I was at the airport and ran into Dr. Watanabe of the Mt. Baker Pain clinic in Bellingham, Washington. Dr. Watanabe actually flies around the country teaching other physicians the techniques and applications for platelet rich plasma (PRP) and stem cell injections – so he is on the leading edge of the newest developments in this emerging field of bio-medicine.
We got talking about stem cells (isn’t that what most people talk about at the airport?)…as the great hope for treating and repairing damaged knees. Before I get into the specifics of the surprising news that he shared, let me just back up to briefly summarize how stem cells work.
Very briefly, stem cells are the “raw materials” – cells that haven’t yet decided what they want to be when they grow up. The medical thought is that when stem cells are placed in a area needing repair (eg your torn knee cartilage), that they will stimulate repair.
For a more thorough discussion of stem cells and all of the types of knee pain relief injections, click here for my article titled Will Injections Help Your Knees? Corticosteroids, Viscosupplementation, Platlet-Rich Plasma, and Stem Cells.
Dr. Watanabe told me that there may be some concern about using the “whole” stem cell. Think of a cell like a fried egg. The yolk is the nucleus and holds the majority of the DNA. Remember, DNA is unique genetic code for each individual. Instead of using the whole cell, there is a process now to leave out the “yolk” (nucleus – their could be concerns about introducing others DNA in this way) and use the “white” which which has a component called (drumroll please) EXOSOME.
I just like saying the word… EXosome. EXOSOME. It sounds like it should have superpowers and a cape. Its actually a nanopartical that is responsible for cell to cell communication. When harvested from stem cells and injected in the knee, it has the capability (as do stem cells) to stimulate tissue regeneration. 
Dr. Watanabe says that he is getting away from stem cell applications in favor of a blend of platlet rich plasma (PRP) and exosomes for half the price of a stem cell application and getting as good or better results.
WOW! That’s GREAT news because stem cell applications can cost $3,000-$10,000 out of pocket where he offers the PRP/Exosome blend around $2,100.
I’m on deck for right total knee replacement (TKR) and, simply put, would rather repair than replace. I don’t know if this is possible given my unique circumstances, but for $2,100 I’m willing to find out. It’s better than the trauma, risk, and cost for a TKR.
I’m set up for an consultation with him for my own knee on May 16th – I will let you know what I learn and if I’m going ahead with the treatment.
I had my left total knee replacement with the Conformis custom knee in November 2017- read all about my knee replacement journey starting here. Don’t get me wrong, I love my new knee, am totally pain free on that side. But TKR IS an irreversible choice, odds are I will have to re-replace it in 22 years (I’ll be 78 years old) and that means more trauma and recovery.
I want to believe that EXOSOMES are the answer – the body of research is mixed for stem cell results. I think there is much to be learned as science and medicine advances with stem cell techniques.
 Theranostics. 2017; 7(1): 180–195.Published online 2017 Jan 1. doi: 10.7150/thno.17133; Shi-Con Tao et al.Exosomes derived from miR-140-5p-overexpressing human synovial mesenchymal stem cells enhance cartilage tissue regeneration and prevent osteoarthritis of the knee in a rat model. Retrieved online 4/12/19 from