Frequently Asked Questions

The Regenerative Clinic team aims to make your patient journey as seamless as possible and we are committed to providing you a personalised service and the highest standard of care.

We can offer you an initial free 10 minute telephone call with one of our consultants to discuss your condition and answer your questions directly. Please click here to complete the form on this page to book your session.

Please read a selection of answers to our most frequently asked questions around costs and pricing.

We hope you find our answers helpful. Please do call us on +971 55 6568787 with with any queries that you may have, we are always happy to answer questions.

About Stem Cells

The human body is made of a variety of different types of cells that come together to perform various functions. In comparison, this is much like a city. In order for the city to function there are groups of people that perform different tasks. Policeman keep the peace, cleaners keep the streets clean, water work engineers make sure that households have water and healthcare professionals look after the sick. Different groups of cells in the body perform functions in much the same way. The kidneys filter and clean the blood, the muscles allow us to move our bodies and our skeleton has a support function which works in synergy with the muscles to allow us to move. 

Similar to how individuals can be trained into different professionals, stem cells are groups of cells that have the potential to become any of the specialist cells in the body such as muscle, skin, bone, cartilage and blood. 

Embryonic stem cells are derived from the undifferentiated inner mass of an embryo. They are able to multiply and grow into a human being when in the womb. 

The use of embryonic stem cells for medical treatment is currently against the legislation. They are under very strict conditions with scientists being able to study them but not use them in any treatments unless part of a research study.

Pain in other parts of the body, particularly the lower back, can also cause pain to appear in your hip – this is known as referred pain. Read more on stem cells.

Embryonic stem cells

Embryonic stem cells are derived from the undifferentiated inner mass of an embryo. They are able to multiply and grow into a human being when in the womb. 

The use of embryonic stem cells for medical treatment is currently against the legislation. They are under very strict conditions with scientists being able to study them but not use them in any treatments unless part of a research study.

Pain in other parts of the body, particularly the lower back, can also cause pain to appear in your hip – this is known as referred pain.

Adult stem cells

Adult stem cells are found in the fully-grown human and have potential to differentiate into various tissues such as nerves, muscles, bone and cartilage.

These cells are less versatile than embryonic stem cells but can divide to replenish dying cells and regenerate damaged tissues. Read more on stem cells.

Minimally-manipulated stem cells

Adult stem cells can be harvested from parts of the body which can be rich in these cells. These tissues include bone marrow and fat. Once removed they are then processed in a very minimal way before being used for treatment. This tends to mean that the cells are not cultured or altered in a laboratory before being used for treatment.

Minimally-manipulated stem cells are termed as such because they maintain the normal architecture of the body tissue that they have been retrieved from but are not subject to the same rules.  

Manipulated stem cells

These cells are harvested in the same way however following removal from the body the stem cells are separated in a laboratory. These cells are then grown and multiplied under strict laboratory conditions before being used in a separate procedure for treatment. This process of manipulating stem cells is not allowed by legislation both in the UK and the European Union if they are being used for treatment. These techniques are allowed by the government for scientists to study and are occasionally used under very strict regulations in research studies run by various Universities.

Read more on stem cells.

There are two main types of stem cells in the adult. One is in the bone marrow and the other is found in fat (adipose) tissue.

Fat derived stem cells

Stem cells derived from fat are also known as ‘Stromal Vascular Fraction’ cells. A component of these cells are called ‘pericytes’. These are cells that sit around all small blood vessels of all tissues in the body; ‘peri’ meaning around and ‘cyte’ meaning cells. These ‘pericytes’ are thought to then become stem cells which then can be used in the treatment of various conditions. Fat is an easy place to access these cells as it lies directly under the skin and is quick and relatively painless to harvest. This procedure called ‘lipo-aspiration‘, which is very similar to ‘lipo-suction’ performed by plastic surgeons for aesthetic purposes.

Bone marrow derived stem cells

Bone marrow stem cells are harvested with a technique called ‘bone marrow aspiration’ which involves drilling into the bone of the pelvis and sucking out some of the soft tissue from inside. This bone marrow is then usually centrifuged to concentrate the stem cells. It has been shown that the quality and the concentration of bone marrow stem cells deteriorates as we age. Younger individuals will have better functioning and greater numbers of stem cells in their bone marrow compared to an older individual. 

Read more on stem cells.

There are a number of ways that stem cells can work. In the laboratory, using very complex techniques, stem cells can become different kinds of tissue cells such as bone or cartilage. They are placed on scaffolds and then placed inside the diseased parts of the body to try regenerate these areas. This technique has been performed for the past twenty years and scientists have found varying degrees of success when trying to treat numerous diseases including arthritis.

More recently, scientists have realised that stem cells do not necessarily turn into a variety of different cells types within the body but it maybe that they act as marshals in guiding the regenerative process within the tissues that are injured. The stem cells work by secreting a variety of chemicals that act in the injured tissues. These chemicals help in the clean up of the damaged tissues and then work to recruit the undamaged parts of the same tissue to start regenerating and replacing what has been lost. 

Read more on stem cells.

“MSCs are one of the body’s greatest natural healing forces. Over the coming years there is no doubt that they will be utilized more frequently as the driving force behind new treatments that will improve healing and regeneration of tissues throughout the body”.

Mesenchymal cells are a subgroup of stem cells. They are only capable of making a certain type of tissues such as bone, cartilage, muscle and fat.

They originate from the primordial ‘mesenchymal’ tissue during embryological development. They have the unique capacity to recognise their environment within the body and release signals and chemicals that protect against damage and injury and enable healing and regeneration; in addition, they have the capability to multiply and to convert into skeletal tissues to help produce new cartilage, bone or fat (known as tri-lineage differentiation). Originally identified within the bone marrow, these adult multipotent cells are present in even higher concentrations within fat tissue living on the surface of blood vessels, and in other organs and tissues at lower concentrations (placenta, cord blood, dental pulp et al).

They were originally described as MSCs by Arnold Caplan in 1991 referring to them as ‘medicinal signalling cells’ that can be identified by their expression of markers on the cell surface which include OCT4, Nanog and Sox2, CD73, CD90 and CD105 and a lack of blood cell markers such as CD34 and CD45. They also form colonies known as colony forming units [CFUs]. 

Fat or adipose-derived MSCs are of particular interest since here they are found in the highest natural concentration within the body, extraction from the fat is far easier than for bone-marrow, and there is no reduction in numbers or potency/capability as we age. There is therefore a great potential to utilize these cells in the treatment of injury and disease.

Read more on stem cells.

MSCs react to injury by lifting off the surface of the blood vessels and moving towards the area of damage where they begin to produce very high concentrations of tissue and cell specific targeting substances known as growth factors, cytokines and microRNAs, that support, maximize and direct self-repair and regeneration. These secretions significantly support recovery by:

  • Blocking excessive inflammation; primarily through production and local secretion of molecules such as TSG-6 and IL-1R-alpha antagonist that can clean, clear and completely attenuate the pathological ongoing inflammatory condition thereby enabling and promoting the healing process and at the same time providing long-term pain relief.
  • Scar-less tissue healing and regeneration; MSCs produce vast quantities of molecules that support tissue regeneration including SDF-1, HGF, TGF-beta and VEGF that cause the host tissue to react producing more of its own healing substances creating the perfect environment for repair. When these cells have been injected or implanted into damaged joints, the natural healing processes of the body are vitalized and maximized
  • Innate immunity; MSCs can modify the body’s own immune responses. They secrete substances including IL-6, IL-10 and PGE2 that interact with the body’s white blood cells e.g. T-lymphocytes, instructing them to block inflammatory pathways, create the M2 type of anti-inflammatory macrophages, and significantly increase anti-bacterial activity protecting the injury site from infection.

Long-term delivery of this ‘medication’ is provided due to the extraordinary capability of the MSCs to release these substances enclosed in tiny parcels known as exosomes, and this provides a long-term capacity of delivery to be maintained, as long as the viability (capability to remain alive) of cells or tissue is maintained inside the body. Meaning that the beneficial effects could continue for months or years as long as the MSCs remain resident at the site of the injury. This has been shown to be the case particularly when they are used in conjunction with a carrier such as the original fat of origin which makes them ‘sticky’ and in effect constitutes a type of tissue graft rather than a simple injection of cells. The MSCs seem to have an ‘intelligent’ perception of where they are since the content of and release of the exosomes and other secretions as well as, ultimately, the fate of the MSCs, is determined by the environment in which they reside.

For example, a highly inflammatory, hypoxic (low oxygen) environment often seen within an osteoarthritic joint will induce the MSCs to develop what is known as a Th1-phenotype- concomitantly releasing more anti-inflammatory molecules and providing enhancement of osteogenic and angiogenic (production of new blood vessels to aid healing) potential. There is an enormous potential to more highly ‘tune’ (optimize) the MSCs making them even more fit for purpose depending on the place within the body and the type of treatment required and this demonstrates a great future capability and capacity as a key therapeutic for healing.

Read more on stem cells.

There are currently over 1000 FDA-registered clinical trials, utilizing MSCs, ongoing with >20 at phase-3 (used in the treatment of patients) world-wide. An excellent safety profile has been observed over this period. A clinical indications prediction scale (CLIP) based on the capability of a particular donor sample to activate protein markers in vitro, can be used to define the activity of a population of MSCs. This could help in future to predict probable super responders as well as those that may require optimization or alternative strategies in order to benefit from the treatment.

Repair or regeneration of body tissues is an extremely complex process, and one requiring concerted and coordinated interaction of many different cells and substances-for this reason it ultimately has to be a process organized from within the body. However, the evidence is clear that supplementing the tissue with MSCs can strongly assist and support the natural healing processes.

Read more on stem cells.

There are many misconceptions around the use of stem cells. Below are two main examples.

1. That embryos and foetuses are destroyed in order to provide stem cell treatments 
This is clearly not the case as the use of embryonic stem cells is illegal in both the United Kingdom and in Europe. The stem cells that are used for treatments are from an adult which are harvested from the same individual that is being treated. 

2. That stem cells can cure absolutely everything
This is certainly not the case as with any treatment modality, there are failures. In most orthopaedic treatments anywhere between 5-30% of individuals having a surgical procedure end up not having the full benefits that the surgical procedure intends. It is the same with a variety of non-surgical treatments including physiotherapy, manual therapy, injections of various compounds including steroids and of course, stem cell treatments. 

Read more on stem cells.

What is Platelet Rich Plasma therapy? Platelet Rich Plasma (PRP) is derived from the blood. Blood has two main components, the fluid (the plasma) and the cells. The Red Blood Cells transport oxygen and the white blood cells are part of the immune system.  The blood is taken from a vein in the arm and placed inside a centrifuge to spin the blood. Spinning separates the red and the white blood cells from the plasma which is in the fluid portion of the blood. Within the plasma there are tiny fragments called platelets, which along with the plasma, form clots. The clots are usually formed where the body is injured and within these clots are various chemicals and compounds that are integral to the healing process. PRP has been used for over 20 years to treat a variety of conditions including inflammation around tendons as well as arthritis in joints.

How does it differ to Stem Cells therapy?
PRP includes a number of compounds that the body uses for the healing process. It is thought that MSCs are the factories that produce these compounds. The difference is between the battery and the generator. The PRP is much like a battery which is pre-loaded with a certain amount of electricity, whereas, a generator (stem cell) can go on to generate as much electricity as is required. The cells are the factories which produce the compounds used for the healing process in great variety and amount.

Read more on stem cells.

About Lipogems® and the Regenerative Clinic

This procedure has been available worldwide for approximately 7 years.  In the UK, it was first started by the Regenerative Clinic 2.5 years ago. 

This procedure has been available worldwide for approximately 7 years.  In the UK, it was first started by the Regenerative Clinic 2.5 years ago. 

At the Regenerative Clinic, we have treated approximately 5,000 patients and a total of 900 joints.  We are by far the largest and busiest group in the Europe and the UK using this technology.  There have been approximately a further 100 individuals who have been treated in other centres across the UK, which of course, do these in much lower volume.  Worldwide, it has been used to treat over 35,000 patients with surgeons all reporting great results. 

Although fully FDA approved, this treatment is still undergoing assessment.  There are many studies that clearly demonstrate its efficacy but in order for new and novel treatments to become available on the NHS or covered via private medical insurance, there is invariably rather complex processes that may take a number of years before acceptance.  A good example of this is the use of platelet rich plasma which, although having been around for approximately 25 years, is only recently finding its way to the NHS and is now being offered across various NHS trusts in the  UK.  There still continues to be some insurance companies that do not approve platelet rich plasma despite overwhelming evidence of its benefits.

We have treated a number of patients with auto-immune conditions such as rheumatoid arthritis that predominantly effects joints, however, the numbers are small, some have responded, and some have not but it is difficult to draw general conclusions about autoimmune conditions.

The Lipogems® procedure

The cells that we’re interested in collecting are called pericytes (Mesenchymal cells) as these cells have naturally regenerative properties, there’s a very high concentration of these cells in your fat tissue, what we call adipose tissue.

Quite simply what we do in the Lipogems® procedure is we remove a small amount of your fat tissue from your tummy. We then put this tissue in a closed loop system and wash it with a saline fluid to get rid of any of the impurities and then re-inject the tissue back in the joint being treated.

The pericytes then get to work at regenerating and rejuvenating the damaged structure including cartilage. It also helps lubricate the joint and reduce inflammation. It can also act on nerve endings in your joint to relieve some pain.

The procedure itself is performed in just under one hour and you are free to leave the clinic the very same day.

The cells that we’re interested in collecting are called pericytes (Mesenchymal cells) as these cells have naturally regenerative properties, there’s a very high concentration of these cells in your fat tissue, what we call adipose tissue.

Quite simply what we do in the Lipogems® procedure is we remove a small amount of your fat tissue from your tummy. We then put this tissue in a closed loop system and wash it with a saline fluid to get rid of any of the impurities and then re-inject the tissue back in the joint being treated.

The pericytes then get to work at regenerating and rejuvenating the damaged structure including cartilage. It also helps lubricate the joint and reduce inflammation. It can also act on nerve endings in your joint to relieve some pain.

The procedure itself is performed in just under one hour and you are free to leave the clinic the very same day.

We carry out nearly all of our procedures with our patients sedated, this means they are awake but very comfortable. Throughout the procedure an anesthetist will look after you to ensure you are happy. You can opt for local anesthetic only or alternatively we carry out some procedures under general anaesthetic e.g. facial and spinal treatments. 

It’s a very small amount of fat, around 50ml, around the size of an espresso cup this is for one joint. This is then reduced to approx 5ml which is injected into each joint.

The Lipogems® procedure is a good alternative to major replacement surgery. The procedure is minimally invasive with a minimum recovery time. You do not have to go under general anesthetic and they are comparatively priced.

The harvesting of stem cells from bone marrow is an invasive treatment, conducted under general anesthetic that can be very painful. The mesenchmyal cells present in the fat tissue are easier and less painful to access. There is also research to show that the quality of stem cells in bone marrow decreases significantly as you get older, especially in women. Age and gender has no effect on the quality of stem cells present in fat tissue. Both methods of harvesting have been tried, tested and have proven to be very affective.

The Lipogems® consultation

Yes of course, we have a large team of orthopaedic consultants who specialise in different areas of the body. We can arrange for you to have some imaging done of the extra joint if you do not have any already and for you to meet with the relevant specialist. 

Yes of course, we have a large team of orthopaedic consultants who specialise in different areas of the body. We can arrange for you to have some imaging done of the extra joint if you do not have any already and for you to meet with the relevant specialist. 

Our clinicians are orthopaedic surgeon consultants who are specialists in joint preservation and rejuvenation. They will be able to discuss all traditional orthopaedic surgery and other regenerative options with you, not just Lipogems®. If the clinician thinks you are not suitable for Lipogems® they will suggest an alternative course of treatment. 

The outcome of Lipogems®

We have kept a registry of all of the patients that have been treated and we have found that 75% of all patients treated have had a positive outcome with improvements in both pain scores as well as functional scores.  The level of improvement for the treatment in our knee arthritis patients has been equivalent to the improvement seen in a total knee replacement in severe arthritic group.

We have kept a registry of all of the patients that have been treated and we have found that 75% of all patients treated have had a positive outcome with improvements in both pain scores as well as functional scores.  The level of improvement for the treatment in our knee arthritis patients has been equivalent to the improvement seen in a total knee replacement in severe arthritic group.

There are a number of different patterns of response to this treatment.  There are some individuals who have an immediate effect with a profound reduction in their symptoms.  Others demonstrate an initial increase in their symptoms following the injection but then things settle down and they slowly improve.  Interestingly, some patients having hip Lipogems have a slower response with sometimes a 3 week period before the benefits start appearing.  In some of our patients, they continue to improve after 3 months. Most patients improve from 6 weeks and we tend to see patients improving most between 3 and 4 months after the procedureThis may be due to the fact that by reduction of the pain in the joint, the muscles then start regaining some of their strength and the control which is achieved by the strengthening of these muscles further stabilises the joint improving symptoms.

This treatment has been undertaken by a number of our colleagues in Europe for almost 4 years.  Some of those treated have reached 3 years and it appears that in those who respond, in the first year, this response may well be maintained for up to 3 years.  Some feel that a “booster” injection of Lipogems may be necessary at 2 years but the numbers for these are small and are only the personal case series of these surgeons.  

We have not noted any adverse outcomes.  In cases where the treatment has not worked, it has been the natural progression of the disease.  This treatment does not interfere with any future interventions required for the knee.  There is no evidence that it will interfere with having a total knee replacement.

The procedure is very safe and the risks are minimal. All procedures including an injection do come with risks. However, some patient experience mild bruising from the fat harvest site. The biggest risk is that this doesn’t work and this is 25%.

In our experience only 25% do not respond and it is difficult to predict which patients will not benefit.  However, it does seem that the patients across all grades of arthritis benefit in a similar way with 3 out of every 4 having reduction in pain and improvement in function.   Currently we find it difficult to predict the responders and non-responders prior to undertaking the procedure.

The effect of steroids on the Lipogems is thought to be detrimental and not advised.  We have no direct experience of this because we advise patients to leave a time of at least 3 months between the steroid injection and the Lipogems treatment in order to make sure that the joint returns to a normal state, therefore gaining full benefit.

The Lipogems® technology has been used successfully on patients with all stages of arthritis, that being said, each case is unique and that is what is so important about the consultation. Our clinicians can offer all conventional surgery but are also specialists in joint preservation and rejuvenation and will be able to assess your individual suitability for the procedure. This is why the clinical assessment is so important and it means the patient is receiving some of the top care in the country.

We don’t generally advocate injecting into joints that have had a joint replacement.  In this case, we would certainly recommend a review by one of our specialists before any further treatment is advised.

If the treatment does not work, we can try other forms of injections including platelet rich plasma and hyaluronic acid.  In some cases, the injection of these other substances can trigger a response.  In cases where there is a deformity in the limb which is a cause for mechanical symptoms, this can be corrected with osteotomy surgery and in cases of instability around the joints, particularly in the shoulder, the elbow and the ankle joint we can also offer reconstructive surgery to stabilise the joint and mitigate the symptoms.

After the Lipogems® procedure

Prior to the procedure it is important to continue with your normal activities and exercise.  If these activities cause pain, it is important to reduce the activities to avoid pain but by exercising and continuing to be active, muscle tone and strength is maintained and balance will continue to improve.  These are very important features in the post-operative rehabilitation as well. Once the pain in the joint is reduced, it then becomes very important to exercise in order to regain muscle tone, muscle strength and then rehabilitate balance.

Prior to the procedure it is important to continue with your normal activities and exercise.  If these activities cause pain, it is important to reduce the activities to avoid pain but by exercising and continuing to be active, muscle tone and strength is maintained and balance will continue to improve.  These are very important features in the post-operative rehabilitation as well. Once the pain in the joint is reduced, it then becomes very important to exercise in order to regain muscle tone, muscle strength and then rehabilitate balance.

We advise patients to be prepared to take up to 2 weeks off.  The purpose for this is the site of lipo-aspiration can be uncomfortable and will take a number of days to improve.  Occasionally, if the joint has also become a little bit uncomfortable and swollen following the injection, it would be best to reduce activities to allow the joint to settle down. Post-op patients will experience a dull aching pain in the joint for 2-3 days, however the pain is not debilitating and can be managed with regular strength painkillers.  

Before your procedure, you receive a physiotherapy guide with some basic exercises to aid recovery following procedure. After your procedure, you receive post-op pack including: post-op care leaflet, discharge summary medication and extra dressings. The post-op leaflet outlines ‘do’s and don’ts’ before and after your procedure and provides an out of hours number to get in-touch with our clinical nurse. You will also have a follow-up appointment with your consultant at 6 weeks so we can monitor your improvement. 

We value the importance of measuring outcomes and the ongoing assessment of each patient having treatment. In order to allow us to assess the success of your procedure(s) we are interested in the short and long term effects of your treatment, in you as an individual, as well as in comparison with other patients treated. To do this we carry out important pre-operative and post-operative questionnaires. Before your procedure we ask you to complete a questionnaire and then complete this again at 3, 6 and 12 months, then finally after 2 years. Thank you in anticipation for your help with our important research and audit, not only will this allow us to monitor your progress, your contribution (which will be anonymised) will contribute to our evidence based database and other global studies as we continue to evaluate the growing evidence for the treatment itself.

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