Liparthroplasty
Cartilage damage severely impacts the quality of life for affected patients due to the associated pain and limited mobility. While conservative treatments focus on managing the symptoms, cartilage regeneration targets the root cause.
The Knee
The knee is a complex joint. In both sports and everyday life, the knee is subjected to significant stress. As a result, the knee is prone to injuries and wear. The stability of the joint is maintained by ligaments, menisci, and muscles. Intact cartilage surfaces are essential for a pain-free knee joint. Injuries or wear can lead to pain or swelling, often making weight-bearing activities impossible.
Cartilage Damage and Osteoarthritis
The inside of the knee is lined with a layer of cartilage. Cartilage is the most important structure of the knee joint and can be damaged by various factors, primarily injuries and wear. When cartilage damage occurs, pain, swelling, and limited weight-bearing capacity of the knee are predominant. Osteoarthritis is the dreaded large-scale cartilage wear in the knee. In many cases, joint replacement with a knee prosthesis was previously the only treatment option.
Fat Stem Cells and Liparthroplasty
Regenerative medicine today allows the repair of specific tissue types using the body’s own substances. Therefore, the motto today is more "Regenerate, not Replace." In a minor procedure under local anesthesia, stem cells can be isolated from abdominal fat. These are referred to as "Adipose-Derived Stem Cells (ASC)." These stem cells are pluripotent and can differentiate into various tissue types. After isolation, the stem cells are injected into the knee, where they are expected to differentiate into cartilage cells and regenerate the damaged cartilage. The procedure takes about an hour and is performed at the "Academic Stemcell Center" under optimal conditions. Patients can bear weight immediately after therapy. Routine follow-up checks are conducted at regular intervals.
Permanent Symptom Improvement
While conservative methods treat only the pain as a symptom rather than addressing its underlying cause, cartilage regeneration aims to tackle the root issue. The goal is to prevent progression and reverse the damage. Consequently, current research is focused on developing methods that not only address the symptoms of cartilage damage but actively promote its regeneration. The objective is to achieve long-lasting symptom relief and preserve cartilage and joints for as long as possible. A key focus in the treatment of damaged cartilage is currently on adipose-derived mesenchymal stem cells (ASCs), which are intended to support the biological regeneration of cartilage.
Stem cells are unique in that they possess the ability to self-renew and undergo asymmetric division, which underlies their differentiation into specialized cells. This mechanism can be harnessed to enhance the regeneration and repair of injured or damaged tissue. Mesenchymal stem cells have already shown potential in promoting tissue repair in the past. These cells can be derived from bone marrow, umbilical cord blood, dermis, and adipose tissue. Compared to peripheral blood, adipose tissue contains up to 25,000 times more reparative cells. In comparison to bone marrow, adipose tissue also has a 500-fold higher density of mesenchymal stem cells and progenitor cells. Additionally, adipose tissue is relatively easy to obtain and has a complex composition that can be utilized in regenerative medicine.
Adipose-derived mesenchymal stem cells are pluripotent stromal cells that, depending on their cultivation, can differentiate into bone, cartilage, tendons, or fat. They enhance wound healing and closure rates by increasing fibroblast proliferation and the expression of pro-angiogenic factors such as VEGF and bFGF. Other paracrine properties of adipose-derived mesenchymal stem cells include anti-inflammatory effects through the release of IL-10. This immunosuppressive effect reduces the secretion of inflammatory mediators that would otherwise contribute to the progressive destruction of cartilage tissue. Additionally, these cells stimulate the proliferation of chondrocytes and the release of collagen type 2, creating an optimal microenvironment for chondrocyte survival, inhibiting chondrocyte apoptosis, and improving the integrity of cartilage tissue. A study further demonstrated that adipose-derived mesenchymal stem cells increase the release of anabolic mediators and downregulate catabolic mechanisms in cartilage tissue.
Infiltration of Adipose Tissue
Due to the properties of adipose-derived stem cells, they are used in cartilage regeneration for damaged tissue—specifically through the infiltration of fat tissue into the affected joint (Liparthroplasty). The use of autologous fat tissue as an infiltrate for arthritic joints has already been studied in various parts of the body, with no negative long-term effects observed. Instead, positive effects included a reduction in pain levels and an improvement in functionality compared to pre-treatment conditions. Favorable results were also seen when compared to corticosteroid infiltrations—not only was there a significant reduction in pain at rest, but also in symptoms during physical activity compared to corticosteroid therapy. Improvement in pain symptoms occurs more quickly with Liparthroplasty than with surgery. Compared to corticosteroid infiltration, Liparthroplasty shows superior symptom relief after three months.
The acute improvement in symptoms may also be due to the mechanical function of the fat in the joint space: the transplanted fat acts as a buffer between the joint surfaces, improving intra-articular lubrication, which reduces mechanical friction and consequently decreases pain during movement. A study examining the use of Liparthroplasty for hand osteoarthritis found that 58% of patients experienced symptom remission after two years, and the need for invasive surgical procedures was reduced by 61% over five years. Additionally, it was demonstrated that symptom improvement occurs after just one session of Liparthroplasty, regardless of the severity of joint wear.
The stem-cell-rich therapeutic material is obtained by liposuction of subcutaneous fat tissue, typically from the abdomen. Prior infiltration with a tumescent solution consisting of 0.9% NaCl solution, local anesthetic, and epinephrine separates the fat cells from each other and their surroundings, preserving them during the suction process. After liposuction, the tumescent solution separates from the lipoaspirate in upright syringes, leaving behind pure fat containing adipose-derived stem cells, which can then be infiltrated into the affected joint. The morbidity of the extraction site is minimal. The amount of lipo-infiltrate needed varies depending on the joint to be treated: for example, approximately 10 ml is required per knee joint, while only about 1 ml is needed for the thumb's metacarpophalangeal joint.
The adipose-derived mesenchymal stem cells in the fat tissue can be further enhanced with additional factors. Current studies are exploring the combined effects of fat enriched with Stromal Vascular Fraction (SVF). In this process, the lipoaspirate is further enriched with previously extracted mesenchymal stem cells to increase the stem cell concentration in the same infiltration volume. The goal is to achieve an optimal, long-lasting secretory effect of cartilage-protective regenerative factors. Platelet-rich, leukocyte-poor plasma (PRP) is also being studied in conjunction with cartilage regeneration to potentially achieve synergistic effects with Liparthroplasty. PRP is obtained from the patient's centrifuged blood and, like ASC, has anti-inflammatory properties and positively influences chondrocyte metabolism.
In conclusion, Liparthroplasty is a treatment method that promotes cartilage regeneration through the anti-inflammatory and chondroprotective properties of adipose-derived mesenchymal stem cells, while also achieving acute symptom improvement through the mechanical lubrication provided by the fat tissue. As a result, patients can experience rapid symptom relief and delay the need for invasive surgeries. The authors believe that Liparthroplasty can be a genuine alternative to early joint replacement in many cases of osteoarthritis.
Mission Statement
Our declared goal is the regeneration of joint cartilage. "Regenerate, not Replace" is our motto. Pain reduction, returning to sports, and resuming normal daily activities reflect the success of our treatment. Through our comprehensive documentation and studies, we stay at the forefront of medical technology and science—truly academic.
