Exciting Cellular Orthopedic Debates

Exciting Cellular Orthopedic Debates

Well, it is really an internal debate as to whether I should have a concentrated platelet rich plasma procedure or a bone marrow concentrate procedure as I get ready for the upcoming ski season. While it is true that I exercise five to six days a week rotating between outdoor cycling, strength training and rowing, the demands of skiing on the knees are such that I need to rethink my approach. I share this personal flow of conscience to provide guidance and council for readers of this blog. As for so many of us senior recreational participants, each activity has unique demands so we must anticipate each activity from a separate approach. While generalized fitness improves the quality of life and even well-being, maybe even prolonging life, if you want to ski with arthritic knees, now is the time to plan ahead.

Let me share with you my plan based on an observation of the outcomes in over 1500 patients in whom I have intervened with Cellular Orthopedic alternatives over the past five years. In the next several weeks, I will undergo a concentrated PRP intervention ultrasound guided into both of my knees. I will be using the upgraded methodologies for preparation of injectate and customize the PRP with our soon to be activated cell counter. This will provide me with a 20x dosage over that which has been available up until the present; and yes, I too have to pay for the methodology. I will then wait until mid-December, and if I am not satisfied, I will undergo a Bone Marrow Cell Concentrate procedure for both of my knees.

Below are two reasons received in the last 48 hours as to why I believe Cellular Orthopedic is exciting:

“My uber-condensed version, though, is that on almost all days in the last 8 months, I’ve had virtually no knee pain with daily activity. That’s a massive improvement from even the 12-month follow-up visit. I first started to suspect things were improving at about 10 months post-op. At 12 months, I was hopeful but still skeptical. At 14 months things, rapidly improved and have mainly remained there ever since. So, on the whole, I’m vastly improved. I suppose any number of factors could have contributed to that improvement, but Regenexx certainly seems to have helped tremendously.”

“Attended the company golf outing this past weekend. Last year I was concerned so I took an Advil before we started and ended up taking another halfway through the 18 holes. The last four holes I didn’t even leave the cart (to sore/tight to get in and out).

This year I fully intended to bring the Advil again but forgot it. Turned out I did not need it. Finished the 18 holes like nothing. Felt fine after and the next day.

Believe we can consider this a win!!!!”

Do you want to enjoy relief from arthritic symptoms and limitations?

Call 312 475 1893 to schedule a visit or visit my website to watch my webinar   www.Ilcellulartherapy.com

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The Subchondroplasty Procedure for Bone Marrow Lesions; what is it and when is it indicated?

Assume that you schedule an office assessment for knee pain, altered function and a slight limp. I complete the examination and review the radiograph only to find it “normal”. The examination excludes referral from the low back and hip so the next step is an MRI. 48 hours later I am able to diagnose a Bone Marrow Lesion (BML) as the cause of the problem. The Bone Marrow Lesion is an abnormal area of defect inside the bone. Also called Bone Marrow Edema (BME), they are defects typically found below or adjacent to a joint. They appear a hazy white area on the MRI against the background of darker, unaffected bone and bone marrow. Pathologists have shown that the BML represents a healing response as a result of a bone injury that doesn’t heal properly. In other cases, the MRI finding may be consistent with a stress reaction that forms from overuse or poor joint mechanics.

Obesity and poor diet are thought to increase the likelihood of developing BML. They are more commonly found in middle-aged patients rather than younger patients. Patients with poor joint alignment (bow legs or knock knees) are more likely to develop BML. Adults who quickly increase activity may develop Bone Marrow Lesions or Edema.

As in most initial diagnoses, a course of conservative treatment should be instituted so as to allow the body to heal itself. If the lesion doesn’t heal with medications, braces, non-weight bearing, injections and physical therapy, then an intraosseous injection into the lesion is indicated. Left untreated, the problem may result in the loss of joint support and the development of osteoarthritis.

I treat the symptomatic, non-responsive BML with an intraossous, intralesional procedure called a subchondroplasty whereby Bone Marrow Concentrate rich in stem cells and growth factors is injected into the non-healing insufficiency fracture. Fluoroscopy is used (intraoperative X-ray) to guide the placement of a special drillable cannula into the bone defect.  At times, should the BML be of sufficient size as to cause me to be concerned about a possible fracture, I will use a Calcium Phosphate preparation in addition to the Bone Marrow Concentrate. The engineered Calcium Phosphate readily fills the subchondral defect and mimics the properties of cancellous bone eventually being resorbed and replaced with new bone.

Most Orthopedic Surgeons believe that Chronic Bone Marrow Lesions will not heal without intervention. Additionally, the pain generator in osteoarthritis diagnosed by narrowing of a joint space may in fact be secondary to a BML. Bone Marrow Edema and lesions were among the topics I reviewed during my Instructional Programs in St Petersburg, Russia, two weeks ago. To learn about chronic joint pain with a “normal “or even abnormal X-ray, call for a consultation and evaluation.

312 475 1893

Or visit my website and watch the webinar   Ilcellulartherapy.com

Regenerative options for patients receiving chemotherapy, immunosuppression or radiation therapy

Regenerative options for patients receiving chemotherapy, immunosuppression or radiation therapy

There has always been a category of patients for whom Bone Marrow Concentrate derived stem cells and growth factors were not a viable option. Patients who have received or are receiving chemotherapy, radiation therapy or immunosuppression have diminished stem cell viability and actual numbers. Such patients have historically been denied cellular orthopedic intervention; at the same time, they are problematic candidates for a joint replacement. Within the last 18 months, scientific advances are changing the algorithms of regenerative care for patients with symptomatic and debilitating osteoarthritis. I now have several options available for patients who would have been denied interventional orthopedic opportunity; patients who are impacted and limited by Osteoarthritis but for whom there previously was not a viable non-surgical alternative.  

 1. Alpha 2 Macroglobulin (A2M)

A2M is a very large plasma protein found in blood acting as a very strong protease inhibitor; and for patients who meet certain prerequisites, could well be highly effective in the treatment of osteoarthritis. The prerequisite is a synovial fluid analysis looking for the Fibronectin Aggrecans Complex (FAC). While it sounds complex, it is an uncomplicated testing of a sample of synovial fluid easily preformed under ultrasound guidance in the office setting. Recently, A2M became available in a synthetic recombinant format as an “off the shelf” alternative

2. Umbilical cord derived blood and cells

When our first grandchild arrived, our gift was a regenerative one; namely, the gifting of the cost of freezing her umbilical cord should there ultimately be a need for stem cells in her life. Now, there are scientific and pharmacologic interventions available from allograft umbilical cords retrieved at delivery, sterilized and frozen. It is a new but emerging resource with regenerative and pain-relieving potential for patients with osteoarthritis who otherwise have no other treatment options.

3. Amniotic fluid concentrate

While there are no living stem cells in amniotic fluid once sterilized, frozen and fast thawed, hence no regenerative possibility; the anti-inflammatory effect is real and the pain-relieving potential, although limited in duration, is being scientifically documented. Harvested by amniocentesis at the time of a cesarean section in a donor screened for communicable and infectious diseases, it is possible to repeat the intervention after a year should symptoms return. There are now “off the shelf” preparations of lyophilized Amniotic Fluid Concentrate

4. Bone Marrow Concentrate derived stem cells and growth factors

I am in the in the process of developing a protocol to be submitted for IRB oversite wherein a bone marrow analysis would be completed allowing for stem cell and growth factor analysis pretreatment not unlike a bone biopsy for a lesion prior to the definitive surgery. This would allow me a patient specific approach to those who otherwise would not be considered candidates for regenerative autograft options.

 

If you want to learn more about postponing or perhaps even avoiding surgery for a joint that alters your quality of life, call 847-390-7666.

To learn more, check out my web site at www.Sheinkopmd.com

View my webinar at www.ilcellulartherapy.com

Discovering new pathways to healing with stem cells

Discovering new pathways to healing with stem cells

On October 28, 2013, I received IRB approval for a clinical trial with Regenexx Sciences, LLC as the sponsor and me as the Principal Investigator. The study, A Randomized Controlled Trial of Regenexx SD versus Exercise Therapy for Treatment of Knee Osteoarthritis with Historical Comparison to Total Knee Arthroplasty, was undertaken by me because of my recent “graduation” from joint replacement surgery to the new world of interventional orthopedics and because of my 37-year history as a joint replacement pioneer. Earlier this month, I was able to begin forwarding outcomes data to Regenexx in Broomfield, Colorado, for statistical tabulation. The results of this trial will not only impact what and how the Regenexx Network will make interventional recommendations, as the first and most comprehensive study of its kind, it will serve as the basis for comparison of all ongoing and future Regenerative Medicine methodologies for the care and treatment of the arthritic knee.

From Stem cells to Growth factors, the integration of our clinical research and clinical practice is having a major impact within the field of interventional orthopedics. Our results are allowing patients to return to activities they enjoy using a needle instead of a knife. I do not claim to be a cellular biologist but my network now allows me insight into the latest cellular advances. With the incorporation of the Abbott’s Ruby cell counting system into my clinical practice, I now customize the Bone Marrow Concentrate to the individual needs of a patient and thus not only quantitate but qualitate that which I inject into an arthritic joint.

Many Musculoskeletal injuries and certainly arthritis, do not heal with conservative management and historically required surgical intervention. The most contemporary method of effecting healing and regeneration is both Platelet Rich Plasma and Bone Marrow Concentrate. If you take a second look at the title of the clinical trial cited above, you will see the complete title ends with “Historical Comparison to Total Knee Arthroplasty”. The control group for the trial were patients with an arthritic knee in whom I had performed Total Knee Replacements during my surgical years. I am one of the few Orthopedic Surgeons who have experiences both in joint replacement surgery and interventional orthopedics. The majority of stem cell recipients have returned to activities they enjoy; the majority of Total Knee recipients are couch potatoes. When the numbers become available after statistical tabulation, I will post the data on my Blog.

Recently, I became aware of a relatively new web site www.Desirelist.com. The web site allows you to discover, capture and list all you may desire with a high probability of realizing your desires. So, I went on line and listed that which I want for my patients in 2017; namely, Internal Peace in a World at Peace. Where I can make a difference for those limited by arthritis of a major joint , and deliver on your desire for an improved quality of life is through Regenerative Medicine and Interventional Orthopedics.

Happy Chanukah, Merry Christmas and Happy and Healthy New Year

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Evidence Based Medicine and Looking Back at 2016 Interventional Orthopedics

Evidence Based Medicine and Looking Back at 2016 Interventional Orthopedics

I use bone marrow derived stem cells because they have been proven to be most effective at treating orthopedic conditions when compared to adipose derived stem cells.  There have been 13 papers published showing bone marrow superiority to adipose tissue in regards to treating orthopedic conditions and to the best of my knowledge, none reporting adipose derived results for arthritis. In addition to Adult Mesenchymal Stem Cells, bone marrow has 1,000-10,000x more hematopoietic stem cells than adipose tissue; the former is necessary for muscle repair. Recently, we learned that bone marrow also has osteochondral reticular cells which are not found in adipose tissue and serve as orthopedic repair cells.  While adipose tissue and bone marrow both have stem cells, the skeletomuscular specific cells only found in bone marrow make it the best at treating orthopedic conditions. I don’t have a stake in doing bone marrow derived stem cells, I practice evidence based medicine and do what’s been shown to provide the best results.  If with continued research something superior to bone marrow derived stem cells becomes available, then I will gladly adopt that protocol.  

http://www.regenexx.com/fat-vs-bone-marrow-stem-cell-video/

  • As I have reported on this Blog many times, research has shown the amniotic fluid samples being marketed as having stem cells actually do not have any viable stem cells when received and viewed in the laboratory. I do use amniotic fluid concentrate from time to time for its concentrated hyaluronic acid effect.

http://www.regenexx.com/amniotic-stem-cells-great-deception/

  • Since we manually process bone marrow when aspirated, I am able to customize PRP which we call SCP or super concentrated platelets.  The ubiquitous beside centrifuge only has one setting for volume and concentration so those using this approach are treating every patient without concern for individual differences. With the addition of the Abbott Ruby Hemocytometer, I am able to customize the treatment of the individual patient.  We can concentrate our SCP from 3-40X over baseline-with or without red or white blood cells. From my outcomes data base, I know what volume and concentration works best for treating the various body parts.  
  • We’ve developed HD BMC or high dose bone marrow concentrate which is far superior to that produced with bedside centrifuges used by most claiming expertise in Regenerative Medicine
  • I perform BMAs in compliance with the peer-reviewed literature recommendations as well as in keeping with my internal best practices research to maximize MSC yield. As stated, I count cells and know the quality in addition to the quantity of the injectate. Most doctors don’t count cells and have no idea what dose they are giving their patients

 

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Optimizing Strategies for the Practice of Interventional Orthopedics

Optimizing Strategies for the Practice of Interventional Orthopedics

The FDA again held a meeting to address issues pertaining to Regenerative Medicine. At the conclusion of the meeting, an updated set of guidelines was developed for patient protection in the use of stem cells, growth factors, and platelet rich plasma. While still being interpreted by the Regenerative Medicine community, what becomes clear is the call for better self-regulation. It is not ethical or acceptable for anyone holding themselves out to be practicing cellular medicine to hold a seminar, recruit a patient, inject some substance into a joint and request payment. Equally important are the credentials of that practitioner.

For the past four and a half years, I have followed the outcomes of all my patients using the same subjective and objective parameters in my practice of Interventional Orthopedics that I used to follow the results during my joint replacement career. Over that 37-year span, because of my data collection initiative, many new generations of Hip and Knee Prostheses were introduced into adult reconstructive orthopedic surgery. Statistical analysis of data allows for progress in care and development of new product. Today, I still gather outcomes data for each patient. That initiative has led to refinement and advances in the emerging subspecialty of Regenerative Medicine; both in my own practice and around the globe.

Anticipating the future, I am headed off this upcoming weekend to join a small group of those looking to the future in advancing the practice of cellular medicine. Up until now, our data collection and Outcomes registry was clinical in nature; in a short time, that data will also include cellular data. This latter is the next way to refine the practice of regenerative medicine.

By having tighter control over the composition of autologous PRP and BMC preparations for use in my practice of regenerative medicine, through comprehensive analysis of autologous patient samples, I will have a chance to see what levels of important constituents like Stem Cells, Growth Factors, Platelets, RBCs, WBCs, and so on are present in the preparation.

How might I take advantage of the data? The most obvious use would be for me to record values of your sample analysis in a spreadsheet and enter in demographic and clinical outcomes data. I will continue to enter your results of outcomes assessments obtained during follow-up visits that I routinely use to monitor your recovery. By applying this strategy to all patients I treat, an internal database will inform me about optimization strategies for treating my patients, allowing me to modify and customize the make-up of that which will be injected. Why go to the trouble, you might be asking yourself? Having a detailed knowledge of what I am injecting into my patient puts me in a position to refine my practice of regenerative medicine. And that is a good thing, since you the patient ultimately will benefit from my optimizing the use of autologous materials like PRP and BMC.

To schedule your appointment call 312 475 1893

 

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