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Ubercool,I have good news and bad news. The good news - Lipogems is available in the U.S., you do not need to travel to Europe. Lipogems has not explicitly been approved for arthritis, I'll spare you the legal details. But the procedure is legally available and you can find a provider off Lipogems' site.The bad news - based on the radiology report you shared, your medial compartment appears to be too far gone to expect anything meaningful from MFAT.Recommend seeing a knee surgeon who also has a sideline doing regenerative, like Dr Vangsness. This type of physician will not push regenerative if they think it's meaningless, given they have a mainstay surgery business. If you go to a "stem cell clinic" (tend to have "regenerative" in their business name), some of the better ones may turn you away but I suspect most will be happy to take your money, possibly arguing that you don't know if it'll work until you try it.Best!
Yes, Ubercool, Dr Tremolada is the driving force behind Lipogems. Have not dealt with him directly. There are parallels in some respects to Dr Centeno in that one needs a major entrepreneurial drive to translate research into practice. Dr Centeno has had his critics, he's taken flak in this forum, too. I haven't seen similar attacks on Dr Tremolada. A lot of good research is done by pure academic types, languishes in journals, and gets nowhere fast. And then there is the not so good research.If you consult with Dr Tremolada it would be great if you let the forum know of what he says in your situation. I am open to trying MFAT even though I hold no high hopes. A lot of people spend $3-4K on a beach or cruise vacation, basically eating and lounging around. I am willing to spend that kind of money on my knees. May not work but I would sooner kick myself for not trying. I am at an earlier stage of this disease where any supposed benefit is more likely. Otherwise I am trending in your direction and in 15-20 years may well be where you are now, if not sooner.
This thread has been a very interesting read.Useful to know that 'regenerative' options are still pretty sketchy. Knee replacements seem like the only 'proven' solution.My surgeon warned me (in 2012, age 49) that my partial (1/3rd) medial menisectomy may well lead to arthritis later on. The fact that I continued to cycle hard before the menisectomy with the loose piece flopping around did me no favours at all, as it caused chaffing on my femur cartilage which still gives me grief today.My approach now is to work on strength & balance issues, try to manage my weight (increasingly harder in middle-age) while still training/racing shorter triathlons in an attempt to stave off replacement, and still do a little of the sport I enjoy (Ironman aspirations are on hold - maybe I'll have a crack at my one and only in my late 60's or 70's if I'm lucky). But it is a very fine line that I sometimes stray across = medial pain.
Ubercool,I had read this study in Sep. 2021 and now re-read it so I can comment while fresh. I won't dwell on the fact the study design is a prospective case series, i.e. lower level of evidence (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/). The study was good in that it tried to answer an important question - what baseline characteristics of KOA make for a better or poorer response to Lipogems MFAT.The good news for you is that age was not an issue at 12 months - younger patients (<=50 y.o.) responded more quickly at 3 months but by 12 months the older ones had caught up.The bad news is that the presence of bone marrow lesions (BML) is a huge negative for effectiveness. I can't recall if you had BML but you have osteophytes and these tend to be correlated (https://pubmed.ncbi.nlm.nih.gov/28115233/). Also, medial meniscus damage, esp. to the posterior horn, is a negative, at least at 6 months. (I am in this camp too with a complex medial meniscus tear involving the posterior horn).Don't worry too much about the initial inflammatory flair. Such a flair was actually associated with a stronger 12 month response, you'd want some early inflammation. The study also briefly compares against other injectables and notes such flairs are common after PRP, too. I have had 6-7 PRP shots and I found the inflammatory flairs quite manageable (no medication needed).Some discomfort at the adipose harvest side is well known to occur and some clinics advise the wearing of a compression belt for 24-48 hours. Eventually this resolves. Could lead to minor cosmetic changes, e.g. a dimple. Not sure whether you can "iron" these out eventually through nutrition, in any case minor stuff compared to the knee.You have to be fully prepared that you are not the ideal patient. Responder/non-responder is not a boolean division, see the chart on p.4. Quite possibly you could end up a "low responder".As previously discussed, the alternative is TKR or maybe unicondylar KR. Please see ref [5], Evans et al in the Lancet about how long these last. You may be ok if you go straight to TKR/UKR now but if you live long and need a revision in your 90s I am not sure how many docs would do revisions in patients 90+, that's something you could explore. If docs won't do revisions 90+ and you are in pain, then you could be on opiates until the end of your days.Yes, effectiveness of stem cells is sketchy. Because there is no going back from TKR, if cash is not an issue trying a stem cell treatment seems defensible to me given lack of serious complications. If it doesn't work, well at least it's been tried and then a TKR/UKR could be done knowing full well there is no other option left (not seriously counting joint distraction, https://pubmed.ncbi.nlm.nih.gov/28618871/). If there is some effectiveness from stems then, of course, this is good news. If the effectiveness is low, maybe not bother with repeats - start making plans for TKR/UKR. If the effectiveness is moderate then repeat shots could be worthwhile.Best!
I've been biting my tongue pretty hard reading most of these posts. Glad to see it changing direction.