Joints

The joints (such as hip, knee and shoulder) are the anatomical parts that allow the use and movement of the extremities of the human body. These joints perform a continuous mechanical work and are protected by cartilage, a complex tissue that has the task of cushioning and making fluid the joint movement. 

Cartilage is in fact a fundamental support tissue for the joints and very often it can be subject to wear due to the onset of arthrosis or other pathologies. 

Orthopaedics and Rheumatology are certainly some of the specialist sectors that have benefited most from the new technologies for the treatment of the most common osteoarticular pathologies. 

Osteoarthritis (OA) is a chronic joints disease characterized by degenerative changes in joint cartilage and secondary bone hyperplasia.  Characteristic features of articular cartilage are the absence of blood vessels and the low rate of conversion of chondrocytes into cartilage matrix, which is why until now any type of specific treatment has proved to be poorly effective.  In fact, the traditional treatments used for the treatment of OA, such as arthroscopic debridement, micro-fractures, autologous or allogeneic cartilage transplantation, chondrocyte transplantation, have only had symptomatic pain management endpoints, without being able to contribute in any way to the regeneration of degenerated cartilage or to the reduction of joint inflammation. 

The cartilage therefore, having a non-vascularized structure and being made up of cells (chondrocytes) with low reproductive activity, unfortunately has a limited capacity for self-regeneration. This makes it one of the most fragile and wear-prone parts of the body. The loss of space and the consequent approach of the bone heads can cause intense pain associated with difficulties in walking and in the normal use of the limb. 

In many cases, the pain is bound to become more and more acute to the point of making even the simplest movements as descending and climbing stairs or getting out of bed more difficult. What often begins as a passing nuisance can quickly turn into a severe chronic pain that adversely affects the working and private lives of patients.

Traumas, malformations, postural errors, inflammatory and degenerative diseases, autoimmune diseases are the main factors that can determine or aggravate excessive and premature wear of the cartilage. 

Until very recently, the only therapeutic approach to these problems has been either conservative-palliative, with joint infiltration, or radical and invasive with surgery.  

The first choice, better known as visco-elastic therapy, can be helpful in the initial phase of the symptomatology or to try to procrastinate the surgical moment. Infiltrations of different components such as anaesthetics, such as Lidocaine, to fight pain, anti-inflammatory drugs, such as Cortisone, to contain the inflammatory reaction, or lubricants, such as Hyaluronic Acid, to facilitate the flow of the articular surfaces, have been and are still very often used. These three components are often mixed together in very different proportions and concentrations, according to the personal experiences and habits of the treating specialists, but in any case they have only a symptomatic purpose and without actually being able to bring concrete reparative benefits. 

Surgery can be either endoscopic, to clean the joint cavity and to remove damaged or necrotic tissues (shaving), or open for prosthetic rehabilitation. These solutions involve prolonged immobilization of the affected joints, long rehabilitation protocols and significant costs. 

Today, however, it is possible to intervene very effectively to stimulate cartilage regeneration, obtaining a natural biological regrowth of the tissue and stimulating and guiding a process of self-healing, without the use of external synthetic materials and decreasing, or significantly distancing, the need to resort to more invasive surgical solutions. 

These regenerative effects can instead be obtained with the use of mesenchymal stem cells (MSCs) which, thanks to their ability to differentiate into chondrocytes and their immunomodulatory properties, have now established themselves as the new most effective therapeutic means in the treatment of OA.   

These new methods of regenerative orthopaedic surgery use autologous grafts of adult adipose Mesenchymal Stem Cells (ADSCs) taken from the same patient that, after a particular procedure of isolation and concentration, are reinstated in the damaged joint often mixed with other regenerative components such as enriched PRP, Amino Acids, Vitamins and Bioproteins. 

This new therapeutic approach based on the use of Bio Active Composite Grafts has now established itself and spread in the most important International Scientific Events. 

Once grafted into the suffering joint, these regenerative mixtures are able to stimulate the production of cartilage, improve lubrication of the intrarticular compartment, increase the distance between the heads of the joints reducing friction, maintain the space necessary to improve the visual activity of the synovial fluid, cause cartilage regeneration after a traumatic event or as a result of a bone deformity. 

Today, therefore, it is possible to resort to this new type of regenerative surgery by undergoing autologous grafting of biological derivatives composed of minimally invasive and effective compounds, especially in those cases in which classic conservative medical, infiltrative and physiotherapeutic therapies have proved ineffective and the surgery does not accept the patient.

The autologous graft of ASC is a very simple and minimally invasive intervention that involves the collection and grafting of mesenchymal cells extracted from the adipose tissue of the patient who is therefore both donor and recipient. 

If necessary, it may sometimes be useful before reinstalling the regenerative cocktail, to proceed to a joint washing in arthroscopy to remove any damaged or necrotic cartilage surface frustules and especially to limit as much as possible an inflammatory reaction to the point of promoting integration with the receiving tissues. 

It is important to underline the absolute necessity that these regenerative therapies are agreed and carried out in close coordination with the orthopaedic surgeon or with the referent rheumatologist. The grafting of the Regenerative preparation must be carried out directly in the joint cavity under strict ultrasound guidance. 

At the end of the operation, the area of the extraction is treated with an elasto-compressing bandage that is maintained for 5/6 days and the patient is required to keep the limb in unloading for 48 hours to facilitate the grafting. 

The operation is carried out in a single operating time according to a minimally invasive procedure, usually without hospitalization and has a total duration of about 40 minutes. 

Sometimes, in situations of particular suffering of the articular surfaces, treatment after 6 months may be necessary until the attenuation or disappearance of the clinical symptoms. 

Using this methodology offers indisputable advantages such as: little or no possibility of rejection, impossibility of contracting infectious diseases from another donor, ease of reintegration by the body and fast recovery times with substantial benefits in the medium and long term. 

An integral part of the therapeutic protocol is the subsequent ultrasound monitoring of the effect of the autologous graft at regular intervals during the following six months and one year MRI for the evaluation of tissue repair.

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