what remain was to determine with the efficacy of various methods. There are lots of competing things out there from where they harvest the stem cells to how they apply them into how often they apply them. As far as I can tell, they simply haven’t done enough of them to know what is the most effective course of treatment. There is however highly strong indications that the stem cells are in fact very effective against arthritic knees.

Knowing, despite the fact that I had to sign the clinical trial consent papers that used big scary words like “death’, that I was highly unlikely to come out harmed, and that the probable downside was that the stem cells were just going to be a waste of a few thousand dollars without any real effect. I decided that I’d rather spend the money and have nothing happen just to see if I could avoid replacing the knees completely.

In my case the procedure involved umbilical scored derived stem cells injected directly into the knees on a single occasion. I cannot comment, nor do I believe there’s enough body of data for anyone to be able to say where the best place to harvest the cells is.

The results: Wonderful! It was like a magic potion out of Hogwarts. Within 90 days I have done 10 miles in the Devils River area. No pain but I could feel that they were a bit weak. In the preceding nine months I have done three pretty good hikes. Big Bends Outer Mountain Loop, the Eagle Rock Loop in Arkansas and last week a good hike in the Gila national forest. Each time my knees become stronger and stronger.

It is interesting to note that on the first day of each of the hikes I feel some weakness and slight pain in the knees. It’s odd, and I can’t explain it, but it is almost as if the pain is signaling where the work needs to be done and by the third day my knees feel like they have been worked on.

I will note though that the geometry of my gate has changed a bit. Probably because the knee has been degrading over so many years and there was a week or so where my back got so out of whack I had to sleep on the wooden flood at home to keep it stable. This passed.

As of this moment I will be just under 10 months out. I’m ready to tackle some pretty damn remote trails in Greenland. Bucket list stuff. Without fear that I’m going to have issues getting to the other end.

Do not feel they are strong enough to resume downhill skiing, or running marathons. I’m too damn slow to chase a tennis ball anymore, so I guess that’s out too.

I cannot tell you if the procedure is ready for prime time. I think the clinicians are just figuring out now what is the most effective way to administer these things as opposed to lesser efficacy. But in my case I could not be happier. My case has been documented in the Texas medical Association journal Texas medicine. I am “JM from Travis County. Male 57”

Hope this information is useful for you..

[Gumbo]

Awesome to hear this worked so well for you, Jay, and that it’s enabled you to get back on the trail.

[BlackHatGuy]

Thanks for sharing this Jay. Very much appreciated.

[d k]

Thanks, Jay, I was just rereading your earlier post yesterday and wondering how things were going for you and your knees.  That’s wonderful news.

[jscott]

Crap I jsut lost my entire post.

anyway, I had a total knee replacement on my right knee and it’s great. Stem cell therapy that could regrow destroyed meniscus would be better still. I was down to bone on bone and absolutely nothing other than the TKR or possibly stem cells would work. “Arthritis” is what the doctors called my bones rubbing together.

[W I S N E R !]

I’m 44. I tore my left ACL skateboarding 3 years ago. In the MRI I was informed that the same knee is close to bone on bone (again, likely thanks to a lifetime of skateboarding)…they presume the right is just as bad.

 

The ortho said he looked forward to seeing me for knee replacements in the coming 5-10 years. Thanks for sharing, I will certainly ask about this as an alternative and possible preventative treatment before a they’re too far gone.

[Brad W]

Have you had before/after imaging done to see if cartilage/tissue regenerated?

[jscott]

Brad: good question.

 

Wisner wrote:

“I’m 44. I tore my left ACL skateboarding 3 years ago. In the MRI I was informed that the same knee is close to bone on bone (again, likely thanks to a lifetime of skateboarding)…they presume the right is just as bad.”

I wonder about the right. Could be!  but maybe tearing the ACL on your left leg led to your favoring that leg, and resulted in a slightly imbalanced stride. Maybe you stand straight on your right leg, and askew on your left.

Are your legs of equal length? How are your feet? Your hips? If you ‘lean in” towards one side, that can cause abrading of the meniscus on one knee, but not the other.

My friend’s doctor used a sonogram to look at the soft tissue in her sore knee. My doctors only wanted to use x rays. X rays don’t show soft tissue–i.e. meniscus tissue. I finally managed to get an MRI of my right knee. It merely showed what everyone knew: I had no more meniscus. Once that’s gone, it’s game over.

Having a sonogram didn’t occur to me. maybe that would be quick, easy, informative and cheap. But maybe there are limits I don’t know about.

I don’t necessarily see how skateboarding would wreck your meniscus, but I’m entirely a  layman. I do see how backpacking might wear down the meniscus in one or both knees.

[Edward John M]

Impact

Impact of any type has consequences.

Continuous small impacts may have the same long term effects as a few bigger ones.

This thread has made me think about investigating this treatment here as my own knees are slowly giving me curry

[Sam Farrington]

Jay,
It was great of you to share a good outcome with this procedure. Like you, I was somewhat leery of it being a scam; however, the “reduced” price of $12000 for one stick per knee made a knee replacement paid by insurance the only option, and that ended that.

Was going to have one knee replaced this year, but the virus occasioned three postponements, so just to stay mobile, tried a process called PRP (Plasma Rich Platelets), that is said to encourage our own bodies to produce stem cells. And it was only a fraction of the cost.

It certainly was not as remarkable as your outcomes; but was enough to hold me over for a while when I had gotten to the point when Hyaluronic acid compounds (Synvisc, Orthovisc etc.) would no longer help. In evaluating these novel treatments, I think one has to watch closely for a possible placebo effect; but the savant who said “know thyself’ may have been pulling our legs, given human nature.

I did find one Doc who is recoating areas of lost cartilage, but only where the areas are in only a small part of the knee, and certainly not in all three compartments. Some day they will be able to implant artificial cartilage; but haven’t heard any reports that day is near.

[W I S N E R !]

I don’t necessarily see how skateboarding would wreck your meniscus, but I’m entirely a  layman. I do see how backpacking might wear down the meniscus in one or both knees.

Ummm…Skateboarding vs. Backpacking? Go to 1:47…

https://www.youtube.com/watch?v=J-O_WRRA-0o

 

[John “Jay” Menna]

My situation was rather unique. So the going costs may be a little skewed in favor of cheap. I had to separately purchase the stem cells from a laboratory in San Antonio Texas and have them shipped on dry ice to my doctors office in Austin. Basically the stem cells were FOB San Antonio. If they didn’t make it to my doctors office well I still have to pay for them.

I paid $1000 for the sales and another $2500 for the procedure. Then of course there’s all the follow up visits and physical therapy visits that are 250 bucks here and 500 bucks there. All and I think I’m into it for $5000(?).  Perhaps a little less.

I’m told that imaging the knees is not accurate enough to actually see regeneration of cartilage. And whenever I said “hey the cartlidge has been regenerated”, everybody involved said” you can’t prove that.”.   But everyone also says it’s likely that some of the Cartlidge has regenerated.

The cells I used were derived from umbilical cords.   There’s lots of arguments either way about which is better. Umbilical derived, or extracting them from your own body. There’s arguments on either side. As of a year ago I could not find any data that addressed the issue one way or another. Probably simply because the data does not yet exist. Not enough clinical trials have been done. And that’s why I was part of a clinical trial.

 

[d k]

I just saw this:

 

http://med.stanford.edu/news/all-news/2020/08/Researchers-find-method-to-regrow-cartilage-in-the-joints.html?fbclid=IwAR1RC197BX_yGmHjR4gU82dROY7zocXmJtHrz-lG8pNakUjRPvqtEttoNw4

 

[Gumbo]

Wow, looks very promising. Wonder how many years we’ll have to wait…

[John “Jay” Menna]

It been a while since the knees have been done. And I thought I would come back here and give a six moths later review.

Unfortunately the news is not good.

If I regularly exercise the knees, things feel OK. By regular exercise I mean an hour on a bicycle, or 45 minutes of knee specific exercises every other day.

However recently I got overconfident and let the knee specific exercises slack off. I attempted to do a section of the lone star Trail in Texas which is really flat. And at the end of day to my knees were very unhappy.

Oddly, because I tore up my knees running flat roads, I think the Repetitious nature of the stride on flatland made the situation worse.  It wasn’t so bad that I had to abort the hike, but it was bad enough to make me feel uncomfortable, and recently my day-to-day activity of sitting at a desk hurts like hell when I get up from the chair.

There are lots of other things to be done here, standing desk, running in the pool, but those are my personal challenges.

I just wanted to come back here and let everyone know that the initial panacea that the stem cells seemed to be has been short lived.

 

[Bruce Tolley]

@ Sam

” I think one has to watch closely for a possible placebo effect; but the savant who said “know thyself’ may have been pulling our legs, given human nature.”

The placebo effect is real and if medicine could find a way to harness it, it could be great medicine.

@ John

You reference clinical trials and the start of your posts but from your description of how you obtained the stem cells and that you paid money for them, it sounds like you were not part of a trial. Is that correct?

The last orthopedic surgeon I saw about my knee said it would really help to lose 15 pounds. And that weight lose helped a lot.

Cheers!

[jscott]

I came to learn that “arthritis” is a term that covers a wide range of conditions when it comes to our knees. I was told I had arthritis. Actually, what I ‘had’ was no meniscus and my knees were bone on bone. All of the exercise and therapy in the world won’t cure the pain that results from having two bones in your knee grinding on each other. some arthritis! it’s like saying a sprained ankle is just arthritis…

I had knee surgery that inserted a pad between the two bones–like an artificial meniscus–and the results were immediate. As in, the first steps out of my hospital bed. That said, for two months the recovery was painful. but I could tell that the knee pain that sent me in was gone. The pain from the surgery was soemthing else and it disappeared eventually.

I was intrigued by stem cell therapy. But it’s hard to imagine that stem cells could re-grow the necessary biological padding to keep knee bones from grinding on each other, once that padding is gone. Remember, you’re still using that knee with every step–it’s not like we’re back in the uterus.

I’m very pleased with my knee replacement surgery.

[Greg Mihalik]

^^^

“I’m very pleased with my knee replacement surgery.”

You got a “re-tread”.  Probably good for 25,000 miles.

When that wears out, Then you might get a total replacement.

[Diane Pinkers]

I just saw this tonight. We’ve been doing both stem cells and platelet-rich plasma (PRP) in vet med for about 7 years for stem cell and a little more recent for the PRP.  I’ve had some patients receive a second dose for either one, and they seem to get just as much benefit the second time around. The stem cells for dogs are auto derived harvested from subcutaneous fat. The sample is purified, concentrated,  and the sample is split and half banked for later. Maybe humans don’t have as many stem cells in other tissues? Or maybe they can figure it out for people too, once it becomes less experimental. Several older people in my family have had knee replacements,  so I’m interested to see these improvements.

[Keith W]

Interesting discussion, especially Jay and Diane’s experiences.  I have had both stem cells and PRP in my knees.  I tore my meniscus in spring 2016.  For three months I could not ascend a single stair in my house with my right leg.  In addition to the meniscus, I had mild to moderate arthritis.  I walked into the clinic with a cane and got my first PRP in June.  Then I received stem cells (auto derived from fat) in October 2016.  After 3-4 months, there was notable improvement, with additional improvement for about a year.  I was hiking and skiing again.  In June, 2018, PRP treatment again and more improvement.  I was pretty much back to normal and on the trails, including a rugged 50 miles in the Olympics.  Then in September, I climbed Mt. Adams.  That felt really good after not being able to climb the stairs in my house 2 years before.  I continue with PRP in both knees once per year…  kind of like an oil change for your car.  Arthritis is a continuous process, so you have to keep after it.  Downhill skiing is hard on my knees-  I look for soft smooth snow and really avoid the chatter of ice and broken crud.  Hiking feels good- especially when it is moderate and regular.  I was skeptical about these treatments, as they are new, not well proven, and often performed by quacks.  The clinic is really important- mine only does knees, practitioners are MD’s.  I hiked today and I will be skiing tomorrow, and I’ll be 71 next week.  I don’t think I would be doing this without these treatments.

[John “Jay” Menna]

Don’t get me wrong I’m not saying that the net result was a total failure. Though the initial results were a hell of a lot better off than I am currently experiencing.

I’m going back hard into every other day knee exercises. Now that it’s warming up I’ll probably be running the length of the swimming pool a lot. And riding the bike.   I’ve got a permit of Buckskin Gulch in June — dont want to miss that hike!

I was in fact part of a clinical trial. Yes I did purchase the stem cell separately, but that’s a very long story.

It is ironic that you have been doing it in veterinary medicine. Given my professional background and all the wild claims about stem cells curing everything from AIDS to hair loss I was really shying away from it.

Then I was talking to a friend of mine who is in the equine insurance market. He said they were getting wonderful results with stem cells in Thoroughbreads.  I was pretty sure I wasn’t going to see a placebo effect on a horse

Ill check back in with y’all in six months and let you know how it’s going.

 

[Daryl and Daryl]

I went to Sports Medicine Dr. today for sore left knee.  Arthritis and reduced padding.  Got cortisone shot.

Dr. said backpacking is hard on knees.  Running is worst.

Bicycling is good for knees.  Eliptical trainer second and, and swimming third.

[jscott]

“reduced padding”.

I was also put on an exercise regime that helped a bit. But think about it. No one can exercise their way out of reduced padding. Sure, you can develop muscles that will take a bit of the pounding we all place on our knees–but no amount of muscle will keep your knee bones from pressing down and up on each other at every step.

In the end I felt I was sold a bill of goods with the ‘exercise your way out of it’ message from my doctors. Xrays showed that I had no padding at all in my right knee. I was grinding bone on bone.

Exercise will not regrow worn down meniscus tissue.

Greg, actually I had what was called a total knee replacement. I’m hoping that in ten years or more, when the new padding wears down, the replacement of the padding will be much easier than the installation of all that hardware on the first round. I picture a surgeon just sliding in a new pad in the established slot.

[Keith W]

Jay, from your September post, you said you were 10 months out from stem cells.  And now it’s 6 more months, so 16, right?  My stem cell improvement peaked at around 18-24 months, then knee pain returned.  PRP seemed to bring the improvement back.  So I do yearly PRP and it sustains me.  Physical therapy and exercise were part of the process, too.  Stem cells are about 5X the cost of PRP-  I think the stem cells did more, but maybe not 5X as much.  Stem cells may be the ultimate non-surgical treatment, but PRP gives you more bang for your buck, in my opinion.

[John “Jay” Menna]

Keith:  Your math is correct.  But my post was inaccurate.    I had it done the first  week of September 2019.  (2109-09-05 to be exact)  So, 20 months ago.

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