Stem cells are cells without an identity. They're essentially" blank slates" with no "writing" that identifies whether they are a heart cell, a brain cell, a skin cell, and so on.

To better explain this process, it helps to understand what happens at the moment of conception.

When eggs are fertilized by sperm cells to form an embryo, a process called cellular division starts. The cells of the new embryo have incorporated DNA material from both the mother as well as the father.

During the early embryonic phase, cells are dividing rapidly but they have not yet become defined organ cells. They are simply cells that will soon undergo programming that will give them a specific identity.

Embryonic cells at this stage are referred to as pluripotential stem cells, meaning they can be made to become any type of organ cell.

(While embryonic stem cells are the most versatile of stem cells, there is some concern that they may multiply too well and possibly cause cancer.)

As the embryo matures, its cells undergo a gradual transformation and begin to take on more well defined characteristics. At this point, these embryonic stem cells are multipotential. This means they can be made to become most types of organ systems, but it is a bit more difficult to cause that transition than if they were pluripotential cells.

Once the embryo has fully developed, stem cells have, for the most part, fully differentiated. Also, in the late fetal stage and in human adults, stem cells are much less common, although they may still be found in bone marrow, brain, spinal cord, blood vessels, parts of the eye, liver, pancreas and fat.

Stem cells in the adult function primarily to repair damage. The cells that have the most usefulness in clinical medicine are the mesenchymal stem cells that reside in the bone marrow. Mesenchymal stem cells in adults are multipotential.

Mesenchymal stem cells (MSCs) can travel to areas of injury via the blood stream. While this is satisfactory for many types of injuries, there is a problem when injury occurs in areas where blood flow is poor. Examples include many tendon structures (For example: Achilles, rotator cuff, lateral and medial epicondyle, patellar tendon), and the cartilage within joints.

Areas where stem cell access is poor do not heal well.

In these cases, mesenchymal stem cells are an important consideration.

Here's how it works at the Arthritis Treatment Center...

Mesenchymal stem cells, as mentioned earlier, are present in the bone marrow. So... to gain access, a large volume of bone marrow is withdrawn from the posterior iliac crest- the back of the pelvis, using a special needle with ultrasound guidance.

Proper anesthetic technique with ultrasound guidance ensures there is very little discomfort with the marrow draw procedure.

The bone marrow is then processed using a special technique. This produces a concentrate of bone marrow that has an extremely high number of mesenchymal stem cells (in excess of five million MSCs). Since these are the patient's own stem cells, they are called autologous stem cells (autologous=self).

A third type of stem cell are allogeneic stem cells or donor stem cells. These stem cells have the advantage of numbers since they can be concentrated and multiplied using growth factor stimulation. The disadvantage is that there can be inadvertent transmission of genetic or infectious diseases.

Another part of the stem cell technique at the Arthritis Treatment Center involves the harvesting of fat. Fat provides the bulk for the stem cell graft and also fat, itself, contains stem cells.

Fat is obtained using local anesthetic and a modified liposuction technique. This procedure is also ultrasound guided.

In addition, platelet-rich plasma (PRP) is used to activate the stem cell graft.

The actual work on the affected joint or tendon requires a regional approach, since there are usually several areas that require treatment. Ultrasound guidance ensures proper identification of the specific treatment areas. Contrary to what many people believe, a proper stem cell procedure is not just a matter of "dumping stem cells into an affected joint."

When the treatment process is completed, special activating factors are added to jump start the process of healing. Once activated, the stem cells in the concentrate and in the fat begin the process of repair.

The repair process usually takes 2-3 months but clinical improvement may be seen before that. In rare instances, healing may take a bit longer.

An important consideration is the age of the patient. There is evidence that stem cells, as they age, become less responsive to stimulation.

In addition, it is important to mention the problem created by mechanical instability. Patients with knee arthritis may have either a varus (bowleg) or valgus (knock knee) deformity. If extreme deformities exist, then stem cell therapy is not recommended. However, with only mild deformities, the use of special bracing techniques can overcome this barrier.

Patients with severe hip disease, where there is abnormal angulation as a result of severe arthritis, are generally not considered good candidates.