Dr. KP Kosygan, Senior Orthopedic Surgeon, Apollo Hospitals – Interview
Regenerative medicine seeks to repair or replace damaged tissues or organs, with the goal to fully restore structure and function without the formation of scar tissue. Cell-based therapies are promising new therapeutic approaches in regenerative medicine. In an interview with Dr. KP Kosygan, Senior Orthopedic Surgeon, Apollo Hospitals, he sheds light on why this form of treatment is the next generation of revolution for medical science.
Q.1. What is bone cell therapy?
It’s a regeneration procedure for various musculoskeletal conditions. We have something called Regrow, which is one type of such therapy for knee and joint-related conditions.
Q.2. What demographic is it generally used for?
Dr. KP Kosygan: Any demographic. We use this mostly in the knee joint and sometimes in the ankle joint. We recommend this treatment to people who have a degenerative joint disease called osteoarthritis and who are at the age group where we feel that they are still young to have a knee replacement with implants. We use this therapy if the degeneration is confined in a small area of the joint and the rest whereby the joint is still normal when we do the arthroscopic procedure on them, during which we put the camera inside. Age is not strictly a bar but we tend to use it more for the middle-aged and for those who are younger and require a joint replacement.
Q.3. Can both males and females undergo this treatment?
Dr. KP Kosygan: Yes. No difference in gender or age group. Anyone can have it.
Q.4. What patient and which country have been using this procedure mostly?
Dr. KP Kosygan: Mostly, it would be in the US and Europe, where the initial research was done. This is for patients who have a degenerative disease of the joint that doesn’t require an artificial joint replacement but they may be able to regenerate their worn-out cartilage using this cell therapy.
Q.5. How is this procedure implemented?
Dr. KP Kosygan: At the first stage, we do an x-ray and an MRI scan. Based on the results, we decide if the patients are suitable. There are two stages currently with the Regrow procedure. In the first stage, we put a camera into the affected joint, most commonly the knee and sometimes the ankle. We assess if the degenerative (loss of cartilage) we are seeing is the same as what we’ve seen on the x-ray and MRI and if the joint is suitable for the procedure. If most of the joints are okay and only a small part of the cartilage is lost, we take cartilage from the same joint, from the non-weight-bearing area where there is no load on walking and we only take from the outer corners of the same joint. We harvest some 5mm – 7mm of the cartilage using a specific kit. This is called arthroscopic assessment of the joint and cartilage harvest.
Then, we transport it in a special medium to labs in two or three centers within India. The cell culture time takes around approximately 28 days to 30 days. Once the cell culture is done, which is transforming that cartilage into millions of cartilage cells, we intimate the patients the culture is ready. From one month to about six months, they can choose a date to come back. We keep it in the cold storage, a specific storage medium. When the patient confirms the arrival for the second procedure on a specific date it gets transported that day morning from the lab to the center where we are doing it. Once it is removed from the storage, we have to use it within 24h hours.
Q.6. What is the success rate of this procedure?
Dr. KP Kosygan: If the selection criteria are very good, it is close to 90 to 95 percent. The second procedure is an open procedure. We curette that small area of the affected joint and then we paste these cultured cartilage cells into the defect. In about 3-6 months, they get transformed into the natural cartilage. So, the selection criteria are very important. It doesn’t matter if someone is 80 years old also, as long as their arthritic process is confined to a small area of the joint and the rest of the joint still looks normal, the medical condition is good and they’re active. Instead of knee replacement or joint replacement, this procedure is an alternative to those selected patients. The success rate can be close to 90 to 95 percent in such patients.
Q.7. Is it a safe procedure? Are there any side effects?
Dr. KP Kosygan: A comprehensive pre-surgical assessment is done. In terms of the actual procedure, the safety is just the same as any other arthroscopy or join replacement procedure. In terms of any reaction is concerned this procedure is based on the patient’s own cells and so no adverse reaction reported. The other risk such as infection, joint stiffness,deep vein thrombosis is as same as or less than as for joint replacement surgery
Q.8. How fast is the recovery time?
Dr. KP Kosygan: In terms of assessing the outcome, we tell them about six months as cartilage takes certain amount of time to regenerate. In 6 months, we will do an x-ray, re-examine the patient, make them to do full activities and at that stage, we could grade the outcome.
Q.9. How expensive is this procedure?
Dr. KP Kosygan: Both stages together should be taken as a single package. At the first stage itself, we take the consent of the patient and because it’s under regional or spinal anesthetic in most cases, we keep them awake during the procedure so that they can also watch the screen — showing them, ‘Look, arthritic is only in this area. You are suitable for the procedure we’ve discussed earlier and that we are proceeding to harvest the cartilage So, they have to commit to both stages. Once the cells go to the lab, it cannot be thrown away. It has to be used. It comes close to about approximately USD 6000- USD 7000 for both stages together.
Q.10. Why should people opt for this rather than the traditional method?
Dr. KP Kosygan: If it is suitable, they retain natural knee joint, ligaments and meniscus are not removed and the patient regains more natural joint there functions. This is an alternative to replacements in those patients where the arthritic process is not extensive.
Q.11. Can this be used for children if they have a fracture?
Dr. KP Kosygan: It is not for fracture. I’m doing one procedure next week. He’s about 18 years old now. Due to some injury, he’s got about the small coin-shaped defects in a small area of the knee joint which is painful. It’s a soft dent. He still has some pain despite physiotherapy and months of not doing any jumping, sports. He’s just been walking. We have harvested cartilage from outer area of the same joint very small (5 mm) and then next month we prepare the affected area of cartilage where he has sustained an injury and pack these new cells. We do in adult and children. We would want to prevent the small area of damaged cartilage to develop into early arthritis. We also don’t want to put in an artificial joint at that young age.
We use a similar cell regeneration technique for ligaments and tendon issues, which is from a different type of cell processed from the serum. Worldwide, it is well-known for type 1, type 2 ligament and tendon injuries where there is pain despite physiotherapy and icing and a break from sport. Their tendons may show changes in the MRI. The ones that are completely torn, you have to stitch it and repair it. But the ones which are strained or partly torn, we use another regeneration cell therapy technique whereby we harvest the bone marrow cells or peripheral blood, turn to specialized cells and inject it to the affected tendon area. It’s very good in patients who have experienced pain from a mild injury initially and not settled with various therapies It also comes under cell regeneration techniques.