Seems strange that I would start thinking about the upcoming winter season but conditioning is sports specific and it will take about eight weeks to get ready. This past weekend, I increased my conditioning program with more cycling and strength training. It is now about nine months since I underwent cellular orthopedic interventions to both on my knees followed by both of my hips. The results have been most gratifying allowing me to extend my recreational lifestyle indefinitely; so here I am planning ahead for the upcoming ski season even though the Chicago temperature prediction is for a high of 87 degrees. Last year at this time, I questioned whether my skiing days were over. The reasoning behind much of my autobiographical, recreational subject matter is so the reader will better understand what is possible through stem cell, growth factor and platelet intervention for those with pain and limitations inherent in osteoarthritis. While an orthopedic surgeon does not need to break his or her own bones to better enable that surgeon to treat a fracture, given the number of clinics now advertising stem cell treatment, the patient choosing a regenerative medicine provider might take note of the fact that not only have I been playing a prominent role in the evolution of this expanding specialty of Cellular Orthopedics by introducing evidence based care over five years ago, I can tell you what works best from the standpoint of a patient.

There is an ever-increasing number of good and some excellent outcomes logged into our database. To be quite frank, there are some who have not fared as well. By continued surveillance and monitoring of outcomes, I am able to identify those who would improve their results by some means of augmentation be it a Platelet Rich Plasma follow-up or a repeat stem cells intervention. Let me paraphrase a message received from a patient in whose knees I have completed several cellular orthopedic interventions over the past three years. This mid 50s farmer is back to regularly playing age related group basketball several evenings each without limitation and without recurrence of symptoms the following day. Concerning yet another patient, this one in his early 90s from a patient who happens to be a family acquaintance, “I watched your patient painting the side of his garage the other day.”

Yes, these are anecdotes and so is my story; however, I think you get the message.

To learn more, you may call (847) 390-7666 to schedule a consultation. Access my web site at www.sheinkopmd.com.

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Resolving a regenerative medicine dilemma

I rode my bike this past Saturday and Sunday through the Chicago Forest Preserve bike trails and I had some time to reflect. Just as in fly fishing, cycling is meditation time. I tried to answer questions that came to mind such as how could Abraham have fathered both Izsak and Ishmael in his late 90s? Was it the triumph of stem cells or something more? I reflected on this through the Monday service without resolution other than we are still dealing with the ramifications.am

On Tuesday morning, the usual and customary ad in the Chicago Tribune paid for by the Stem Cell Institutes of America appeared inviting readers to a seminar to learn more about their approach to pain from arthritis and assuring the reader that their techniques are FDA compliant. Their approach is based on Amniotic Fluid injection. What I do know is FDA compliance requires that the stem cells must be yours (autologous) and that amniotic fluid once processed, sterilized, frozen and fast thawed has no viable stem cells. I also am cognizant of the large body of scientific evidence supporting the notion that pain of arthritis is generated by the supporting bone as cartilage has no nerve supply. How does a single and costly injection of amniotic fluid result in long term benefit? I have to deal on a daily basis with the fallout of this marketing campaign.

Next the Wednesday, September 12, addition of the Chicago Sun Times carried an ad sponsored by The Pain Relief Institute headlining Stem Cell Recruitment. As I understand the approach, Amniofix, a placental derivative, micronized, is reconstituted and injected into the arthritic joint. Reader please note that the first bullet states “FDA Regulated”. Of interest is the fact that I refused and still refuse to use Amniofix in my practice as there are no evidence based clinical trials to support any clinical claims. Those trials are taking place now. Amniofix is a product rushed to market before there was scientific proof to support use. You may learn more about Amniofix by searching the product online. If you don’t count cells with a hemoanalyzer, how could you know what is being “recruited”?

My commitment is to stand up for my patient in this regenerative medicine chaos. I resolve to do better in the upcoming year with introspection and ongoing review of the discipline.  

With best wishes for a happy and healthy 5779

You may visit the website at www.sheinkopmd.com

Schedule an appointment by calling (847) 390-7666

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Effective use of blood and bone marrow derived biologics

Effective use of blood and bone marrow derived biologics

Evidence for the efficacy of Platelet Rich Plasma, a blood-derived formulation, and bone marrow derived biologics in osteoarthritis continues to grow in the orthopedic community. On the other hand, as I continually monitor the current landscape of indiscriminate and sometimes inappropriate marketing and use of biologics by the non-orthopedic opportunists, I doubt if the charlatans and camp followers have an overview of what is known about these agents. The increased presence of clinics Is driven by the popularity of PRP and its biologic cousins:

  1. consumer demand
  2. aggressive marketing
  3. a low regulatory bar for many of these regenerative medicine clinics
  4. the autologous nature that makes many approaches largely safe
  5. positive data from centers such as ours demonstrating functional and symptom modification

PRP works by activating cellular pathways; more than 3,000 genes are related to these and other pathways, suggesting that PRP probably acts by inducing a transitory inflammatory event, which then triggers tissue regeneration. Bone Marrow Concentrate, does more and addresses the subchondral bone when appropriately injected as well as initiate joint preservation and possible regeneration.

Taking aim

I use a hemoanalyzer to characterize a dose of PRP or Bone Marrow Concentrate allowing me to quantify the composition and biologic activity of these agents. Soon, I will begin pretreatment assessment of the synovial fluid of the arthritic joint so as to best determine who is the optimal candidate for a particular procedure

What do we know?

  1. Knee osteoarthritis: white blood cell-poor PRP has a positive effect on symptoms, not structure; while Bone marrow Concentrate affects symptoms and structure. I identify what I am putting into the patient. My goal is to have reliable predictors of outcome; that is, do the composition and biologic activity of the material implanted in the patient predict the clinical/imaging outcomes? My PRP contains a high concentration of anti-inflammatory cytokines and anabolic growth factors whereas my use of Bone Marrow Concentrate inside the bone adjacent to the joint in addition to the joint itself is improving the outcomes of the patients I treat.
  2. To learn more, call my office to schedule an appointment at (847) 390-7666
  3. You may view my Web site at  WWW.Sheinkopmd.com

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What to expect from a cellular orthopedic intervention

What to expect from a cellular orthopedic intervention

It is my belief and practice that each patient has full understanding of his or her orthopedic condition, its implications, the various options for treatment, and the expected outcome of each treatment. As a basic principle of bioethics, respect for autonomy recognizes an individual person’s right to live that life consistent with personal needs, desires and morality.

Stepping away from the lectern, let me share with you my motivation for the theme running through this blog. I have two arthritic hips, two arthritic knees and one arthritic low back. On Sunday, two of us completed a 35-mile, arduous bike ride from Chicago’s Lincoln Park, stopping for coffee at the northern end of Glencoe and returning home making for a four-hour effort. 12 hours earlier, Sharon and I had danced the night away at the wedding of one of my part time staff members. As an aside, we long ago decided we would never become the older guests at an event that sat out the evening watching the younger crowd shaking their booty to KC and the Sunshine Band. While it is easier for me to write about others and their recreation, athletic and fitness pursuits; even tough more difficult, I wanted to share with my readers what is possible with cellular orthopedic interventions such as I have received. None of this would have been possible prior to my joint preservation and restoration procedures eight months ago.

Stepping back up to the lectern, all too often, a patient will share with me a statement from an initial orthopedic surgical visit in which he or she was subjected to the outdated practice of paternalism, in which that physician dictated the “best” treatment; for arthritis, probably a total joint replacement. Another bioethical principle is one of beneficence; the latter obligates the physician to help the patient do well. This requires the physician to have a knowledge of the expected outcomes of each treatment. Just as a certain restaurant chain’s tagline is “we have the meats”, one of the best reasons for seeking a cellular orthopedic intervention in my practice is we have the outcomes data for each cellular orthopedic intervention we offer.  

Nonmaleficence simply means that physicians should not harm their patients. This is why we have an FDA; yet the plethora of claims for umbilical cord blood, Wharton’s jelly, amniotic fluid, the latter all without proper scientific clinical outcomes or living stem cells when thawed and injected violates the concept of primum non nocere, first do no harm.

If you want to learn more about Cellular Orthopedic interventions to help you postpone or avoid a major surgical procedure, call (847) 390-7666 to schedule a consultation. You may visit my website at www.sheinkopmd.com

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Autologous Bone Marrow Concentrate for Osteoarthritic Knee

Autologous Bone Marrow Concentrate for Osteoarthritic Knee

The argument frequently advanced by orthopedic surgeons in response to a patient’s inquiry concerning stem cells for arthritis is that it is too early, there is not enough research, It is better to have a major surgical procedure. For those of you who have read my blog or have sought orthopedic consultation in my office, I have emphasized that my recommendations are evidence based. Each patient, for whom I have completed a cellular orthopedic intervention for arthritis, has been entered into a registry or clinical outcomes data base, IRB approved. Just as I pioneered the integration of clinical care with clinical research over 37 years as a joint replacement surgeon, so too do I now partake in the growth and development of the clinical pathways for regenerative medicine.

Last month, I exhibited a poster at a large regenerative medicine meeting wherein I shared my preliminary outcomes and thus educated other professionals using Intraarticular and Subchondral Bone Injection of Autologous Bone Marrow Concentrate and General Fluid Concentrate for Osteoarthritic Knees-A Prospective Clinical Study. Osteoarthritis is an organ disease that affects most structures of joints including cartilage, synovium and subchondral bone. Pathology in subchondral bone contributes to the initiation, progression and pain of Osteoarthritis. In previous European studies, the injection of autologous bone marrow concentrates into bone supporting the joint significantly relieved pain and improved function of the affected knee. The preliminary outcomes in the study that I presented via a poster exhibit, investigated the effectiveness of injections of Bone Marrow Concentrate with General Fluid Concentrate (Growth factors), into both the knee joint and the subchondral bone. The study recorded all the standard Endpoints I had previously used in joint replacement clinical outcomes trials.

Bone Marrow was collected from the pelvis and a filtration system allowed for concentration of Mesenchymal Stem Cells, Platelets, Precursor Cells and Growth factors such as A2M, IRAP, EGF, PDGF, TNF-B blocker, etc. After preparation, a mixture of Bone Marrow Concentrate and Growth factor Concentrate was injected into the bone (subchondral) and into the joint.

In the study, all patient injections went well and there were no complications. The Preliminary Results documented diminished pain and improved function. We concluded that injection of Bone Marrow Concentrate and Growth factor Concentrate into both the subchondral bone area and joint cavity significantly improved function of the affected knee joints and significantly reduced joint pain. While there are many stem cell providers to be found because of their marketing, choose the center of excellence in Cellular Orthopedics that is evidence based.

Call to schedule a scientific based consultation from an orthopedic surgeon 1 (847) 390-7666.

You may access my web site at www.SheinkopMD.com.

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I don’t treat an image, I treat the patient

Just as I cringe when a new patient announces that they have “bone on bone”, so too do I squirm when I am told by a patient “I have a torn” at times meniscus or cartilage; others, a torn rotator cuff; and then again, a torn labrum. Attention please, your X-ray or MRI image is not causing pain, the inflammation in or around your joint is the pain generator. 95% of the population over age 45 will have an abnormality interpreted by the radiologist on the report their MRI, be it of the shoulder, hip or knee. Cartilage and meniscal changes at the knee, labral tears at the hip or shoulder, and rotator cuff abnormalities are part of the attritional process; alternatively, these changes are commonly over diagnosed.

Last week, a 70-year-old woman called to schedule an appointment and indicated that she had a torn acetabular(hip) labrum diagnosed on a recent MRI. I responded, “your pain generator is arthritis unless you are a hockey goalie”. I was being a bit facetious but at the same time truthful. My 37-year experience as a reconstructive orthopedic surgeon specializing in hip and knee replacement really prepared me for this life after surgery; namely, a cellular orthopedic interventionalist.

It takes a history and hands on physical examination prior to review of images to determine what is causing a painful musculoskeletal condition. The common denominator is inflammation, not a computer image. In the case of arthritis, unless the cartilage (meniscus), labrum or rotator cuff alteration is generating mechanical problems such as weakness, locking, “clunking” or giving way, we frequently need not address the former with a maximally invasive surgical procedure; a needle will suffice and deliver the platelets, Mesenchymal Stem Cells, Growth Factors and precursor cells required to address pain, improve function, increase motion, stop progression of arthritis and restore, at times regenerate the joint.

Cellular Orthopedics encompasses a full joint Preservation, Restoration and Regenerative scope of options. The notion introduced by a print media ad, that it is “one and done”, won’t help you postpone, perhaps avoid a joint replacement. In my practice, we monitor progress and intervene when necessary at five months or five years if indicated.

To learn more, visit my web site at www.SheinkopMD.com or call and schedule a consultation at (847) 390-7666

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