What is involved with a Bone Marrow Graft (Stem Cell) Procedure?
For most patients, the recommended protocol is a series of injections of different orthobiologics that happens over the course of about a week depending on each unique situation. These injections include a prolotherapy pre-injection, the same-day Bone Marrow Graft (stem-cell extraction and re-injection procedure), and a blood draw and post-injection of multiple Regenexx proprietary platelet-rich plasma concentrations.
This process applies to procedures for the knee, hip, shoulder, hand, wrist, foot, ankle, elbow, and spine.
First Day (Pre-injection)
Your first visit involves an injection of a special hypertonic dextrose solution that creates a mild inflammatory environment that is conducive to healing. The purpose of this part of the procedure is to cause the same kind of acute inflammation that might occur during an injury.
Second Day (Stem-Cell Procedure)
On the morning of your bone marrow aspiration (stem-cell extraction), you will lie on your stomach on the procedure table where a local anesthetic will be applied. The physician will then draw bone marrow from the back of your iliac crest using precise image guidance. The doctor will draw from both hip bones. Some patients will be given an oral or IV sedative to help to ease anxiety and relax the muscles prior to the bone marrow draw. The procedure we use is called a bone marrow aspirate which is significantly less invasive than a painful bone marrow biopsy. The bone marrow aspiration process is often described by patients as being only mildly uncomfortable and is typically well tolerated.
While your cells are being processed by a Regenexx lab technician, you will have some downtime to relax and to eat lunch. The re-injection of stem cells into the site of the injury takes place between three and eight hours after the bone marrow aspiration. Local anesthesia is used to numb the area and the stem cells are precisely reinjected using real-time imaging guidance (ultrasound or fluoroscopy).
Third Day (Blood Draw )
Concentrated PRP, a concentrated blood-platelet injection that contains healing growth components that increase the activity of the stem cells. It is created in our on-site orthobiologics lab by a skilled technician who can include more of the blood components that encourage and support healing while removing other components that cause unnecessary inflammation and discomfort. Blood is drawn from a vein in your arm and processed and prepared in our lab for re-injection within 24 hours as your post- injection.
(Re-injection of Concentrated PRP)
During a second visit, PRP is injected into the treatment site and works in conjunction with your reinjected stem cells. Platelet lysate (PL), which is the growth factors isolated from your blood platelets may also be use to act as an immediate release of helpful growth factors versus the slow release from the whole platelets contained in PRP.
The stem-cell injection produces a pseudo-injury in the joint. As a result, expect the joint to be sore for one to three days. Your physician may prescribe pain medicines that will not hinder the healing caused by the procedure. Patients can additionally take Tylenol but are asked to avoid NSAIDs. The goal is to allow the stem cells to attach and then to protect them while they differentiate into various tissues. For the first day after, you should limit activity on the joint.
Most patients report a modest improvement in the first month. You will notice that as time goes on your pain that occurred before is less severe and frequent. Most patients are able to resume light activities after 5 to 7 days. Usually at 6 to 8 weeks patients begin to resume a more vigorous exercise schedule. Most of our very active patients are able to return to their regular routine in 6 weeks and push their performance to higher levels in 8 to 12 weeks. Improvements will continue throughout this time period. Most patients notice continued healing over many months. Our outcome data suggests peaking at 1-2 years out. Results vary by patient and depend on the condition of the area treated, age, and general health.