April 17, 2008 -- With the dexterity of a carpenter, the finesse of a master chef and the tools of a painter, Dr. Thomas Einhorn uses stem cells to do something on the cutting edge of science: grow brand new bone. Today, orthopaedic stem cell surgery earned significant backing from the federal government, which announced plans to dedicate $85 million for the creation of the Armed Forces Institute of Regenerative Medicine (AFIRM) to fund this procedure for veterans injured in Iraq and Afghanistan.
The hope is that the new funding will offer wounded soldiers a chance to heal from injuries that might otherwise have left them unable to return to work, or even walk.
'His Own Live Cells'
Einhorn, the chairman of orthopaedic surgery at the Boston University School of Medicine and Boston Medical Center, used stem cells to try to repair a patient's hip, after seven conventional surgeries had failed. It was the first time he had attempted this specific surgery, which to the untrained eye looks a little like spray painting.
"That's the excitement for me," Einhorn said. "To develop new things and help people as a result."
Orthopaedic stem cell surgery has been practiced by only a handful of doctors nationwide. Proponents complain that medicine involving adult stem cells is underfunded because it is often confused with controversial embryonic stem cell research. But the stem cells Einhorn uses don't come from embryos; they come from the patients themselves.
"His own live cells," Einhorn said.
Einhorn extracts stem cells from the patient's bone marrow, drawn from the pelvis. Some is used for what Einhorn calls "grout."
"By mixing the bone marrow cells with protein, it gives me a kind of a grouting material that I can use to fill in the gaps," he said.
Dr. George Muschler, who pioneered the surgery at the Cleveland Clinic in Ohio, which is a grant recipient, said, "I think [the procedure] has applications to some challenges that might have previously cost patients their leg, because we didn't have a way to heal their bone."
Muschler has been monitoring patients in the past six years, and says he is convinced that the method results in the growth of strong, new permanent bone.
Monique Biggins, 44, was one of the first to try the surgery. A classically trained pianist, nurse and mother, she suffered a debilitating injury indulging her lifelong passion for playing softball.
"I was running after a line drive and my foot got kind of stuck in the turf and my body weight was propelled forward and the shoulder took all that impact," she said. "And as soon as it happened I knew something was wrong. At first I thought I dislocated my shoulder, not realizing I fractured my clavicle."
In 2002 Biggins underwent multiple surgeries during a two-year period but nothing — including the insertion of a plate and five screws — worked. In time, her spirits were just as shattered as her collarbone.
"It was devastating because I couldn't play softball, couldn't play my piano, I couldn't do anything," she said.
And she'd been told by her doctor there was nothing more they could do to fix her collarbone.
"He said 'you know, this is the worst broken collar bone I've ever seen,'" she added. "It was actually fractured in two spots. There were two breaks in the bone and he said 'I don't know what to do with you.'"
Biggins had heard about pioneer Muschler because she was a nurse at the Cleveland Clinic, and agreed to try the experimental surgery.
"I was in such a bad place with my shoulder at that time; I knew anything could help," she said.
Said Muschler: "I'm always inspired by Monique in particular in the way she initially sought out care with the courage to be one of the first people to accept this technique and be willing to undergo it."
After Muschler explained the procedure, Biggins said it "made total sense" to her. "I thought 'it sounds great,'" she said. "Otherwise, I had nothing else to do."
As for Muschler's part, "the way I explained this, we don't know if it's going to work any better, we don't know if it's going to work at all, although it seems to work in every place we've tested it so far."
And the results?
"It was a miracle," Biggins said. "It really was. Just like a miracle. Because you could see it in the X-ray, there's just like a gap, there's no bone, and then later on it's a solid bone."
Stem cells healed Biggins bones and turned her life around. The U.S. government is now banking that the same surgery that lets Biggins play softball and the piano will provide new hope to wounded veterans.