Stem Cell vs PRP Therapy: What’s Best for Your Pain?

Patients often ask which works better, Stemem cells or PRP? Both work, but they're actually used for different types of pain and recovery. Both stem cells and PRP have regenerative properties and they're both cellular medicine. They both come from your own body, but they do slightly different things. We can think of PRP as fixing injuries in managing chronic inflammation and actually managing minor diseases such as minor arthritis. And we can think of stem cells as repairing things that are more advanced, have more degeneration, more degradation, to bring things back to life again and rebuild things. A classic example would be a rotator cuff tear. I was the first patient we treated with regenerative medicine. I had torn my rotator cuff subscapularis 70% in 2011, and I was scheduled for a surgery where they would open my shoulder up, take my biceps tendon and repair the tendon. And I had read about certain celebrities and athletes that were using prp, platelet rich plasma. Kind of a new thing at the time. So I bought the equipment. We had our technologists learn how to use the ultrasound on the shoulder. One of my orthopedic friends came to the office, drew my blood, got the PRP out, injected my rotator cuff. It's been over a decade, zero problems, just completely healed. This was a 70% tear, but with just a shot of platelet rich plasma. I also might use platelet rich plasma in minor inflammatory arthritis or early arthritis. So somebody is starting to get symptoms and are sort of being preventative. PRP can turn that off. But now somebody with, say, bone on bone arthritis, degenerative arthritis, something that's impairing your function because of actual arthritis. This is more of a stem cell problem. Stem cells will go in, we inject them into the joint, and they actually cause your existing cells to wake back up and start repairing and reb the joint. So stem cells are more for arthritis to advanced arthritis, PRP more for inflammation injuries, chronic injuries, tears, or mild arthritis. So one of the top confusions people have or misconceptions is what is a stem cell? Where does it come from? These are not embryonic stem cells. Those are not legal in the United States. But stem cells typically come from your own body's tissue. Now, there is examples where we buy stem cells from a bank that has umbilical cord stem cells. And that's possible and available in the US So that's one option. But typically stem cells are coming from your own bone marrow or from your fat. A common question I get is, what's better? My own bone marrow Stem cells or my own fat stem cells. Bottom line is it doesn't make any difference. Clinically, they work the same. We can definitely identify some different characteristics between the two, but clinically there's no difference. We, we prefer fat derived stem cells for a few reasons. Number one, we have a plastic surgery practice. We're used to doing liposuction. This is something that we do. We like to give less pain. The bone marrow aspirate is more painful. But in some cases there's particularly orthopedic doctors, they're comfortable doing bone marrow aspirates. They can make it comfortable for you and they may choose bone marrow. Bottom line, it does not matter. This is an alternative to surgery. So I'd say, well, before you do surgery, try something. But the different forms of stem cells will make no difference. Another common question I get is should I get the umbilical stem cells I've heard about because they're from babies that were born healthy babies where the mother donated the umbilical cord or my own stem cells? Clinically it doesn't make any difference. We don't see a difference. So concern with using any umbilical stem cell from a different person might be communicable diseases. With these labs, they check for communicable diseases, but typically we're using fat derived stem cells and a few reasons for that. First off, it's, it's ready to work just like an umbilical stem cell. They still work the same way, but it comes from your own body. And also these can be stored and groaned and put into a stem cell bank. You can do that with your own stem cells. That way if you need more down the road, you don't have to get another liposuction procedure and you just order your stem cells from the bank and they can be put into your joint. This is common for somebody that's thinking, well, I'm going to do this for wellness. I might treat multiple joints or you have arthritis in your joint. If we treat it, it's not going to last forever, but might last anywhere from two to five years. Because you're continuing to wear on that joint, you might want to do it again and you're going through a less complicated procedure. So we prefer fat derived stem cells, but they all work clinically about the same. Big question about do I use stem cells or PRP for my knee pain? Well, it depends on a few things. And I don't like to say it depends on, but everything does depend on is it arthritis or is it a recent injury? Or is it an injury you maybe just had surgery and you're trying to get better healing, you've had an injury that's not healing. Typically, injuries are most appropriate for prp, platelet rich plasma, which imagine is fixing things. So platelet rich plasma has three factors that we would consider important. One is called vegf, vascular endothelial growth factor and this actually brings blood vessels in that help heal the area. The other one's called pdgf, which is platelet derived growth factor that brings in growth factors and makes cells start growing and healing. Another one called transformative growth factor tgf, which helps migrate stem cells in the area to start repairing things. So think about platelets as repairing things, even if it's a chronic injury or is this not healing? Tendon injury, soft tissue injury, Platelet rich plasma works great. And platelet rich plasma also benefits people with arthritis. Actually, regardless of the degree of arthritis, it still works. Doesn't have a long duration because it's not causing as much healing or regeneration of tissues. So if somebody has knee pain, they've got some advanced arthritis, they're thinking about knee replacement surgery. Platelet rich plasma can get you, it gets you significant relief of symptoms, but it's not going to last too long. You might get nine months or a year out of it and you can always repeat it. That's when you might start thinking more about stem cells that are much more regenerative. The current stem cells in your knee are no longer functioning. They're what we call senescent or sleeping. It kind of wakes them up and allows your tissues to start regrowing cartilage, which isn't necessarily due from an injury, it's from arthritis. Stem cells can regenerate that and give you a longer duration order of years versus months with platelet rich plasma. So again, it depends on what condition we're treating. Think about injury, inflammation, minor arthritis preventative. I'm thinking platelet rich plasma. We're thinking about bone on bone arthritis. We're considering a surgery. Stem cells are more appropriate. Platelets will help, they'll help reduce symptoms, but they're really not going to cause the healing and tissue regrowth as robustly as stem cells will. So I have a lot of patients come in, they say, the doctor says, the orthopedic doctor says, I have bone on bone arthritis and I need surgery. And they are spot on. If you have bone on bone arthritis, which is typically defined as having radiographic or X ray evidence of arthritis where the joint is really compressed and a lot of pain if you do not treat that, your lifespan is materially shortened. And if you do treat it, your lifespan is materially extended and your risk of morbidities goes down, such as diabetes, heart disease. And it's not from the arthritis directly, but anything that limits your ability to do your normal activities shortens your life. Movement is essential to longevity. Now, do you have an alternative? You do you have an alternative? Stem cells don't care how bad your arthritis is. When we say bone on bone arthritis, it's not like there's no cartilage there. It's just that a lot of it is gone and it's not very alive. It's not replacing itself. When you're 30 years old, you can have all kinds of running and damage and your cartilage gets injured and it keeps repairing itself and repairing itself and repairing itself. And over time, just because of aging, our cells, our stem cells in our knee become senescent. That word sounds like senile because that's what it kind of means. They actually stop functioning. And when those cells stop functioning, you've got other healthy stem cells right in the immediate area, but they're actually put to sleep by the adjacent six cells. And we put stem cells, fresh stem cells from your adipose tissue, from your bone marrow, from umbilical stem cells, any source, it wakens them back up so they can start healing and repairing the joint and starting growing cartilage back. So if your doctor tells you you need a knee replacement surgery, they are spot on. This is going to help extend your lifespan. But you might decide, I really don't want surgery because I know if I do surgery, there's some problems with that. I can't run again. But because you're not supposed to do anything aggressive after knee replacement, you can consider stem cells to potentially put that off forever. So I would say clearly that when your doctor says you need a knee replacement surgery, just take that seriously. When he or she say knee replacement surgery, they mean you need to do something about this. Injections aren't going to work anymore. Medications aren't going to work anymore. Your life and your quality of life would be better if you fix the problem. And we're here to tell you is that surgery is not your only option. It's certainly an option. It's not your only option. If you decide, I really don't want to go through surgery. You can consider other things such as stem cell therapies or even platelet rich plasma. But it's not that the medical machine is trying to replace a bunch of knees. This is actually critical to having a healthy population is taking care of arthritis. But I mean, these were invented 60, 70 years ago, and there's newer technologies out there. That might be something you want to consider if you don't want to go through knee replacement surgery. Sam.