Image courtesy of Lipogems
Arthroscopic knee surgery for degenerative knee disease is a common orthopedic procedure, reportedly performed more than two million times a year globally. And these are just the statistics for knee procedures. The shoulder, hip, wrist, elbow, and ankle joints are all also candidates for arthroscopic surgeries.
A few studies have cast doubt about whether such surgeries are necessary. It is true that most of the time, patients report lessening of pain after the procedures. But could this be just a placebo effect?
In the case of osteoarthritis in the knee, there is no evidence that arthroscopy cures or arrests the osteoarthritis. In a controlled trial, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure. Another randomized trial conducted in 2016, found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy.
In shoulder procedures, a randomized study of 313 patients across 32 hospitals showed that real surgery compared with both placebo surgery and no intervention at all were clinically equal in addressing shoulder pain.
A recently introduced and FDA-cleared technology may offer a minimally invasive alternative to arthroscopy for repairing tissue, and it could also be used an additional step to arthroscopic surgeries to support soft tissue defects.
Lipogems offers a microfragmented adipose tissue transplant system that uses a patient’s own fat to help provide needed cushion and support and to facilitate healing. FDA cleared the new Class II single-use device, the company announced in July. It consists of a transparent plastic cylinder with filters and beads for microfracturing adipose tissue, the company explains on its Web site.
“Lipogems may be used as another option to major invasive surgery,” said Lipogems’s Amisha Patel, in an interview with MD+DI. “It is a minimally invasive procedure that can be used in the office. If surgery is needed, Lipogems may also provide cushion and support to help support the healing process for any damaged or injured tissue.”
Research has shown that regardless of a person’s age, his or her fat maintains its reparative properties, unlike other tissues such as bone marrow, which may lose healing capacity over time.
Other processes for isolating the reparative cells from adipose tissue have been tried. These involve digesting it with a chemical enzyme, such as collagenase, to disrupt and dissolve the structural tissue. The resulting heterogeneous cell mixture is separated by centrifugation to create a product called stromal vascular fraction. This process is not only time consuming, but it is considered more than minimal manipulation by FDA (and so is not cleared for use), removing structural properties needed for a scaffold and changing tissue from its natural state.
The Lipogems method keeps the cells and tissue intact and thus functions much like the way it does naturally in the human body. In the procedure, a few tablespoons of fat are taken from the patient for each site they want to inject. “Fat has a lot of impurities such as blood, oil, and cell debris that need to be washed away,” said Patel. Therefore, the doctor will collect about four times the amount they want to finally inject.