1. Dr.A.K.Venkatachalam MS Orth, DNB Orth, FRCS, M.Ch Orth Specialist in Arthroplasty, Joint preservation & Regenerative medicine Guest hospital E mail- drvenkat@kneeindia.com Orthopedic Biological treatments

2. Goal in Regenerative medicine To recreate original tissue Pain relief Preserve joint function

3. Cartilage It is the lining tissue at the end of bones It acts as a shock abosrber. Wears down due to number of factors. Gives rise to pain, grinding, catching when worn out.

4. Final condition is Osteo-arthritis Osteo-arthritis is a joint failure. Has epidemic proportions in India and world wide. In India, Knee OA is commonest. Final treatment is Knee replacement when non operative measures have failed.

5. Environment within OA joint Presence of signals which promote inflammation, suppress cartilage synthesis. Progenitor stem cells present in joint fluid which is not present in normal cartilage.

6. Biological therapy Growth factors derived from Platelets. Platelet rich plasma. Adult mesenchymal stem cells. ( Medicinal signalling cells) may be a better name. Others- Human Embryonic stem cells, Inducible progenitor stem cells.

7. Stem cells Pluripotent stem cells –They're able to make cells from all three basic body layers, so they can potentially produce any cell or tissue the body needs to repair itself. Multipotent stem cells are cells that have the capacity to self-renew by dividing and to develop into multiple specialised cell types present in a specific tissue or organ. Most adult stem cells are multipotent stem cells. Multi potent stem cells are more limited than pluripotent cells.

8. Adult Mesenchymal cell therapy Mesenchymal cells can be obtained from bone marrow, adipose tissue, synovial fluid, umbilical cord Have potential to differentiate into cartilage. Act by recruiting growth factors, chondrogenesis.

9. Source of stem cells – bone marrow

10. Bone marrow technique Bone marrow aspiration Centrifuging Bone marrow concentrate

11. Conclusion Osteo-arthritis is very common in India and abroad OA knee is commonest. Cell based treatments are most promising to restore normalcy. Early results are encouraging. Pain relief is certain. Grinding sensation takes time to disappear. MRI evidence takes time to appear.