Mesenchymal Stem Cells as an Alternative to Knee Replacement Surgery Elizabeth Hartman, PhD, RN, Michelle Villegas-Downs, MS, RN DePaul University, Chicago, IL 60604 BACKGROUND Pub Med CINAHL Complete Number of studies found using keywords 227 42 Number of studies meeting inclusion criteria 98 10 Number of studies after excluding duplicates 88 Number of Studies after exclusion criteria 23 7 Number of studies selected based on total content 3 Total number of papers utilized FUTURE DIRECTION Knee osteoarthritis is a chronic, degenerative disease that indiscriminately affects all races, ages and genders Current estimates indicate that by 2030, 67 million Americans will suffer from knee osteoarthritis The treatment option for knee osteoarthritis is total knee replacement surgery, which carries significant risks for complications Recent research has proposed the use of mesenchymal stem cells as a non-operative treatment modality for knee osteoarthritis A standard protocol for mesenchymal stem cell retrieval, implantation and follow-up procedure must be established Large scale studies must be conducted to determine the long term safety and efficacy of mesenchymal stem cell use for the treatment of knee osteoarthritis before the procedure becomes standard practice NURSING IMPLICATIONS Nurses can educate patients on alternative treatment options available for knee osteoarthritis; thus, opening the opportunity to enroll patients into active clinical trials Nurses must be able to recognize and advocate for patients that would benefit from alternative treatments like mesenchymal stem cell injections before their condition progresses significantly enough that total knee replacement is inevitable Nurses can use their advocacy skills to improve and change health policy, thereby influencing the way the government makes health care decisions and allocates funding for research PURPOSE Investigate the safety and efficacy of mesenchymal stem cell injections as a treatment modality for patients with osteoarthritis Evaluate patient outcomes when using mesenchymal stem cell injections as treatment for knee cartilage repair RESULTS Mesenchymal stem cells can effectively regenerate cartilage by self-renewing and differentiating into chondrocytes, adipocytes, and osteocytes Studies in the clinical phase have reported increased cartilage growth, better joint function and less pain for clients treated with mesenchymal stem cell injections Selecting the appropriate mesenchymal stem cell retrieval and application method can lead to a stronger therapeutic response Pain after the procedure was the most common adverse effect reported post mesenchymal stem cell injection Patients receiving bone marrow concentrate reported the least adverse effects Results in the pre-clinical and clinical phase have demonstrated the efficacy and safety of mesenchymal stem cell use for the treatment of knee osteoarthritis RESEARCH QUESTIONS 1. Have clinical trials been conducted using mesenchymal stem cells as a treatment modality for knee cartilage repair in patients with osteoarthritis? 2. What are the risks of injecting mesenchymal stem cells into damaged knee cartilage? 3. What are the reported benefits stated by clients who have undergone mesenchymal stem cell injections? REFERENCES Centeno, C. J., Al-Sayegh, H., Freeman, M. D., Smith, J., Murrell, W. D., & Bubnov, R. (2016). A multi-center analysis of adverse events among two thousand, three hundred and seventy-two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. International Orthopaedics, 40(8), 1755–1765. doi:10.1007/s00264-016-3162-y Freitag, J., Bates, D., Boyd, R., Shah, K., Barnard, A., Huguenin, L., & Tenen, A. (2016). Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy - a review. BioMed Central Musculoskeletal Disorders, 17. doi: 10.1186/s12891-016-1085-9 Li, M., Xiao, R., Li, J. B., & Zhu, Q. (2017). Regenerative approaches for cartilage repair in the treatment of osteoarthritis. Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2017.07.004 Martin, G. M., Thornhill, T. S., & Katz, J. N. (2016). Total knee arthroplasty. In D. E. Furst (Ed.), UpToDate. Retrieved from http://www.uptodate.com/home/index.html Uth, K., & Trifonov, D. (2014). Stem cell application for osteoarthritis in the knee joint: A mini-review. World Journal of Stem Cells, 6(5), 629–636. doi:10.4252/wjsc.v6.i5.629 Wyles, C. C., Houdek, M. T., Behfar, A., & Sierra, R. J. (2015). Mesenchymal stem cell therapy for osteoarthritis : current perspectives. Stem Cells and Cloning: Advances and Applications, 8, 117–124. https://doi.org/10.2147/SCCAA.S68073 Yubo, M., Yanyan, L., Li, L., Tao, S., Bo, L., & Lin, C. (2017). Clinical efficacy and safety of mesenchymal stem cell transplantation for osteoarthritis treatment: A meta-analysis. PLoS ONE, 12(4). doi: 10.1371/journal.pone.0175449 CONCLUSION Knee osteoarthritis is a degenerative disease that causes a myriad of symptoms including disability and persistent pain Presently, the treatment of choice for chronic knee osteoarthritis is total knee replacement surgery The findings of this literature review show regenerative medicine is a safe and effective treatment modality for joint preservation and restoration in knee osteoarthritis MATERIALS AND METHODS A systematic integrated literature review search within the databases CINAHL Complete and PubMed Terms that were searched while researching the topic include mesenchymal stem cells and knee osteoarthritis