Bone on Bone – Grade 4 Osteoarthritis – How do Stem Cells help?

How do Stem Cells help if your joint has become “Bone on Bone”

Osteoarthritis is a very complex condition it involves all of the tissues in your joint not just the cartilage.

First we need to understand what actually happens in your joint when you become “bone on bone”.

  1. Prior to becoming bone on bone, as your cartilage is wearing out, your body will try to repair the damage. Where these repairs have failed, small bony formations will occur, formally known as osteophytes. These osteophytes can cause severe pain.
  2. The cartilage in between the bones wears away completely; this means you have lost all of the “cushioning” between the bones.
  3. At this point your joint will be inflamed, inflammation can cause severe pain. Some people deal with this well, other will not.
  4. Chronic inflammation damages surrounding tissues and structures of the joint
  5. This means your blood vessels, synovial membrane & bursal sacks become inflamed then damaged over time.
  6. When the synovial membrane becomes inflamed, it is not able to produce good quality lubrication. This will lead to further aggravation. (similar to an engine running without any oil)
  7. The bone may suffer from oedema (swelling). When weight bearing this will cause significant pain.
  8. The nerve endings around the bone and general joint structure will become inflamed. This is what causes your night pains or resting pain.
  9. Pain restricts movement, inflammation and swelling causes stiffness.
  10. Restricted movement means the muscles and tendons supporting your joint become weaker and lose their flexibility
  11. Many patients with osteoarthritis regardless of being bone on bone will develop tendonitis.
  12. The lack of cartilage and ongoing movement in your joint allows the bones to rub against each other. This leads to bone sclerosis (hardening) of the bone.
  13. Over time, the nerve endings to the sclerosed bones will lose their sensation
  14. The lack of movement along with the ongoing degeneration (wear and tear) of the joint will push you to a point where you have no choice but to replace your joints….. OR WILL IT?

(Netzer et al., 2016) (Finnilä et al., 2016) (Michalek etal,. 2015) (Hayes et al., 2005) (Cassar-Pullicino, Darby and Davies, 2004) (van Ochten et al., 2014) (Li et al., 2013)

Now, let’s now look at what these cells can do

To begin, we harvest some of your body fat. Once we have your fat, we will then begin the process of cell separation, where we will extract the Stromal Vascular Fraction (SVF). This is the cellular mix which contains multiple cell types such as;

  • pericytes
  • adipocytes
  • fibroblasts
  • endothelial cells
  • vascular progenitorts
  • haematopoietic progenitors
  • mesencymal stem cells (MSC)
  • haematopoietic stem cells (HSC)
  • endothelial progenitor cells (EPC)

Let’s take a closer look at the SVF and the abilities

  • Migrate to injured tissue
    Migration includes the ability to travel throughout the vascular system, homing to areas of damage.
  • Differentiate into multiple tissues
    Differentiation is the process where less specialized cells becomes a more specialized cell type, eg: stem cell becomes a cartilage cell or muscle cell.
  • Release of trophic factors
    Trophic Factors support, grow, nourish and feed all the cells in the body.
  • Inhibit apoptosis
    Apoptosis is the death of cells which occurs as a normal and controlled part of an organism’s growth or development.
  • Stimulate angiogenesis
    Angiogenesis is the formation of new blood vessels, involving migration, growth, and differentiation of endothelial cells. This improves blood supply to the cells.
  • Inhibit inflammation
    Inflammation is our biological response to harmful stimuli, inflammation causes pain and this is how we identify areas of damage or areas that require our body’s attention. Inflammation is the common pathway for all chronic degenerative disorders. These cells can remove inflammation.

(Rohban and Pieber, 2017) (Fu et al., 2017) (Lauvrud et al., 2016) (Nguyen et al., 2016) (Chen et al., 2016) (Zachar, Bačenková and Rosocha, 2016)

Let’s link the above information with “bone on bone” osteoarthritis.

The improvements you will see relates to pain, stiffness and strength you have lost in your joint.

These cells are able to repair the damage caused to joint structures by;

  1. Stopping the inflammation present inside your joints. This will reduce or even eliminiate your daily pain.
  2. When bone oedema is present, these cells can resolve the swelling which will reduce the physical pressure and sensitivity you are feeling and take away the weight bearing pain.
  3. They can prevent some cell death. This can slow down the process off degeneration for the surrounding tissues of your joint.
  4. By inhibiting inflammation, these cells can get your synovial membrane to resume normal function. Inturn this will allow you to have proper lubrication back in your joint. Therefore allowing your joint to move in a more fluid motion.
  5. The EPC’s can repair damaged blood vessels and promote growth of new healthy blood vessels. This can improve nutrient delivery to your muscles and tendons. When you exercise these tissues will have the ability to recover without significant restriction.
  6. By resolving the inflammation present at the nerve endings the pain that is keeping you awake at night as well as resting pain will improve significantly.
  7. When the bone becomes sclerosed it becomes very hard and smooth, rather like marble. Since your synovial fluid is functioning properly, you will have slippery movement just as a marble floor would if it were wet.

(Matsumoto et al., 2009) (Michalek et al., 2015)(Wu et al., 2013) (Gibbs et al., 2015) (Jo et al., 2014) (Freitag et al., 2016) (Paz Rodriguez et al., 2012) (Chang et al., 2016)

Previous literature along with our own experience from patients indicate, you may not need cartilage to have comfort and eliminate pain from your joints.  (Michalek et al., 2015)

We have seen many patients over the past 8 years who are completely bone on bone to begin with and they remain bone on bone many years after the treatment BUT they have been able to get back to work along with their favorite activities with minimal to no pain.

Though this is a very hard concept to grasp, it will eventually become a part of common medical knowledge. SVF Treatment will be the step prior to joint replacement.

You will have to put in the hard work of rebuilding the lost muscle and tendon strength/flexibility. Then with a good diet, exercise as well as rest you will be on the right track for long term improvements. Just keep in mind everyone responds differently to the treatment!


You can read more about OSTEOARTHRITIS here & TREATING TEARS here.

To find out more please feel free to contact us!

Tags: Macquarie Stem Cells, Dr. Bright, Osteoarthritis Treatment, Dr. Ralph Bright, Stem Cell Therapy, Stem Cell Treatment, Stem Cells for Arthritis

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