How Culture Expanded Cells Can Get you the Best Results for Severe Hip Arthritis

The Regenexx Cayman clinic is the world’s most advanced cell culture facility. What does that mean? The best way to understand how Regenexx and Regenexx-C clinics do it best was coined by Chris Centeno, MD – his mantra is What+Where+How(1). This helps our patients to understand the framework around what makes a regenerative procedure a good one because not all are created equally. Then, we will discuss how Regenexx Cayman takes it to the next level. 

What Makes a Good Regenerative Procedure?

The mantra What+Where+How was coined by Regenexx founder Chris Centeno, MD as a simple checklist(1), for patients to consider when evaluating a regenerative procedure. There are a lot of “bad actors” out there, both on US soil and internationally, overpromising results with non-evidence-based, and even questionable, treatment methods. You can trust a procedure to be sound and follow the most recent medical literature if you have the following answers to the questions What? Where? and How?:

  1. WHAT: The “what” stands for what is injected. The answer should be platelets or bone marrow concentrate derived from the patient. This is called autologous, or originating from the patient themselves. This does not include fetal or umbilical stem cells. These substances are allogenic or originate from another person or tissue that does not belong to the patient. There is no published research showing these injectates from sources other than the patient themselves are effective. In fact, this type of therapy poses additional risks to the patient. 
  2. WHERE: Where the injection is placed is very important. All Regenexx physicians perform injections with platelets or bone marrow concentrate under the guidance of live X-rays and/or ultrasounds. Many clinics charging upward of $25k for fetal stem cell procedures are performing what we call “blind” injections into a joint. These procedures take a few minutes since the doctors place one needle into the knee joint and inject it. Conversely, our procedures often take an hour plus to perform because there are many different injections precisely positioned and performed under imaging guidance. 
  3. HOW: How the injections are performed is extremely important. All of the current literature supporting the efficacy of regenerative medicine are performed by following the standard of care, including image guidance. If a physician suggests a blind injection into a joint or an Intravenous delivery of stem cells, they are not practicing under evidence-based guidelines.

What is Regenexx-C?

Regenexx-C denotes procedures performed in the Regenexx Cayman clinic. All physicians in the Regenexx network follow the What+Where+How by performing image-guided, highly specific procedures with patient-derived platelets or bone marrow concentrate. These standards are also upheld in the Regenexx Cayman clinic in Grand Cayman; however, there is an opportunity to augment the bone marrow concentrate and platelets in ways not permitted in the US. There are four major benefits to exploring the Regenexx Cayman clinic (1):

  1. Higher cell density: Cells from blood and bone marrow samples can be culture-expanded. Meaning, the cells from a single patient sample can be grown into a more dense sample.
  2. Multiple treatment sites: through the culture-expanding process, there is more product to treat patients. So, where a patient would usually have just a shoulder treated in the US, for example, a patient would have enough product to treat a shoulder, both knees, Achilles, back, and big toe.
  3. Cell Storage for Future use via Cryo: Regenexx Cayman clinic has the ability to save the mesenchymal cells for a patient’s future use. Specific Conditioning Protocols: in the cell-culture process, there are protocols where the cells can be conditioned for a certain purpose.

What Can Be Done in the Regenexx Cayman Clinic?

Let’s dive a little deeper into the benefits the Cayman clinic offers, as compared to its US Regenexx counterparts, and why it might be a good choice for you. 

Culture expansion is not permitted in the US but is permitted by the local regulations in the Cayman Islands. This means the mesenchymal cells that are collected during the bone marrow aspiration undergo a culture process where the number of cells is grown to a larger number. This allows for the concentrated mesenchymal cell injections to be 100 times to 1,000 times the concentration of what your body naturally produces. This is especially good for certain cases, like severe hip arthritis. 

In the Regenexx Cayman clinic, it is common for patients to have multiple treatment sites in one treatment session. The cells from the bone marrow concentrate can be combined with the patient’s platelet-rich plasma. Not only does this increase the volume of healing cells, it also allows for more joints or tissues to be treated at once. This is a fantastic option for patients who have a large number of problem areas they wish to have treated. 

In the US Regenexx clinics, there are strict USFDA guidelines that are closely adhered to. For example, when having a same-day (SD) bone marrow concentrate procedure, the patient must come back the same day the bone marrow sample is collected and processed for reinjection into their tissue or joint. This is because the USFDA states you cannot legally store the cells from bone marrow concentrate in the US. Regenexx Cayman allows you to cryogenically store the cells from a bone marrow aspiration so they are preserved at their chronological age when they were extracted. This is an excellent option for the aging patient who anticipates more injections being needed as they age. Dr. Centeno states, “We do this with several NFL athletes who can store cells at their younger biologic age and then use them later in their careers”(1).  

Lastly, a benefit of seeking a regenerative procedure in the Regenexx Cayman clinic is because of the potential to condition cells for certain purposes. The cells, when being cultured, are exposed to the harsh chemical conditions that mimic the condition they are supposed to heal, for example, the noxious pain-producing chemicals present in the case of a disc herniation. These cells may also be cultured with additional substances to steer them towards a certain job, like cartilage repair, for example. This process of conditioning or grooming the cells when they are cultured is akin to the process of growing grapes or coffee beans that are intended to become wine or flavorful espresso. The farmers seek stressful conditions like an arid environment, high altitude, or cold weather to put a functional stress on the plants, altering their flavor. These cells, similarly, are conditioned to perform differently based on what they are exposed to during the culture process. 

Who Would Be a Great Candidate for the Regenexx Cayman Procedure? 

As mentioned above, patients who have several treatment sites to be addressed, want to have a high density of cells, or want to store their cells should all consider a Regenexx-C procedure. 

However, we wanted to make an example of a specific case that had outstanding, visible results with a Regenexx-C procedure. As it relates to how joints respond to Regenexx bone marrow concentrate procedures, Chris Centeno, MD states, “While patients with mild to moderate hip arthritis have always done well, severe hip arthritis almost seems like a different disease”(1). When a patient has severe hip arthritis, it often includes lesions or cysts within the bone. Those cysts are dead bones in the unhealthy, painful, and stiff joint. When a joint demonstrates lesions in the bone, it is the standard of care to treat intraosseously, or within the bone. 

Below (Figure 1) is an example of a patient with severe hip arthritis. There are MRI images from three different angles of the hip joint. Visualized in the images on the left are bright white spots within the hip bone. This patient was treated with bone marrow concentrate that was culture-expanded at least 100 times. A year later, the MRI revealed the white spots had decreased tremendously, and some even were gone. This is a powerful image of the healing capabilities of treating the bone in severe hip arthritis with culture-expanded cells.

If any of the benefits of a Regenexx Cayman procedure sound like a good fit for you, our physicians at Regenexx at New Regeneration Orthopedics can discuss if this is the best route for your condition. 

It is important to note that all of the providers in the Regenexx Cayman clinic are US-trained and licensed physicians in US practices within the Regenexx network. Other clinics in other countries touting regenerative procedures oftentimes are staffed with locally-trained physicians, who are not held to the same standard as our doctors. Remember to do your homework, and if a clinic does not pass the What+Where+How “test” discussed earlier in this article, think twice!

The Regenexx Cayman clinic is the most advanced regenerative medicine with cell culture facility in the world that follows the most up-to-date evidence, has highly trained physicians, and are committed to doing what is safest and best for the patients.



About The Author
Ignatios Papas, DO

Ignatios Papas, DO

Ignatios Papas, DO, is a non-surgical orthopedic physician specializing in Physical Medicine and Rehabilitation at Regenexx® at New Regeneration Orthopedics.
Ignatios Papas, DO

Ignatios Papas, DO

Ignatios Papas, DO, is a non-surgical orthopedic physician specializing in Physical Medicine and Rehabilitation at Regenexx® at New Regeneration Orthopedics.

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