This procedure has been available worldwide for approximately 7 years. In the UK, it was first started by the Regenerative Clinic 18 months ago.
At the Regenerative Clinic, we have treated approximately 500 patients and a total of 750 joints. We are by far the largest and busiest group in the Europe and the UK using this technology. There have been approximately a further 100 individuals who have been treated in other centres across the UK, which of course, do these in much lower volume. Worldwide, it has been used to treat over 30,000 patients with surgeons all reporting great results.
Although fully FDA approved, this treatment is still undergoing assessment. There are many studies that clearly demonstrate its efficacy but in order for new and novel treatments to become available on the NHS or covered via private medical insurance, there is invariably rather complex processes that may take a number of years before acceptance. A good example of this is the use of platelet rich plasma which, although having been around for approximately 25 years, is only recently finding its way to the NHS and is now being offered across various NHS trusts in the UK. There still continues to be some insurance companies that do not approve platelet rich plasma despite overwhelming evidence of its benefits.
We have treated a number of patients with auto-immune conditions such as rheumatoid arthritis that predominantly effects joints, however, the numbers are small, some have responded, and some have not but it is difficult to draw general conclusions about autoimmune conditions.
The cells that we’re interested in collecting are called pericytes (Mesenchymal cells) as these cells have naturally regenerative properties, there’s a very high concentration of these cells in your fat tissue, what we call adipose tissue.
Quite simply what we do in the Lipogems® procedure is we remove a small amount of your fat tissue from your tummy. We then put this tissue in a closed loop system and wash it with a saline fluid to get rid of any of the impurities and then re-inject the tissue back in the joint being treated.
The pericytes then get to work at regenerating and rejuvenating the damaged structure including cartilage. It also helps lubricate the joint and reduce inflammation. It can also act on nerve endings in your joint to relieve some pain.
The procedure itself is performed in just under one hour and you are free to leave the clinic the very same day.
We carry out nearly all of our procedures with our patients sedated, this means they are awake but very comfortable. Throughout the procedure an anesthetist will look after you to ensure you are happy. You can opt for local anesthetic only or alternatively we carry out some procedures under general anaesthetic e.g. facial and spinal treatments.
It’s a very small amount of fat, around 50ml, around the size of an espresso cup this is for one joint. This is then reduced to approx 5ml which is injected into each joint.
The Lipogems® procedure is a good alternative to major replacement surgery. The procedure is minimally invasive with a minimum recovery time. You do not have to go under general anesthetic and they are comparatively priced.
The harvesting of stem cells from bone marrow is an invasive treatment, conducted under general anesthetic that can be very painful. The mesenchmyal cells present in the fat tissue are easier and less painful to access. There is also research to show that the quality of stem cells in bone marrow decreases significantly as you get older, especially in women. Age and gender has no effect on the quality of stem cells present in fat tissue. Both methods of harvesting have been tried, tested and have proven to be very affective.
Yes of course, we have a large team of orthopaedic consultants who specialise in different areas of the body. We can arrange for you to have some imaging done of the extra joint if you do not have any already and for you to meet with the relevant specialist.
Our clinicians are orthopaedic surgeon consultants who are specialists in joint preservation and rejuvenation. They will be able to discuss all traditional orthopaedic surgery and other regenerative options with you, not just Lipogems®. If the clinician thinks you are not suitable for Lipogems® they will suggest an alternative course of treatment.
We have kept a registry of all of the patients that have been treated and we have found that 75% of all patients treated have had a positive outcome with improvements in both pain scores as well as functional scores. The level of improvement for the treatment in our knee arthritis patients has been equivalent to the improvement seen in a total knee replacement in severe arthritic group.
There are a number of different patterns of response to this treatment. There are some individuals who have an immediate effect with a profound reduction in their symptoms. Others demonstrate an initial increase in their symptoms following the injection but then things settle down and they slowly improve. Interestingly, some patients having hip Lipogems have a slower response with sometimes a 3 week period before the benefits start appearing. In some of our patients, they continue to improve after 3 months. Most patients improve from 6 weeks and we tend to see patients improving most between 3 and 4 months after the procedure. This may be due to the fact that by reduction of the pain in the joint, the muscles then start regaining some of their strength and the control which is achieved by the strengthening of these muscles further stabilises the joint improving symptoms.
This treatment has been undertaken by a number of our colleagues in Europe for almost 4 years. Some of those treated have reached 3 years and it appears that in those who respond, in the first year, this response may well be maintained for up to 3 years. Some feel that a “booster” injection of Lipogems may be necessary at 2 years but the numbers for these are small and are only the personal case series of these surgeons.
We have not noted any adverse outcomes. In cases where the treatment has not worked, it has been the natural progression of the disease. This treatment does not interfere with any future interventions required for the knee. There is no evidence that it will interfere with having a total knee replacement.
The procedure is very safe and the risks are minimal. All procedures including an injection do come with risks. However, some patient experience mild bruising from the fat harvest site. The biggest risk is that this doesn’t work and this is 25%.
In our experience only 25% do not respond and it is difficult to predict which patients will not benefit. However, it does seem that the patients across all grades of arthritis benefit in a similar way with 3 out of every 4 having reduction in pain and improvement in function. Currently we find it difficult to predict the responders and non-responders prior to undertaking the procedure.
The effect of steroids on the Lipogems is thought to be detrimental and not advised. We have no direct experience of this because we advise patients to leave a time of at least 3 months between the steroid injection and the Lipogems treatment in order to make sure that the joint returns to a normal state, therefore gaining full benefit.
The Lipogems® technology has been used successfully on patients with all stages of arthritis, that being said, each case is unique and that is what is so important about the consultation. Our clinicians can offer all conventional surgery but are also specialists in joint preservation and rejuvenation and will be able to assess your individual suitability for the procedure. This is why the clinical assessment is so important and it means the patient is receiving some of the top care in the country.
We don’t generally advocate injecting into joints that have had a joint replacement. In this case, we would certainly recommend a review by one of our specialists before any further treatment is advised.
If the treatment does not work, we can try other forms of injections including platelet rich plasma and hyaluronic acid. In some cases, the injection of these other substances can trigger a response. In cases where there is a deformity in the limb which is a cause for mechanical symptoms, this can be corrected with osteotomy surgery and in cases of instability around the joints, particularly in the shoulder, the elbow and the ankle joint we can also offer reconstructive surgery to stabilise the joint and mitigate the symptoms.
Prior to the procedure it is important to continue with your normal activities and exercise. If these activities cause pain, it is important to reduce the activities to avoid pain but by exercising and continuing to be active, muscle tone and strength is maintained and balance will continue to improve. These are very important features in the post-operative rehabilitation as well. Once the pain in the joint is reduced, it then becomes very important to exercise in order to regain muscle tone, muscle strength and then rehabilitate balance.
We advise patients to be prepared to take up to 2 weeks off. The purpose for this is the site of lipo-aspiration can be uncomfortable and will take a number of days to improve. Occasionally, if the joint has also become a little bit uncomfortable and swollen following the injection, it would be best to reduce activities to allow the joint to settle down. Post-op patients will experience a dull aching pain in the joint for 2-3 days, however the pain is not debilitating and can be managed with regular strength painkillers.
Before your procedure, you receive a physiotherapy guide with some basic exercises to aid recovery following procedure. After your procedure, you receive post-op pack including: post-op care leaflet, discharge summary medication and extra dressings. The post-op leaflet outlines ‘do’s and don’ts’ before and after your procedure and provides an out of hours number to get in-touch with our clinical nurse. You will also have a follow-up appointment with your consultant at 6 weeks so we can monitor your improvement.
We value the importance of measuring outcomes and the ongoing assessment of each patient having treatment. In order to allow us to assess the success of your procedure(s) we are interested in the short and long term effects of your treatment, in you as an individual, as well as in comparison with other patients treated. To do this we carry out important pre-operative and post-operative questionnaires. Before your procedure we ask you to complete a questionnaire and then complete this again at 3, 6 and 12 months, then finally after 2 years. Thank you in anticipation for your help with our important research and audit, not only will this allow us to monitor your progress, your contribution (which will be anonymised) will contribute to our evidence based database and other global studies as we continue to evaluate the growing evidence for the treatment itself.