Musculoskeletal Care of the Mature Patient

On January 9, 2009 I wrote my first Blog. The emphasis at the start up was joint replacement of the hip and the knee for arthritis. All are archived at www.sheinkopmd.com. In mid-March, 2010, my emphasis shifted to Musculoskeletal Care of the Mature Athlete or how to avoid joint replacement, somewhat influenced by personal motivation. Today is my 100th blog and I will focus on the future of orthopedics: Bone and Joint Rejuvenation.

Treatment of Pre-collapse Osteonecrosis Using Stem Cells and Growth factors. Avascular Necrosis or (ON) of the femoral head is a devastating disease, a form of arthritis, affecting young patients at their most productive age, causing major socioeconomic burdens. ON is associated with various etiologic factors, and the pathogenesis of the disease is unknown. Most investigators believe the disease is the result of secondary microvascular compromise with subsequent bone and marrow cell death and defective bone repair. Could local delivery of vascular endothelial growth factor (VEGF) and bone morphogenetic protein-6 (BMP-6), which induces angiogenesis and osteogenesis respectively, reverse the disease process and provide a treatment for precollapse ON?

Use of genetically engineered bone marrow stem cells, carrying VEGF and BMP-6 genes, to enhance angiogenesis and osteogenesis in the necrotic bone by local delivery of growth factor in addition to the bone-forming property of the stem cells, tissue repair of the femoral head may be possible.

Imagine an injectable bone graft substitute containing engineered stem cells and therapeutic growth factors rather than hip replacement for a young person in need of treatment for ON.

Non Surgical Orthopedic Therapy: A Growing Trend and increasingly viable option.  Pittsburgh Steelers ‘s Hines Ward and Troy Palomalu underwent Platelet Rich Plasma injections in 2009. Tiger Woods went to Canada in 2010 for PRP to the knee. Superbowl Champion Jarvis Green underwent stem cell therapy in 2010 and subsequently signed with the Houston Texans when it was thought his career was finished. Yankees” Roberto Colon underwent stem cell management of his shoulder in 2011.When it looked as if this 35-year-old pitcher had reached the end of his career; he now is in the Yankee starting rotation. Kobe Bryant traveled to Germany for non-surgical management of his arthritic knee earlier this summer.

Elimination of surgical risks, the extensive rehabilitation following joint replacement and the inherent restrictions of a total hip or total knee is my motivation with this 100th Blog. To do everything I can to make the future available in a clinical setting in the here and now. Last night, we came very much closer to making stem cell care of bone and joint pain a reality.

 

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