Been there, done that with joint replacements; what’s the role of stem cells?

Been there, done that with joint replacements; what’s the role of stem cells?

Last week, a call was placed to my office by the sponsor of a multicenter knee replacement clinical trial in which I had taken part since 2004.The FDA mandated Post Release Requirement for the Zimmer Mobile Knee had been fulfilled.  Because of my world wide teaching and visiting professorships starting in 2001, I had been asked to be a co-investigator in that initiative. My participation in part led to the release of the High-Flex Zimmer Mobile Bearing Knee in 2007 and several major clinical papers in which I was the Co-Author. As many readers of this Blog are aware, I had dedicated 37 years of my professional endeavors to integrating joint replacement research with my clinical practice at Rush for the care and treatment of the arthritic hip and knee. For the past two and a half years, I have dedicated my professional energies to assisting patients with osteoarthritis avoid or at least postpone the joint replacement.

I want to go on record; when a patient has altered function, unrelenting pain, and an image with a Kellgren/Lawrence Grade 4 osteoarthritic hip or knee, that patient needs a joint replacement. While I have called the readers’ attention to inherent risks of a joint replacement, the effected patient with medical approval will benefit from the joint replacement. On the other hand, the ever increasing evidence and my experience confirm that the patient with Grade 2 and 3 Osteoarthritis of a major joint may significantly benefit from a Bone Marrow Aspirate Concentrate /Stem cell intervention. The end result of an uncomplicated major joint replacement is pain relief, improved function, better motion, and correction of a deformity. The potential risks of a joint replacement gone badly require a revision or major reconstruction with major medical interventions for associated complications. The end result of a Bone Marrow Aspirate Concentrate /Stem Cell intervention is pain relief, improved function, better motion and continuation of or return to a very active recreational profile without risk of complication. While the stem cell procedure will not correct a deformity, it may alter the natural history of the arthritic process at the molecular level. Actually, the presence of deformity puts a patient in a Grade 4 setting and is an indication for a joint replacement; Grade 4 is a predictor of a poor result from stem cells.

Well it’s the week of Chanukah and Christmas so let’s celebrate this week of miracles with a wonderful stem cell story; it concerns hockey great Gordie Howe to be found in the Detroit Free Press. Freep.com:

http://on.freep.com/16AQIIO

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Active, Athletic, Then Why Have a Knee Replacement?

Let’s enter the new world of Cellular Orthopedics into which I graduated three years ago. Several months, ago, a long time friend was visiting his family in Chicago and stopped by to say hello. He told me about his skiing last winter and his hiking over the summer and fall. He also related he was seeing an orthopedic surgeon in the state where he now lived and that he had “bone on bone” in his knee. I launched into my customary spiel about his current level of athleticism, my cellular orthopedic initiative and the limits and risks of a knee replacement. Last week, a mutual friend told me that the out of state visitor had related “Mitch was right, I shouldn’t have done it”. He had undergone the Total Knee Replacement in spite of there being no limit in his recreational capacity and was now readmitted with an infected total knee prosthesis that might have to be removed to clear up the infection. Not being one to suggest “I told you so” but that’s what I am trying to get across to the patients I advise.

The Stem Cell Solution, Using the body’s almost magical repair kit to fix bad knees and hips-no surgery required is the title of an article appearing in the December, 2014, edition of The Saturday Evening Post, written by Sharon Begley, the senior U.S. health and science correspondent at Reuters. Last spring, the author had contacted me for an interview after having followed my Blogs unbeknownst to me. Ms Begley introduced herself and told me about an article she was writing for The Post to be published in June. I had forgotten about the interview until a patient came in last week and told me that she had read the article in the December issue. What I didn’t recognize at the time of the interview was that not only is the bone marrow a source of Adult Mesenchymal Stem Cells but of Growth factors and Cytokines as well that may be of equal importance. The opening of the article features my patient.  In 2011,”I was in a bad way.” ”He was diagnosed with osteoarthritis, a degenerative disease eating away at the cartilage in his knees writes Begley.”The patient: ”and now I’m climbing stairs, have gone on two skiing trips, planning another, and playing golf in the summer.” “I am way beyond pleased.”

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More on Arthritis of the Knee and Total Knee Replacement Dissatisfaction

More on Arthritis of the Knee and Total Knee Replacement Dissatisfaction

Patient dissatisfaction following total knee replacement is a growing concern. An article appearing in the November issue of the Bone and Joint Journal focused on a questionnaire in the United Kingdom attempted to quantify the degree of patient satisfaction and residual symptoms following knee replacements. I decided to focus on this subject after having completed a consultation for a 70 year old woman who four years ago, had undergone a bilateral total knee replacement that went on to fail in 24 months. She then underwent a bilateral revision or repeat total knee replacement and is left with inability to fully straighten either side or bend the right and left knee more than 80 degrees. She is severely handicapped. I don’t know what her arthritic impairment had been prior to the original surgery but there really isn’t much to offer her now. What an awful situation.

The article to which I alluded above reports that somewhere between 35 to 54% of those surveyed reported residual symptoms and functional problems and general dissatisfaction. Those who regularly read my Blog might remember a similar result that I reported about in a Canadian survey of patients who had undergone Total Knee Replacement five years earlier. In the current study, neither the use of contemporary prosthetic designs or custom cutting guides improved patient perceived outcomes. The data clearly shows a degree of dissatisfaction and residual symptoms following Total Knee Replacement and those recent modifications in implant design and surgical technique have not improved the current situation

Activity Levels and Functional Outcomes of Young Patients Undergoing Total Hip Arthroplasty

In yet another journal reviewing Hip Replacement Outcomes, appearing  this month in Orthopedics, patient dissatisfaction described greater hip symptoms and poorer hip-related quality of life in those under age 50 undergoing Total Hip Replacement than anticipated. It only makes sense to postpone a joint replacement until there is advanced arthritic impairment. Until then, our evidence in the laboratory and in the office clearly document that Bone Marrow Aspirate Concentrate has the potential to relieve pain, improve function, increase motion, and alter the actual molecular progress of the arthritic process.

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Cellular Orthopedics in Musculoskeletal Care of the Aging Athlete

I refuse to ignore the 50-plus demographic; that patient population is enormous and growing. According to a Nielson study, by 2017 boomers will control 70 percent of the country’s disposable income. Aging athlete, you are relevant. Additionally, as you are learning, there is an ever increasing deductable in your indemnification. That fiscal obligation could be used as an investment in your athletic future. Let me cite several examples of what is possible through Cellular Orthopedics.

Last year at this time, a 57 year old man presented with an arthritic left hip and had already received several orthopedic surgical recommendations for a left total hip replacement. Having learned about my work from the internet, he decided to get educated about the new world of regenerative medicine made possible through Bone Marrow Aspirate Concentrate. As the father of two teen age boys, he was concerned about a major surgical procedure and the inherent risks. He underwent a Bone Marrow Aspirate Concentrate in late November. When seen in late January, he reported that he had planned to take his two sons skiing in Colorado over their Easter vacation. Last week, he came in for assessment, reported how thrilling it was to have skied with his family: and told me of his New Years reservations for a return skiing trip over the holiday break.

Another example is a soon to be 70 year old avid cyclist and skier who had to stop skiing three years ago because of two arthritic knees. Just as the above individual, he had been advised by several orthopedic surgeons to undergo joint replacements. I shared with him, the activity scale results of patients who undergo a bilateral total knee replacement and compared them with my data base of outcomes for patients with arthritic knees who undergo stem cell interventions. It is now two years later and he has already booked two weeks of helicopter skiing in 2015 and a week with his family skiing in Colorado in February.

A study in 2007 found that 70% of boomers would change home appliance brands and slightly more would switch clothing preferences. Medicine is constantly changing, especially the providers as are surgical techniques and non surgical options. Adult Mesenchymal Stem Cells and growth factors with cytokines contained in the Bone Marrow Aspirate Concentrate carry little risk and great potential to eliminate pain, increase function, help you maintain an active athletic profile; alter the natural history of the arthritic progression and perhaps even influence cartilage regeneration. There will always be an opportunity to undergo a joint replacement but wouldn’t it be better to maintain or return to a high quality of recreational performance with little or no risk and no incisions?

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Total Joint Replacement or Try Stem Cells First

Much of what I write in this Blog is about the musculoskeletal care of the aging athlete. From time to time, I am reminded though that the arthritic changes in a joint may start before the usual aging process ensues. This week, I received an inquiry from a 23-year-old man as to whether he might be a candidate for stem cells based on advanced arthritic changes in his knee. An orthopedic surgeon had just told him that there was little alternative than a joint replacement in the foreseeable future.

Then came the following e-mail greeting from a patient in whom I had performed a stem cell right and left knee intervention about 18 months ago.

Hello Dr. Sheinkop,

While on my way to the health club today walking through the parking lot I marveled how wonderful my knees felt carrying me and my 20 lb. bag of equipment strapped on my shoulder. I felt I was walking a very natural gate with no sign of limp. Was it all in my head ? No way… I was with ” happy knees ” and I feel good.

Inside the health club I met an old friend that I have not seen since the first of the year he was still on crutches since last fall caused by an infection somewhere in his body that wound up on his needing a second knee replacement , the original he has had over ten years. In March he had his replacement. He told me about the surgery ordeal that he had undergone which resulted with a two hour knee replacement, and then an eight hour procedure with another surgeon to do tendon ” whatever”. He is still on crutches  and a leg length brace…looking forward to June when he feels things will be better.

I remember him as a tall, massive muscular strong handsome man who was quite an athlete.  His physical appearance today seems to be a shell of his former self…his whole body seems to atrophied….. I wish him the best.

We had met  18 months ago, and I discussed the Regennex procedure and my decision to go ahead with this…. I got the impression from him it was “hocus pocus” as he pounded his fist into his artificial knee and proclaimed  “these are the best , they can last forever” !

R.R.

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I am doing excellent after my last treatment. Last weekend, I did (6) Spin classes and played 18 holes of golf on Tuesday.

Regarding a reference, I would welcome the opportunity to talk with a patient who is considering Regenexx SD procedure. You can have the patient call me directly or if necessary I could meet them personally. I am a true believer and willing to tell my story !

Thank you for the opportunity !

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