Archive for category Platelet Rich Plasma
Stem Cell Yin-Yang
Posted by Mitchell B. Sheinkop, M.D. in Hip Pain, Osteoarthritis, Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on June 5, 2012
Orthopaedic Care of the Mature Athlete
I had not heard from the hip patient I had written about last week, the “First Time “, so I asked my assistant to call him fearing the worst. “I am doing really great.” “My pain was at 90% and now is 10%” “My back is still a little sore but I am moving around without a problem and back to work”. “I am very happy”. (To be continued)
This past Monday night, my wife and I attended the pre-opening of a new Italian restaurant in our neighborhood sponsored by The MidNorth Organization. We sat down next to a longtime neighbor and his wife, the former, a tax and zoning attorney.
Question: “So are you retired from Orthopedics?”
Answer: “I retired from surgery almost three years ago, but I continued my outpatient practice while I envisioned, studied and trained for a new approach to orthopedic disease, Regenerative Medicine”.
Question: “What’s that.”
Answer: “It is a minimally invasive approach, in my case, to the management of arthritis with stem cells taken from your own body. After all those years of doing joint replacement, I am working at postponing that need, maybe eliminating that need for a joint replacement”.
Question: I watched a piece on 60 minutes about stem cells and schemes, is it ethical?”
Answer: “What you saw on 60 Minutes was about charlatans, criminal opportunists victimizing desperate families.”
Question: “Is it legal?”
The procedure is compliant with CFR 21 Part 1271
Question: “What do you think about this? My client was a big time real estate developer flying high and building to the sky in Chicago until the crash of the real estate market and now he is almost broke. He has a very arthritic hip because of which he had to quit his passion for bike riding. He no longer had insurance and could not afford the approximately $50,000 out of pocket cost of a joint replacement. He went on line, found a stem cell program in Colorado and last year, underwent a concentrated bone marrow aspirate procedure for his hip at a relatively low cost. I thought it was a hoax, a scam”
Answer: “What was the result?”
Question: “He had always biked the Outer Drive in Chicago, the Sunday of Memorial Day weekend when they hold “Bike The Drive”. Last year he had to quit because of his hip. This year he was able to ride for 15 miles. I don’t know what to think?”
Agony or ecstasy, scam or the future, Yin or Yang? That is why my clinical approach is under the auspices of an FDA approved Clinical Pilot
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street
Chicago, Illinois 60610
The Botox for your frame, Stem Cells
Posted by Mitchell B. Sheinkop, M.D. in Osteoarthritis, Platelet Rich Plasma, Stem Cells on April 25, 2012
Musculoskeletal Care of the Mature Patient
The number one reason in the United States for a trip to a physician has to do with pain arising in the musculoskeletal system, especially in the Boomers and maturing athletes. Might regenerative medicine and stem cells provide an extended warranty for your frame? That was my basic question when I attended the American Academy of Orthopedic Surgeons continued medical education course last weekend “Advances in Care of the Aging Athlete”. What was generally reinforced is that the number one way to stay healthy and young is through fitness and sports; stay active on an aging frame. In other words put old on hold. Certainly proper nutrition is a key component as is Resveratrol and maybe testosterone supplementation for Manopause. Woman beware, hormone replacement therapy is generally not good for your health.
In the end though, the real problem is cartilage deterioration with age be it from genetics, congenital, developmental insult or trauma. The recent media attention to stem cells has introduced a clinical possibility of changing the natural history of progression of degenerative arthritis and perhaps even reversing the programmed death of cells. Peyton Manning went to Europe for stem cells in the neck, Governor Perry chose Asia for his back and Terrell Owens returned to football after stem cell intervention in Korea. You all probably are aware of the Fred Couples, Kobe Bryant and Alex Rodriguez having returned to top performance with the assistance of regenerative medicine. By harvesting Mesenchymal Stem cells form you bone marrow and concentrating them, the injectate is the best of all potential immune modulators with the greatest possible ant-inflammatory effect. There are a large number of animal studies confirming the efficacy of stem cell management of cartilage; such clinical treatment is now the standard of care in the veterinarian world, particularly with the injured or arthritic hoarse. As well, there is an emerging body of science to support adult mesenchymal derived stem cell management of the aging human joint appearing in peer reviewed medical journals. The International Journal of Rheumatic Diseases to illustrate, recently published an article concerning four patients with moderate to severe osteoarthritis of the knee who experienced marked improvement with mesenchymal stem cell therapy. The problem is that for the most part, human clinical trials are taking place outside the United States. Enter Regenexx and its IRB clinical trial. That’s why I joined the Regenexx Network. To learn more, schedule an appointment.
Stem cells are how we all begin
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Stem Cells on April 19, 2012
The Regenerative Pain Center is about to begin as well. I completed my training at Regenexx on Thursday and started enrolling patients on Friday. I chose to affiliate with Regenexx because theirs is the longest and largest outcomes database pertaining to the clinical use of stem cells in the care and treatment of arthritis and musculoskeletal injury. Certainly, there remains a major role for orthopedic surgery in the management of arthritis and joint injury but now the patient has an option. Given the fact that 15 to 20% of joint replacement recipients have complication or unsatisfactory outcomes or are never able to resume the type of activity previously enjoyed, it makes all the sense in the world to exhaust the regenerative care option before a joint replacement. While I was writing this Blog, my landlord dropped by to tell me the saga of his son-in-law’s father. The latter, a surgeon himself, still is experiencing pain and repeated hemorrhage into his knee eight months after a knee replacement. The ongoing problem is contributing, in part, to his decision to retire. Might he have avoided a knee replacement if he had tried the regenerative medicine route?
The world of stem cell management is a commitment for me because I believe in the process. It is also dynamic, as another means of approach has been introduced for stem cell harvesting that is very promising and less complicated than bone marrow harvesting. Blood born stem cells may now be captured by concentrating platelet rich plasma. Until now, PRP, while having some stem cell component, was really an anti-inflammatory approach because of a wealth of growth factors. With the recent introduction of a major advance in platelet concentration methodology by Regenexx, ultra concentrated PRP, introduces a potential sufficient quantity of stem cells to begin to mirror the possibilities of bone marrow derived stem cells.
To complete my preparation and credentialing for the transition from a reconstructive joint replacement surgeon to a regenerative medicine restoration physician, I am off to the American Academy of Orthopedic Surgeons course “Advances in Care of the Aging Athlete” on Thursday. In addition to stem cells, the subject matter includes Nutrition and Supplementation: Optimization with Aging; Anti-Aging and Performance Drugs; Cartilage Restoration; Knee Rehabilitation in the Arthritic Knee: How Much Can We Push?; The Basic Science of Aging: Implications for the Male and Female Master Athlete; Injectable Adjunctive Therapies: Solid Treatment or Snake Oil: Performance Optimization in the Masters’ Athlete; and more. I won’t live forever; but while I am still here, my ethos is “Just Do It”. To learn more, call and schedule an appointment.
Mitchell B. Sheinkop, M.D.
847-390-7666 or 312-475-1893
1565 N. LaSalle St., Chicago, Illinois 60610
Bone Marrow Concentrate for Arthritis; the potential benefits and risks
Posted by Mitchell B. Sheinkop, M.D. in Hip Pain, knee, Osteoarthritis, Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on March 8, 2012
Musculoskeletal Care of the Mature Patient
The potential benefit of regenerative medicine is avoidance of orthopedic surgery. That’s the goal and I am the orthopedic surgeon leading the charge. I have spent several years now investigating, meeting, traveling, learning and preparing for that reality with the start-up anticipated in mid-April. While there is anecdote about subjective improvement following autologous, mesenchymal, Bone Marrow Concentrate derived stem cells for management of arthritis, there are no peer reviewed published long-term clinical outcomes to the best of my knowledge. There have been testimonials by orthopedic surgeons that following the adjunctive use of stem cells in conjunction with arthroscopic micro fracture of an arthritis knee, when the patient subsequently underwent knee replacement, hyaline cartilage was observed growing rather than fibro cartilage. This is not good enough for me, as I want a procedure that will postpone the need for a joint replacement or possibly eliminate that need. Is it a matter of when to intervene with regenerative medicine? When there is major deformity of an arthritic joint, significant alteration in function and a “bone on bone” X-ray, it probably is too late. Will regenerative medical intervention delay the joint replacement by a three to five year control of pain by the anti-inflammatory nature of bone marrow concentrate or will the joint cartilage actually re-grow? These are unanswered questions and what I seek to learn as I embark on my clinical project
Recently, the orthopedic surgical spine community became aware of a fourfold risk of cancer in patients who underwent spinal fusion using Bone Morphogenic Protein to increase the likelihood of successful fusion. As a result, attention quickly was redirected to stem cells as an adjunct in spinal surgery to replace human BMP. As of this writing, I have found no evidence of carcinogenesis in conjunction with autologous, mesenchymal Bone Marrow Aspirate Concentrated stem cells used in the skeleton and certainly not when used in a joint. The same might not be said when embryonic stem cells have been injected into the blood of patients to treat probably what shouldn’t be addressed with stem cells in the first place. Desperate people are not infrequently victims of charlatans as has been repeatedly pointed out on 60 Minutes. Contrast the risks of stem cell misdeeds with the benefits of scientific application. Today, the AMA News headline covered the potential for stem cells to eliminate the need for long-term anti-rejection pharmaceuticals in organ transplant recipients.
How to avoid orthopedic surgery by an orthopedic surgeon? Not just a mission statement by an ethos. Call to see if you are a candidate.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street, Chicago, Illinois 60610
Like this:
An experimental treatment offered for sale is not the same as a clinical trial.
Posted by Mitchell B. Sheinkop, M.D. in knee, Osteoarthritis, Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on February 6, 2012
Musculoskeletal Care of the Mature Athlete
As I move closer to actually starting up the Bone Marrow Concentrate Stem Cell Pilot Study, I will continue to educate the perspective patient seeking to enjoy relief from arthritis of the hip and knee without a joint replacement. The delay is based on our having to wait for Institutional Review Board approval of our clinical trial. The fact that a procedure is experimental does not automatically mean that it is part of a research study or clinical trial. A responsible clinical trial can be characterized by a number of key features. There is preclinical data supporting that the treatment being tested is likely to be safe and effective. Before starting, there is oversight by an independent group such as an Institutional Review Board or medical ethics committee that protect patients’ rights, and in many countries the trial is assessed and approved by a national regulatory agency, such as the European Medicines Agency (EMA) or the U.S. Food and Drug Administration (FDA). The study itself is designed to answer specific questions about a new treatment or a new way of using current treatments, often with a control group to which the group of people receiving the new treatment is compared. While historically, the cost of the new treatment and trial monitoring is defrayed by the company developing the treatment or by local or national government funding; to date that has not occurred with stem cell trials in the United States. It takes an average of seven years and $750,000,000 to develop a new pharmaceutical therapy. With the rapidity in evolution of regenerative medicine, so far, no company has been identified that is willing to underwrite the expenses of a stem cell Trial. At the same time, beware of expensive treatments that have not passed successfully through clinical trials.
Responsibly conducted clinical trials are critical to the development of new treatments as they allow us to learn whether these treatments are safe and effective. I believe there is enough clinical experience to support a Pilot Study with Adult, Autogenous, Bone Marrow Derived Stem Cells. First no harm and a then reasonable chance of restoring function. To find out if you would qualify for the Pilot Study, contact Jennifer at 312-475-1893 ext.15
On Proteins, PRP, Bone Marrow Concentrate, Stem Cells and Orthokine
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on January 4, 2012
The difference between platelet-rich plasma therapy, also known as PRP, and the Orthokine treatment that Alex Rodriguez, Kobe Bryant and other athletes have received in recent months in Germany is fairly straight forward. I personally treat athletic injuries and arthritis with PRP; but, do not use the Orthokine procedure because it is not approved in the United States or Canada.
With PRP, I withdraw 20 cc blood, spin it in a special kit and inject plasma that is rich in platelets and lymphocytes into joints, thereby introducing growth factor and hopefully helping the body to heal itself. In the Orthokine procedure, 20 ccs of a patient’s blood are mixed in a tube with ‘factors,’ incubated for a time , the blood is spun down, and the substance is injected much in the same way as PRP.
The theory of Orthokine, which has also been used by Alex Rodriguez, Kobe Bryant and golfers Vijay Singh and Fred Couples, among other athletes, is that Orthokine addresses one of the possible triggers of joint disease; thought to be the protein interleukin. The theory is an attack on one of the culprits behind arthritis. The protein is an important part of the body’s immune system and has the ability to alter the function of other cells. IL-1 can be positive when it allows the body’s ‘repair troops’ to move in quickly to fight infection or other kinds of damage; but it can also trigger inflammatory processes that lead to degeneration and breakdown of cartilage. These negative effects are primarily responsible for the pain and stiffness of osteoarthritis.
The Germans say that another protein that counteracts the effects of IL-1 is a ‘good protein’ in the body called anti-IL(1) produced by blood cells that protects cartilage by keeping the pro-inflammatory proteins in check. It is the body’s own natural anti-inflammatory and that is what gets mixed in prior to incubation.
In none of these treatments, PRP, stem-cell therapy Yankee pitcher Bartolo Colon had performed in the Dominican Republic. Is there good published research readily available that confirms they are effective, although it could turn out to be so. Individual anecdotes suggest they work. The procedures are not banned by the World Anti-Doping Agency or by Major League Baseball. However, Rodriguez was given the go-ahead by MLB and the Yankees to have it done in Germany. While PRP is available throughout the United States, the Regenerative Pain Clinic Bone Marrow Concentrate Stem Cell Pilot is now open for enrollment. Bone Marrow Concentrate has all the right proteins but does it work? Why am I advocating Bone Marrow Concentrate?
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What’s in Bone Marrow Concentrate: Both pro- and anti-inflammatory cytokines and the factors: Fibroblast Growth Factor-b, PDGF-AB, TGF-B, and VEGF. |
Call to see if you might qualify for the clinical pilot trial.
Mitchell B. Sheinkop, M.D.
1565 N LaSalle Street
Chicago, Illinois 60622
847-390-7666
Current Trends in Platelet-Rich Plasma Injections
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma on November 15, 2011
Musculoskeletal Care of the Mature Patient
The application of growth-factor is a treatment to improve tissue repair using a patient’s own platelets and plasma. While initially, PRP was used in heart surgery, it has since been applied to non-healing skin ulcers, orthopedics, podiatry, otolaryngology, neurosurgery, dentistry, wound healing and in preventing post operative blood loss. Blood is composed of red blood cells, white blood cells, plasma and platelets. Platelets are made in the bone marrow and have a circulating life of 7-10 days. They are known to participate in clotting and initiate normal tissue healing. Within the clot, platelets become activated and serve anti-inflammatory, proliferation and remodeling functions. They release many factors responsible for wound healing. With the use of a centrifuge, PRP is concentrated and growth-factor-rich platelets are separated from whole blood and may be re-injected to augment natural tissue healing.
PRP use in joints
In the laboratory, PRP has been shown to increase cartilage growth. When compared clinically with hyaluronic acid injections, PRP far outperforms the former.
Spinal application
The basic science research has focused on how PRP treatment of intervertebral disc injury may result in healing when none otherwise takes place. PRP has recently been shown to be potentially beneficial in treating the pain of facet joint arthritis when intraarticular local anesthetic and corticosteroids fail.
Ligament and Tendon application
PRP has been shown to be effective in the treatment of chronic elbow and ligament dysfunction
Research and clinical use of PRP
I currently am involved in a clinical study using Platelet Rich Plasma for the arthritic knee. The preliminary observations of the registry are very encouraging with approximately 70% clinical improvement in all stages of knee arthritis at six months from the first injection. What have not been tested are closely defined unique regenerative rehabilitation programs. Mary Langhenry, PT, OCS just returned from the First Annual Symposium on Regenerative Rehabilitation held under the auspices of the University of Pittsburgh Medical Center Rehabiliation Institute, November 3-4, 2011. She will be revisiting the physical therapy protocols we have in place and updating them with contemporary modalities to best serve the notion of regeneration along with rehabilitation.
Did you happen to see the 11/14 AMA headline , ABC World news, NBC Nightly News, and CBS Evening News headline “Patients’ Own Stem Cells May Be Used To Reverse Heart Damage”? It is a major step forward in bringing the stem cell promise to clinical practice.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street
Chicago, Illinois 60610
Platelet Rich Plasma and Stem Cell Update
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Stem Cells on November 1, 2011
In case you missed it, The Good Morning America Reporters Notebook by Ron Claiborne Oct. 24, 2011 started out “How to Best Manage Your Back Pain.” You may see the entire program at
Basically, it is a program devoted to introduce the notion of using Platelet Rich Plasma in lieu of steroids for an epidural as has become popular in Europe. The claim is that while an epidural steroid injection may benefit a patient for weeks or months, a PRP epidural will have benefit for years. Golf legend, Fred Couples who won the prestigious PGA Senior Players Championship August 28, despite being sidelined on-and –off the past five years revealed that the secret to his success was a trip to Germany for Regenokine treatment, the injection of autologous platelet rich plasma into the epidural space. The U.S. Food and Drug Administration has not given approval for the treatment to make the claim of effectiveness for osteoarthritis or back pain. The usual and customary cliché holds, “more studies are needed”. Yet there is growing evidence to support the usage of PRP and Bone Marrow Concentrate in pain management. For one, it is a usual and customary practice in Europe and the regulatory bodies in the European Union are not that dissimilar for those in the United States. As I have written about over the past several months in this blog, I soon hope to identify the orthopedic corporate sponsors that will enable me to introduce the IRB regulated clinical studies based on autologous Platelet Rich Plasma and Bone Marrow Concentrate in my clinical practice. In spite of the apparent restrictions from governmental scrutiny, I am amazed by the speed with which the entire American Orthopedic Corporate community is embracing the science and actual clinical offerings to enable PRP and Bone Marrow Concentrate introduction in orthopedic practice. My professional meetings continue to identify the best opportunities, as does my gathering of information concerning the risks and benefits of orthobiologic potentials. I think I will be there by the end of the year.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street
Chicago, Illinois 60610
PRP, Stem cells or Surgery
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Regenerative Pain Center, Stem Cells, Uncategorized on October 4, 2011
To operate or not to operate?
Although Joint Replacement Surgery is a fairly predictable and cost-effective intervention for severe osteoarthritis of a major joint, it is not necessarily the treatment of choice for everybody. There are issues surrounding the decision-making process for surgeon and patient. Treatment should begin with most basic options and progress to the more involved as not all treatments are appropriate for every patient. Not everybody gets better after a total hip or total knee replacement. An important minority estimated at 10%-20% does not improve or are made worse by surgery. Then there is the population of patients who have associated conditions, co-morbidities, which prevent them from undergoing a surgical procedure without severe medical risks.
Try Nonsurgical Therapy First
While orthopedic surgery is based on allopathic medicine, that is the scientific process; the key to good decision-making about whom should have a joint replacement should be a holistic approach. Weight Reduction is paramount; anything greater than a BMI of 25.5 will result in excess loading of your hip and knee. Activity modification is strongly recommended using a bike and the swimming pool for exercising, Low-impact aerobic fitness, range of motion and flexibility exercises, muscle strengthening, and core strengthening. I find a patellar stabilizing knee sleeve to be very valuable, the one with the hole in the center. Acupuncture, glucosamine and chondroitin sulfate still are homeopathic. While there seems to be a greater than 50% positive response to visco-supplementation in the knee, the American Academy of Orthopedic Surgeons will not endorse this approach. There is no question that intra-articular corticosteroids offer short-term pain relief both in the hip and the knee.
Arthroscopy
Not advised for debridement of an arthritic hip. The same holds in the primary diagnosis of symptomatic osteoarthritis of the knee. On the other hand, there is a place for partial meniscectomy or loose body removal when the primary symptom arises in the presence of osteoarthritis.
Orthobiologics (PRP and Stem Cells)
We do not yet know exactly who may benefit from platelet concentrate or bone marrow concentrate and which factors are most critical in assuring the best possible outcome. Even the exact scientific explanation for how stem cells really work is still in the works. Preoperative severity of arthritic disease is probably most important. At this time, the decision to undergo an ortho-biologic procedure is about balancing potential benefits against potential risks. Given the fact that the biologic is autogenous and confined to a major joint, the significant risk is infection; that’s the risk of any invasive procedure and exceedingly rare to date. The case studies suggest that the new world of stem cells is worth consideration before a joint replacement
New Technologies Leading to New Concepts
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Stem Cells on September 13, 2011
Musculoskeletal Care of the Mature Patient
Probably the most important change in Osteoarthritis I have witnessed during my orthopedic career has been in attitudes rather than knowledge. The Boomers look toward continued well-being and extended athleticism and are unwilling to accept impairment and limited function associated with their osteoarthritis. Perception is everything; and new technologies lead to new concepts. Osteoarthritis is common and not necessarily a progressive disorder, with the condition stabilizing in most cases. This is obvious if we compare the number of people in the population with radiographic evidence of OA and the number who come to joint replacement. Recent research has indicated that physical activity optimizes cartilage health and is important in preventing the symptoms even in the presence of radiologic evidence of osteoarthritis. What about these new technologies and their increasing popularity owing to celebrity athletes?
What caused me to focus the blog again on Platelet Rich Plasma and Stem Cell management of osteoarthritis is an article appearing in the September 4, 2011 issue of the New York Times: As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments by Gina Kolata. It is a well-written article and worth a Google. The introduction to the article describes the costly failure of physical therapy, strength training, Platelet Rich Plasma and cortisone injections in the care and treatment of a female marathoner’s hamstring tear. “ Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine” “Celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.” You know what, I believe the author is right but does that make it wrong? I believe we must start with patients before we focus on populations. Researchers are indeed questioning the new procedures such as PRP and stem cells because there are no rigorous scientific studies to back them up. Yet there is a large group of patients eager for treatment, ranging from competitive athletes to casual exercisers to retirees spending their time on the golf course or tennis court who want to keep going.
So how do you protect yourself from the triad of famous athlete, famous doctor, untested treatment when there is so much marketing by sports medicine “experts”? First of all, make sure your sports medicine physician is a member of the American Academy of Orthopedic Surgeons because these experts are trained in offering care based on credible evidence. The continuing education initiative of the AAOS is the most advanced of any medical specialty. Second, when a procedure is new and unsupported as of yet by a large clinical experience/ data base, seek out a clinical trial and not simply a clinical encounter. In 1979, I was involved in the clinical trial of a cement-less design hip prosthesis which ultimately changed the surgical approach to joint reconstruction in the world. Management of osteoarthritis is complex and needs individualizing; so too, new isn’t always better but sometimes it just may be.
Meanwhile back to that “hamstring tear”. Any supposed chronic hamstring tear is more likely referred pain from a degenerated or herniated lumbar disc but referred pain and missed diagnoses are for another blog
Mitchell B. Sheinkop, M.D.
847-390—7666
1565 N. LaSalle Street
Chicago, Illinois 60610
