New treatment options for common orthopedic conditions: Stem Cell Therapy and Shock Wave Therapy
Written by Kristin Kirkby, DVM, MS, CCRT, Diplomate ACVS
Stem cell and shock wave therapies have been used in the equine industry for nearly a decade, but have only recently been recognized as treatments for small animal patients. Seattle Veterinary Specialists is pleased to now offer both of these treatments for the management of musculoskeletal conditions in dogs and cats.
Stem Cell Therapy
Stem cell therapy has sparked much controversy over the last several years. It is essential to note that these debates concern embryonic stem cells that are derived from an embryo or fetus and are pluripotent, or capable of differentiating into any cell line. Stem cell therapy that is currently used in veterinary medicine utilizes adult, or mesenchymal stem cells. These cells are derived autogenously, from an animal's own bone marrow or fat, and are capable of limited differentiation.
Mesenchymal stem cells have the capacity to differentiate into cartilage, ligament, tendon, bone, muscle, nerve, liver, and cardiac tissue. When stem cells are implanted into a region, they secrete growth factors and cytokines that can stimulate repair and regeneration of tissue, similar to using a bone graft to stimulate fracture healing. It is also believed that inflammation is decreased and pain relieved through this process.
Current clinical indications for stem cell therapy in small animals include:
- Immune-mediated poly-arthritis
- Osteochondrosis/ OCD
- Ligament and tendon injuries
The treatment process:
Patients are evaluated through the surgery department. If current radiographs are not available, they will be obtained. Surgery to collect fat from either the falciform ligament or caudal to the scapula is performed on Tuesdays. Animals are discharged the evening of surgery or the following morning. The collected fat is shipped overnight to Vet Stem, in California, where the stem cells are isolated and then shipped back to SVS, so that we receive the cells 48 hours after collection. The animal must return on Thursday for stem cell injection. Heavy sedation or sometimes brief anesthesia is required for stem cell injection into the joints and/or tendons being treated. Fluoroscopy and/or ultrasound is commonly used to aid injection into severely arthritic joints or directly into tendons. The animals are discharged again Thursday afternoon.
All patients should return for follow up examinations every thirty days, for the first three months. Note: When the initial fat is processed, additional cells will be saved (or banked) for future use, if needed.
We believe that stem cell therapy is most effective when combined with rehabilitation. Therefore, we recommend that patients enroll in a physical rehabilitation program at an area rehabilitation facility. Additionally, Dr. Kirkby can prescribe a tailored home exercise program for each patient.
Contraindications for stem cell therapy include: neoplasia (any), and any condition that precludes general anesthesia.
Shock Wave Therapy
Extracorporeal shock wave therapy (ESWT) was first introduced in the early 1980's, as a non-invasive method for treating kidney stones. Over the past two decades, this modality has been increasingly used to treat a variety of musculoskeletal conditions in humans and veterinary patients. Benefits of ESWT include: increased bone, tendon, and ligament healing; accelerated wound healing; anti-bacterial properties; and pain relief.
Indications for use include:
- Chronic tendonopathies (biceps, supraspinatus, Achilles)
- Delayed-union fractures
- Chronic non-healing wounds
- Degenerative joint disease of the spine and lumbo-sacral joint
ESWT is a high power sound wave that causes mechanical stimulation of cells, resulting in increased expression of cytokines and growth factors. ESWT applied to an area of chronic inflammation may enable acute inflammatory mediators to be released, facilitating appropriate progression of healing. The mechanism behind the pain-relieving function of ESWT is thought to be due to increased seretonin activity in the dorsal horn and descending inhibition of pain signals.
Tendonopathies, such as biceps or supraspinatus tendonopathies, are often the result of repetitive activity or overuse injuries and typically cause pain and loss of full function. These conditions are typically non-inflammatory. Rather, degeneration of the tendon fibers and insufficient vascular supply to the area lead to loss of mechanical properties of the tendon. Treatment of these conditions has typically relied on activity restriction or surgery, along with anti-inflammatory medications such as non-steroidal anti-inflammatories or cortisone injections. However, it has recently been appreciated that ESWT, which is aimed at increasing blood supply to the area, is a valuable treatment option for these chronic conditions.
Adverse effects of ESWT have been reported in humans and animals and tend to be mild, including erythema, bruising of the treated area, and transiently increased pain and lameness following treatment. Typically, pain relief is noticed within 2 days.
The treatment process:
Patients will initially be evaluated by one of the surgeons, and radiographs or ultrasound of the effected area obtained if needed. The ESWT treatment takes approximately 5 minutes per joint or area, but does require sedation. Treatments will be scheduled as drop-off appointments for later in the week or the following week. is reversed following treatment, and patients are discharged the same day.
We recommend 3 treatments/ 3 weeks apart for musculoskeletal conditions, and one treatment/ once a week/ for 4 weeks for chronic wounds. Additional "top off" treatments every 6-12 months are occasionally needed for chronic osteoarthritis management.
Physical rehabilitation is an integral part of managing any condition for which shockwave therapy is used. Therefore, we recommend that animals enroll in a physical rehabilitation program at a local rehabilitation facility. Additionally Dr. Kirkby will prescribe a tailored home exercise program for each patient.
Contraindications for ESWT include: unstable fractures, neoplasia and areas over the abdomen or thorax.
Published on February 3, 2011.