A question we're frequently asked in our practice is whether treating an older patient is worth it. Is there really a benefit to using regenerative cells, or other regenerative therapies in someone in their 70's, 80's or beyond? Like many things, there is no one right answer, only the one that's right for the individual. The doctor can only help the patient and family understand the risks and potential benefits of treatment and then let them decide whether any anticipated improvement is worth it.
Fortunately, we're seeing many more patients who are vigorous and active at much older ages. Their minds are sharp, they like to dance, ski, and go out and play. For some, aside from a nagging, painful joint interfering with activities and sleep, they're healthier than many patients with less years under their belt.
For an older patient with arthritis or degeneration in a joint, they should investigate all their options. Unfortunately, many surgical options require general anesthesia or heavy sedation, both of which can pose major risks. The recovery period from any procedure should also be investigated. A full year of limited movement and rehab, such as is typical with a shoulder replacement, may not seem like a good choice for someone who is 85.
The degree to which pain impacts their life is also important. If someone has multiple health issues and only occasional joint pain in the morning, it may not be worth taking the risk of even a very minimally invasive procedure to address this. For someone who is quite healthy and finds their joint pain to significantly decrease their quality of life, this is a very different decision.
Most regenerative therapies are very minimally invasive. There are two steps - the regenerative cell graft harvest and the implantation. Regenerative cells (SVF or stromal vascular fraction) can be harvested using a mini-lipo, requiring removal of only 60cc or 4 tablespoons of fat from just under the skin. For some older and very slender patients, this may be an issue, but for most with even minor deposits of fat, this can be performed with only minimal oral medication (usually Vicodin and Ativan) and a small amount of local anesthesia while still comfortably awake. Interestingly, as long as older patients still have a small amount of fat for harvesting, there is no evidence that viable regenerative cell counts decrease with age. In fact, the highest yield we have seen was in a woman in her late seventies. A few tubes of blood are also drawn for extraction of platelets and regenerative factors.
On the same day, after extraction of regenerative cells, platelets and growth factors, these are injected in the affected area. This is usually a 5-10 minute procedure, requiring only local anesthesia and quite similar to injections of cortisone many patients have previously experienced.
Patients are up and walking immediately after the procedure, usually only with minor soreness for a few days to a week. There is no anesthesia or period of bed rest with their associated risks.
Any medical treatments are always a very personal choice, and the deciding factors unique to each patient. That being said, chronological age is far less important that overall health and the degree of discomfort being experienced when considering treatment options for joint pain.