Musculoskeletal Care of the Mature Patient

 

Might stem cell management offer breakthrough, non-surgical treatment options for people suffering from moderate to severe joint, tendon, ligament, or bone pain due to injury and other conditions? That’s the promise of those worldwide with experience. Is the time right to pursue stem cell therapy in orthopedic injuries and arthritis closer to home in terms of research presentations, publications, and academic achievements? Let me put things in perspective for your consideration.

You may become better informed by looking over my weekly blog postings for the past six weeks (http://sheinkopmd.wpengine.com/archives) Rejuvenation cellular therapy is being offered around the world including here in the US. The restriction in the US has to do with “minimal manipulation” of the cells. Since bone marrow derived stem cells are insufficient in concentration, they have to be maximally manipulated via growth in culture and treatment with growth factors. The leader in orthopedic technology has been Regenexx out of Colorado but the FDA stopped their maximal manipulation of aspirate from the posterior superior iliac spine region, manipulation and subsequent injection after a four to six week delay. That delay necessitates a second visit.

Regenexx has about a thousand case experience over the last several years but can no longer operate as such in the USA. The company is looking to license operations outside of the USA. (http://www.regenexx.com/) The same holds for Celling Technologies in Texas  (http://www.cellingtechnologies.com/). Like Regenexx, they are looking to relocate outside of the USA because of oversight by the FDA concerning their bone marrow aspirate program. 

Enter adipose derived stem cells. While less is known about adipose  derived stem cells and arthritis, the advantage of adipose derived stem cells is the stromal vascular fraction  (SVF) which has concentrated growth factors in addition to the stem cells. Second, the adipose tissue that is derived from liposuction contains unlimited quantities of cells and hence, need not be manipulated. What Cytori  (http://www.cytoritissue.com/)   (San Diego) and Tissue (http://www.tissuegenesis.com/)  (Honolulu) have in common is the absence of a need to manipulate cells other than concentrating in a centrifuge for an hour and immediate introduction into the joint of concern. Incidentally, adipose derived stem cells are very applicable to wound healing and diabetic revascularization of a limb as well, according to published accounts. While the cost of the stem cell harvesting and processing is a patient out of pocket expense, the cost of the facility use, the fluoroscope or ultrasound assisted injection procedure and the payer covers the injection. The cellular rejuvenation procedures could be used to treat and avoid surgery for rotator cuff injuries, intractable lateral epicondylitis, osteoarthritis of the hip, avascular necrosis of the hip, labral hip injuries, knee ligament injuries, avascular necrosis around the knee, degenerative arthritis of the knee, osteochondral injury of the knee, non-union of fractures and osteotomies, osteochondral lesions of the talus, hallux rigidus, etc., etc., etc.

My questions for the reader, if you have an arthritic condition that will require a joint replacement in the next two to five years, for the potential of delaying or possibly avoiding that surgery, would you invest  for rejuvenative cellular care? Is it time for me to establish a treatment program-clinical trial?

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