Treatment of knee osteoarthritis | Overview including symptoms and causes

Knee osteoarthritis is a disorder in which the knee cartilage wears away, resulting in pain and deformity. It is among the most common diseases in middle-aged and older adults. Patients with this condition experience hardships in various aspects of daily life, such as walking long distances and using the stairs. In the past, drug therapy and injections were used to alleviate pain, and ultimately, surgeries such as joint replacements were performed. However, stem cell therapy has recently attracted attention as a regenerative medicine technique aimed at cartilage repair.
In this article, we provide an overview of knee osteoarthritis and explain the symptoms and causes, why stem cell therapy holds promise, and the advantages and flow of treatment in detail. Please read the article to learn more about this novel treatment option that can help reduce knee pain and resume an active life.

What is knee osteoarthritis?

Knee osteoarthritis is a disease in which the cartilage that makes up the knee joint wears down with age and weight, thus causing pain and joint deformation. Cartilage acts as a cushion that relieves friction between bones; when it wears away, the bones rub against each other, resulting in inflammation and pain. It is commonly observed in middle-aged and older Japanese adults, with women being more commonly affected by this disease. In the early stages of knee osteoarthritis, patients experience only mild pain or discomfort; however, gradual joint deformation can lead to difficulty in walking and decreased quality of life (QOL). *1

*1 Reference: OMRON

Symptoms of knee osteoarthritis

The symptoms of knee osteoarthritis are mainly related to pain and limited range of motion. Typical symptoms include:

• Knee pain: In the early stages, pain usually occurs when initiating walking or standing, which is referred to as “start-up pain.” When the disease progresses, the pain may persist even at rest.
• Swelling of the knee joint, warm sensation: When inflammation occurs, fluid may accumulate in the joint which causes swelling or a warm sensation.
• Difficulty in using stairs: It is common to feel intense pain when walking up or down a flight of stairs because of the significant load imposed on the knees.
• Joint deformities: When the cartilage wears down to the inner bone, the legs tend to bow inward. Progression of this condition can limit activities of daily living.
• Limited range of motion: Not moving the joint to avoid pain can lead to a vicious cycle in which muscle strength and flexibility are lost, exacerbating the difficulty in movement.

As these symptoms progress gradually, they can lead to significantly decreased QOL, if left untreated without taking early countermeasures. *2
*(2) Reference: Knee Osteoarthritis Clinic

Causes of knee osteoarthritis

Knee osteoarthritis develops because of a combination of the following factors:

• Aging and cartilage degeneration: Cartilage elasticity and water content decrease with age, leaving the cartilage more susceptible to wearing out.
• Weight gain (obesity): Knee joint load is increased, resulting in increased cartilage loss.
• Vigorous exercise or incorrect movement: Cartilage damage accumulates as a result of knee overuse in sports and at work, as well as due to improper posture and movement.
• Joint sprain or trauma: Cartilage or ligament damage as a result of past injuries makes the joint more likely to become unstable.
• Joint deformity and genetic predisposition: The risk of developing joint deformity may be high in cases of congenital joint alignment issues or if someone in the family has a similar disease.

*3
*3 Reference: Kindai University Hospital

Stem cell therapy as a promising treatment for knee osteoarthritis

Conventionally, knee osteoarthritis has been treated with drugs and injections to suppress pain, rehabilitation to restore muscle strength, or total knee replacement in severe cases.
In recent years, however, stem cell therapy has attracted attention as a key component of regenerative medicine. If an approach that uses stem cells to repair and reproduce the worn cartilage can be realized, improvement in treatments for knee osteoarthritis may be expected.

What is stem cell therapy?

Stem cell therapy is a regenerative medicinal technique that repairs damaged tissue using stem cells collected from one’s own fat, bone marrow, or other approved sources. Stem cells possess the ability to undergo self-renewal and differentiate into multiple cell types; thus, it can be transformed into cell types such as cartilage, bone, and muscle under appropriate conditions. It is hypothesized that stem cells can supplement new cartilage tissue in knee osteoarthritis, where the cartilage is reduced and bones rub against each other. However, this therapy is still under investigation and is being studied, and its effects are not guaranteed for all patients.

Advantages of stem cell therapy

Stem cell therapy displays the following advantages, which may be the reason for the increased interest in this therapy:

• Possibility of cartilage repair: It may be possible to avoid joint replacement in the future, as the therapy attempts to regenerate worn cartilage, rather than simply providing symptom relief.
• Minimally invasive: The burden on the body is less compared with surgery. Moreover, a shorter hospitalization period and faster recovery can be expected.
• Reduced risk of side effects: When autologous stem cells are used, the risk of rejection and serious adverse reactions is relatively low.

Reasons why stem cell therapy is effective

Stem cells do not just differentiate into chondrocytes; they also secrete growth factors, such as cytokines, which can promote the repair of surrounding tissues. Consequently, inflammation is suppressed, and stem cells can improve the knee joint environment in a multifaceted manner by assisting angiogenesis and tissue regeneration, which is a remarkable feature. However, appropriate evaluation by specialists is necessary, because the therapeutic effect may vary depending on the patient’s condition and disease stage.

Flow of treatment at the Regenerative Medicine Division of Korokai Medical Corporation

The Regenerative Medicine Division of Korokai Medical Corporation provides stem cell therapy for knee osteoarthritis through the following process:

• Counselling and tests: We will evaluate the patients’ symptoms and X-ray/MRI reports and diagnose whether they are eligible for stem cell therapy. Blood tests will also be performed to detect any other existing complications.
• Stem cell collection and culture: Stem cells will be extracted from the patients’ own fat, bone marrow, etc., and grown at the cell culture center. The cells will be managed while maintaining high safety and quality standards.
• Stem cell infusion/administration: In case of osteoarthritis, stem cells are injected intra-articularly.
• Follow-up: Medical examination and imaging will be performed regularly to evaluate the status of cartilage tissue repair and the improvement of inflammation. Combined rehabilitation may also be prescribed, if necessary.

Through this process, we aim to increase the therapeutic effect of stem cells while minimizing the burden.

Possibility of treating knee osteoarthritis using stem cells

Knee osteoarthritis is a disease characterized by progressing pain and deformity, which is caused by the wearing of knee joint cartilage. Conventional treatments include exercise therapy, drug therapy or injections, and joint replacement surgery; however, with the development of regenerative medicine, the expectations and potential of better outcomes as a result of stem cell therapy have increased. Given that pain relief and functional recovery can be simultaneously attempted by repairing and regenerating damaged cartilage using stem cells, it is an attractive option for radical cure in the future.

The Regenerative Medicine Division of Korokai Medical Corporation offers stem cell-based regenerative medicine as a medical institution approved by the Ministry of Health, Labour and Welfare. *4

If you are interested in stem cell therapy, please contact our hospital for consultation.
The Regenerative Medicine Division of Korokai Medical Corporation carefully selects evidence-based treatment and offers regenerative medicine according to each individual’s concerns based on novel comprehensive treatment strategies. To optimize the results, oral therapies such as bioidentical hormone replacement therapy or peptide therapy may be combined with stem cell therapy, if preferred.

*4 Source: Ministry of Health, Labour and Welfare

The Regenerative Medicine Division of Korokai Medical Corporation – a stem cell therapy clinic in Tokyo
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[1] Therapeutic Method
The treatment involves harvesting and culturing stem cells from the patient’s adipose tissue and then injecting them locally to the affected area or administering them via intravenous infusion.
[2] Risk of side effects
At the time of fat collection: Adverse reactions, such as internal bleeding, swelling, postoperative infection, postoperative scar, and pain at the injection site, may be observed.
At the time of stem cell administration: Adverse reactions, such as pain at the injection site, allergic reaction, and pulmonary embolism, may be observed.
[3] Contact information
The Regenerative Medicine Division, Korokai Medical Corporation
Precious 18 5F, 4-14-6 Minami-azabu, Minato-ku, Tokyo
TEL:03-6277-4650
[4] Pricing
This treatment is a private therapeutic strategy that is not covered by public health insurance. It will cost about 1.65 million yen including tax (which may vary depending on diagnosis).
Please contact us for further details.
[5] Route of acquisition
Stem cells are cultured at the affiliated CPC.
[6] Presence or absence of devices/drugs approved for the indications in Japan
No approved drugs for the indications are available in Japan.
[7] Safety information from other countries
There are no reports on safety in other countries.
*Significant risks may not have been identified.
[8] The fact that it has not been approved
Drugs used in this treatment are yet to receive approval in accordance with the Pharmaceutical and Medical Device Act.
[9] Unapproved drugs/devices
Public aid systems (such as Relief Systems for Adverse Drug Reactions and Infections Acquired through Biological Products) are not applicable to unapproved drugs and devices.
[10] Notification of regenerative medicine provision plans
To perform this treatment, we have submitted the notification of regenerative medicine provision plans to the Ministry of Health, Labour and Welfare in accordance with the Act on the Safety of Regenerative Medicine.
Ministry of Health, Labour and Welfare, Class 2 Regenerative Medicine Provision Plan No. PB3210146
Ministry of Health, Labour and Welfare, Class 2 Regenerative Medicine Provision Plan No. PB3230187
Ministry of Health, Labour and Welfare, Class 2 Regenerative Medicine Provision Plan No. PB3240017
Ministry of Health, Labour and Welfare, Class 2 Regenerative Medicine Provision Plan No. PB3230218