Jan 11, 2016
The Regenerative Medicine Menu
- Hydrocortisone
- Hyaluronic Acid (HA)
- Platelet Rich Plasma (PRP)
- Amniotic Fluid Concentrate (AFC)
- Bone Marrow Aspirate Concentrate (BMAC)
- Regenexx-SD Procedure
- Simple Adipose Graft
- Stromal Vascular Fraction (SVF)
The human body posses a remarkable capacity to heal. Following tissue damage or disease, the body’s immune response coordinates a sequence of events to fight off harmful disease or infections and repair the damaged tissue. While scar tissue may form as a byproduct of rapid healing, scar tissue may be remodeled over time. This is the Normal Healing Response. The goal of regenerative therapies is to modulate these stages of healing be it soft tissue, cartilage or bone.
As a response to the delisting by the AAOS of Hyaluronic Acid from the osteoarthritis armamentarium, industry has attempted to fill the void with Amniotic Fluid Concentrate. For those unfamiliar, when a pregnant woman schedules a C-Section, she is approached about “donating” her amniotic fluid that may be recovered at the time of the procedure. During the course of the pregnancy, the potential donor is screened for communicable diseases. There is little if any immuno-rejection phenomenon and the AFC has growth factors, anti-inflammatory cytokines and Hyaluronic acid all in high concentration. While there are large numbers of stem cells deposited by the fetus and the placenta during the course of the pregnancy, by time the Amniotic Fluid is concentrated, processed, frozen for preservation and finally fast thawed for usage, little in the way of viable stem cells may be observed. Never the less, the AFC has great potential in the arthritic setting; and when micronized, is a marvelous adjunct in effecting wound healing for the diabetic and wound that won’t heal.
At our Regenerative Pain Center, we have observed over 40 different interpretations for the term PRP. The problem is that there is no standard of concentration, quality or quantity. To that end, an attempt is underway to reach accord on an actual standard definition. Then there comes the dilemma of whether the PRP is best when leukocyte free or not. Next comes the argument to support Platelet Poor Plasma (PPP). In our practice, we alter the formula according to the needs of the patient.
You will note at the get go, the repeat Bone Marrow Aspirate Concentrate bullets. There is bone marrow aspirate concentrate and then there is the Regenexx -SD approach. The latter is what has been so effective in our practice for three and a half years; so much so that it is what I truly believe in for moderate osteoarthritis and even advanced in certain settings.
While “simple” adipose grafts are heavily marketed, let me refer you to Pope Brock’s Charlatans, first published in 2008 to understand my view of how plastic surgeons are victimizing patients by including the management of arthritis in their cosmetic approaches. Last of all is the new introduction of the Stromal Vascular Fraction following the micro-fracture of fat graft. The latter became available in the US in mid summer, 2015. Clinical trials are in progress. If you want to delay or possibly avoid a joint replacement for arthritis, call for a consultation 847 390 7666
Tags: Amniotic, arthritis, athletes, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Oct 16, 2015
Tissue Regeneration has become the new standard for Grades 2 and 3 arthritis. Three years ago, I anticipated the future recognizing that the risks of joint replacement surgery were not fully taken into account when a surgeon recommended a new hip, knee or shoulder. Certainly, in advanced arthritis (Grade 4) there is little alternative for pain relief and restoration of function; but for Grades 2 and 3, do the risks outweigh the benefits? What is not taken seriously enough are the risks inherent in a surgical procedure. A recent scientific article reminds us of those risks.
“Knee, hip replacements might be bad for the heart short-term.”
“Contrary to some recent research, Boston-based researchers found osteoarthritis patients who had total knee or hip arthroplasty procedures were at increased risk of myocardial infarction in the early post-operative period. Their findings, published Aug. 31 in Arthritis & Rheumatology, a journal of the American College of Rheumatology, indicate long-term risk of heart attack did not persist, while the risk for venous thromboembolism remained years after the procedure.”
Up until 2001, the patient undergoing a joint replacement was discharged on post operative day four or five. Any complications taking place were reported as a postoperative morbidity, rarely, as a mortality. Today, a patient will leave the hospital between 23 and 36 hours following a joint replacement. Should, if, or when a complication ensues, it may never be recorded as a readmission to another hospital if not registered. Medicare has started penalizing hospitals for high readmission rates within 30 days of a discharge but this is only a recent development and doesn’t as of yet, include readmissions to a second location.
Last time, I indicated I would start updating the reader with new developments in the field of Regenerative Medicine. The goal of regenerative therapies is to modulate the stages of healing including inflammation, cell migration and proliferation. We do this though use of tissue grafts such as Bone Marrow Aspirate Concentrate.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Oct 1, 2015
As I have previously indicated in my Blog, the world of Cellular Orthopedics is growing at an exponential pace. Evidence Based Medicine supports weight reduction, physical therapy, anti-inflammatories, analgesics, and cortisone injections for symptomatic relief. Evidence Based Medicine no longer supports the use of Hyaluronic Acid injections (visco-supplementation). Historically, the next step is a joint replacement when the aforementioned conservative measures no longer have an effect. When I initiated my practice of Interventional Orthopedics as part of the Regenexx Network, their patient satisfaction surveys supported the use of Bone Marrow Aspirate Concentrate interventions for osteoarthritic joints. Since my entry into the sub-discipline of Regenerative Medicine, we have gathered data on every patient seeking consultation and care and, have expanded the Outcomes measurement intake to include objective data points in addition to those of a subjective nature. Along the way, we have gained a better understanding as to how a patient might better respond to Interventional orthopedic options. The evidence is growing.
Just as my practice has grown and the Regenexx Outcomes Data base has grown, so too have the Interventional Orthopedic treatment alternatives increased. Now there is Amniotic Fluid Concentrates available to replace Hyaluronic Acid as a six to 12 month anti-inflammatory. As of July of this year, two companies have introduced Adipose derived stem cell alternatives claiming a mechanical means of emulsifying fat and eliminating the need for the enzyme collagenase; the latter not approved by the FDA when it comes to the musculoskeletal system. As of this time, there is no scientific evidence to support the claims of success in arthritis with both Amniotic Fluid Concentrate and Adipose Derived Stem Cells. Those studies will take several years before there is clinical evidence to support said use in arthritis.
What we have learned and is supported by clinical evidence is how to better plan and prepare for a Bone Marrow Aspirate Concentrate intervention. First a clinician must rule out referral of pain from other sources; this is accomplished by a thorough history and physical examination. The status of a meniscus, labrum, and the articular cartilage must be taken into account. Mechanical malalignment –a bowed leg or knock knee-must be ascertained and excesses corrected. Ligamentous deficiencies will contribute to the end result and must be corrected before any Intervention of an orthopedic nature.
I have provided a lot for a reader to digest. If you want clarification or to learn if you are a candidate for INTERVENTIONAL ORTHOPEDIC to postpone or eliminate a joint replacement for osteoarthritis, call for an appointment:.
847 390 7666
Tags: Amniotic, arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment
Jun 11, 2015
Cellular Orthopedics for the Musculoskeletal injury and Degenerative Arthritis
What is the problem?
Trauma and Osteoarthritis are part of the cycle of life. Muscle, ligament and tendon injuries frequently occur during sports related activities or accidents; degenerative arthritis may be post traumatic by many years or occur as part of the aging process
What treatments are available?
As of today, it includes Platelet Rich Plasma (PRP) following several protocols and Bone Marrow Aspirate Concentrate (BMAC) rich in stem cells, growth factors and anti-inflammatories called Cytokines. As of next week, all may change as the Orthobiologic update taking place in Las Vegas over the weekend will potentially introduce an entire new menu of therapeutic intervention alternatives for musculoskeletal injury and disease.
What is Platelet Rich Plasma?
Platelets are part of your circulating blood producing growth factors that assist in repair and regeneration of tissue. When a high concentration of platelets are created via the centrifuge, healing may progress more quickly and pain may be reduced
What is Bone Marrow Aspirate Concentrate?
Taken form the back of your pelvis, aspirated bone marrow may be concentrated and prepared allowing for pain relief, improved function, a more rewarding quality of life, and possibly influence the Bio-immune response of degenerative arthritis
What is Amniotic Fluid Concentrate?
The source is the pregnant woman coming to term and delivering via Cesarean section. The recovered amniotic fluid is processed, concentrated, and now available as an alternative to Visco-supplemenation with hyaluronic acid. It is a new option and data concerning the length of pain relief is still being determined.
Do these Regenerative Medicine alternatives work?
When properly applied the answer is yes. What we don’t know is for how long? The effect of Platelet Rich Plasma in injury is intended to speed up the repair process. In the case of Amniotic Fluid, the outcomes are still being studied without a known end point. I have been involved in studying the clinical outcomes of Bone Marrow Aspirate Concentrate intervention for osteoarthritis. The paper I will be presenting this weekend confirms satisfactory results up to two years. The data collection continues.
Is there a downside side to Regenerative Medicine and Cellular Orthopedics?
In my experience the answer is yes and no. Yes because there is no indemnification for the new world of regenerative medicine; care is an out of pocket self pay undertaking because the field is new and five year outcomes data still not available. On the other hand, at three years, I have seen no adverse events and the vast majority have responded well with improved function and quality of life. Out of over 600 knees and over 100 hips, to the best of my knowledge, seven have gone on to a total joint replacement.
Tags: Amniotic, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, C-SCP, Clinical Studies, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Apr 30, 2015
“Dwight Howard dominated the paint during Tuesday’s series-clinching victory, finishing with 18 points, 19 rebounds, four steals and four blocks.” (From Yahoo sport) Three months ago, the following appeared in the Press/News from ESPNDallas.com “Dwight Howard Out Indefinitely. There is no timetable for Houston Rockets center Dwight Howards return.” There are many other athletes who undergo Regenerative Medicine-Cellular Orthopedic interventions during the course of the year, they are not as public about it but there is successful return to sports, more often than not. If you imagine the forces generated across the knee in a 6’11’’, 265 lb. professional basketball player, you must conclude that his regenerative medicine intervention is a success for a continually painful knee.
Cellular Orthopedics is here to stay and is rapidly gaining a foothold as the non-operative treatment regimen for skeletal muscular trauma and the progressive restrictions imposed by degenerative arthritis. This past weekend, I was in Southwest Wisconsin fly fishing and cycling. Wading up a spring creek and climbing up and down the cliffs is as demanding as playing center on a professional basketball team. Cycling for three hours up 1500 foot climbs depends not only on conditioning but on functional knees. It was possible for my buddy and me in part because of the several cellular orthopedic procedures I have completed on him in the past three years. We have many more similar trips planned.
Bone Marrow Aspirate Concentrate-Stem Cell treatment is only one of the possibilities available for helping a patient postpone or avoid a joint replacement, diminish pain, increase motion and assist in returning an injured or arthritic individual to well being and a full recreational profile. From Concentrated Platelet Rich Plasma to Bone Marrow Aspirate Concentrate-Stem Cells, there are several alternatives for altering the natural history of post traumatic and degenerative arthritis. Many more offerings are in the works and I will continually update you as to when these latest interventions become available. In the meantime, please understand that while I don’t have to break a bone to best understand how to treat a fracture, my treatment recommendations for Cellular Orthopedic intervention concerning both post traumatic arthritis and degenerative arthritis in part are influenced by my own experiences so I will continue to report on such. To learn more about what is available in Regenerative Medicine and what clinical trials are in the works, make an appointment for a consultation.
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, C-SCP, Clinical Studies, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Pain Management, PRP, Regenexx, Regenexx-SD, stem cells, treatment
Apr 2, 2015
Intervertebral disc degeneration is characterized by a gradual loss of cellular function and related breakdown of extracellular matrix. This process leads to a decrease in the mechanical stability of the spine and activation of molecules that trigger painful back and neck symptoms. Implantation of mesenchymal stem cells has been shown to counteract the degenerative process in animal models of disc degeneration and in some initial clinical studies. The regenerative activity of Mesenchymal Stem Cells when injected into the disc results in a reversal of that degenerative disc process. In addition, the injection of MSCs also releases trophic factors that may stimulate the metabolism of disc cells and suppress inflammatory reactions. However, in spite of these promising perspectives, clinical application of MSCs has certain limitations. Potential adverse events such as cell leaking and osteophyte (spur) formation are at present, the limiting factors. I am updating my Blog readers concerning what is on the horizon as every week I receive a question about the subject of the low back and stem cells. Low Back degenerative disease also is something I must consider in each and every patient for whom I perform a Cellular Orthopedic intervention in a hip or knee as there is no question about a Hip-Knee-Spine connection and I must understand its importance when I treat hip and knee pathology. These areas are closely related in function and symptom distribution
The limitation at present of Cellular Orthopedic intervention for intervertebral disc degeneration is the need to further identify potential side effects. While an attractive target for future regenerative strategies, Bone Marrow Aspirate Concentrate/Stem Cell intervention is not ready for prime time. The logical question then is how to cope with the limitations of spinal stenosis and Degenerative Disc and Joint disease of the low back until stem cell care is proven safe and effective? First and foremost comes weight reduction. Next in line is core strengthening in conjunction with stretching. This may be accomplished through Pilates, Tai Chi, Yoga and any other program that follows the principles of strengthening and stretching the core. Incidentally, running and jogging are not injurious to an arthritic spine; just the opposite, both help rehydrate the dried out disc.
To learn more about your personal kinematic Knee-Hip-Low Back continuum, you need an assessment. That’s the only way I can determine the key problem and if one or all need to be addressed.
847 390 7666 to make an appointment
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Interventional Orthopedics, Mature Athlete, medicine, Regenerative, Regenexx, stem cells, treatment
