Special Announcement - Now Enrolling for FDA Approved Stem Cell Study
Dr. Mitchell Sheinkop has completed training and is credentialed for the first of its kind FDA approved stem cell clinical trial for knee arthritis. Our clinic is now enrolling patients in this trial. Contact us at 312-475-1893 for details. Click here to learn more.
Your Journey with an Arthritic Joint

Your Journey with an Arthritic Joint

Better stated, how do you bridge the gaps in the continuum of joint care from early intervention to joint replacement? 

Arthritic Joint Pain Management

First and foremost, our goal is functional restoration and maintenance, relieving symptoms, and postponing, perhaps avoiding joint replacement. In the beginning, conservative measures might include non-steroidal anti-inflammatory medications, weight reduction, physical therapy for strengthening muscles and preserving or restoring a full range of joint motion. At times, an unloader brace may be of benefit in settings where a joint shows early signs of mechanical changes such as a knock knee (valgus) or bowed leg (varus). In addition to the aforementioned measures, joint preservation is a major goal using such measures as Platelet Rich Plasma, Highly Cross-linked Hyaluronic Acid and Acellular Amniotic Fluid.

Within the Preservation Classification, there are multiple options available. Our evidence-based practice concentrates on those options in which we have done outcome research; as well as published our results in scientific journals. Only using evidence-based options allows us to provide the patient the highest chance of a successful outcome. 

Cellular Therapy to Treat Joints

There are times in the continuum of care that the patient will present further along in the arthritic process so that Conserve and Preserve are no longer indicated. Joint Restoration is the next consideration that might or could go a long way in postponing or even avoiding a joint replacement. Autologous Growth Factor Solutions contain proteins circulating in your blood that potentially stops pain,  and reverses the arthritic process at the molecular level in the joint. The ultimate Regenerative Orthopedic approach is stem cell mediated and bone marrow concentrate is the only FDA approved source of mesenchymal stem cells at this time. Your bone marrow is recovered by an outpatient aspiration procedure, the recovered bone marrow via a specially designed needle, (troachar), contains adult mesenchymal stem cells, exosomes, platelets, growth factors and precursor cells. When concentrated, your bone marrow is the richest source of joint restoration potential available to date. It is FDA approved as long as guidelines are adhered to; has no potential for disease transfer; and offers pain relief, return of motion and function, and postponement, perhaps avoidance of a joint replacement. Please note that I indicated “at this time.”

The Personalized Stem Cell trial in which I played a major role just concluded. The results are being analyzed. In the PSC Trial, the source of stem cells was adipose tissue, abdominal fat. When approved, Personalized Stem Cells will allow abdominal fat to serve as an alternative source of stem cells in addition to bone marrow on a clinical basis. The next advance will come following the FDA approval for the PSC trial of stem cell culturing. To stay informed, read my weekly blog. To schedule a consultation call (847)390-7666. You may visit my web site and attend a webinar at www.sheinkopmd.com

 

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When it comes to a needle and not a knife, why I recommend Bone Marrow Concentrate

The science and art of my biologic initiative to help a patient deal with the symptoms and limitations imposed by osteoarthritis requires the right tools for each situation. Concentrated Bone Marrow Aspirate or Platelet Rich Plasma has emerged as an important biologic tool for me because I have scientific evidence to support what I recommend.

Mesenchymal Stem Cells are undifferentiated cells that influence healing and growth of tissues making up the musculoskeletal system. MSCs are found in bone marrow.

Osteogenic Precursor Cells are derived from MSCs but basically have the potential to produce bone. Hematopoietic Stem cells are precursors to all red blood cells, white blood cells, platelets and other cells influencing bone density. They are found in bone marrow

Platelets are small, colorless bodies found in blood. They contain alpha granules which play a vital role in blood clotting, inflammation and wound healing. They are found in bone marrow.

White Blood Cells (Leukocytes) provide the body with protection against foreign matter. There are several types of white blood cells and they play a role in inflammation and the immune response

I started this Blog with the sentence “The science and art of my biologic initiative.” At times, the art favors the delivery of autologous, Concentrated Growth Factors contained in your blood so as to reverse inflammation. It is inflammation that generates the pain associated with Osteoarthritis.

By centrifuging your Blood and Bone Marrow, I am able to deliver a large number of stem cells, progenitor cells, and growth factors directly to your arthritic bone and joint thus harnessing the body’s biologic potential. I use a proprietary approach having evolved from our research, when possible, introducing concentrated Platelet Rich Plasma before and after the Concentrated Bone Marrow injection or occasionally all together.

In spite of the misinformation found in the marketplace, the Amniotic Fluid Products do not provide a living source of Mesenchymal Stem Cells. They do contain various growth factors relevant to orthopaedics (platelet-derived growth factor ββ, vascular endothelial growth factor, interleukin 8, bone morphogenetic protein 2, transforming growth factor β1) and may have some value.

As I have indicated, Regenerative Medicine and Cellular Orthopedics is both an art and a science. This morning, I am working on the science as a co-author on the outcomes of the subchondroplasty manuscript. To learn more, visit my website at www.sheinkopmd.com.

You may schedule and an appointment or consultation by calling (847) 390-7666.

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Is it the stem cells or the growth factors?

The New York Times: 2019/05/13 “Stem cell Treatments Flourish with Little Evidence That They Work”

Several years ago, I asked a question of a cellular biologist as to how is Bone Marrow Concentrate effective if the number of adult mesenchymal stem cells diminish as we age? His response: “Bone Marrow contains lots of things including stem cells and proteins called cytokines or growth factors. It may be that the growth factors are most important in joint restoration and blocking pain.”

Let’s take for example, inflammatory arthritis such as Rheumatoid and Psoriatic arthritis. The common denominator is a pro-inflammatory cytokine called Tissue Necrosis Factor found in the body’s immune system.  The growth factor, TNF-alpha blocker is now used to control the inflammation and alter the body’s immune response to the proinflammatory protein. As a result of TNF-alpha blockers, Phil Mickelson is a very competitive golf professional, (You have seen him as a spokes person for Psoriatic Arthritis treatment with Humira). Since the introduction of TNF alpha blockers in Scandinavia five years ago, there has been a 40% reduction in Total Knee Replacements for inflammatory arthritis. When Kobe Bryant traveled to Dusseldorf, Germany almost nine years ago, he received treatment for a very arthritic knee with Interleukin -1 Receptor Antagonist Protein, along with other blockers. Shortly thereafter, he returned to play another five years in the NBA. The IRAP that Bryant received was and is an anti-inflammatory, a growth factor blocker, a cytokine.

As I agree in part with the  criticism in the New York Times concerning Stem Cells, those who read this Blog will recall that I don’t “sell” stem cells. Bone Marrow is used in part because of the fact that it contains stem cells; but more importantly as we age, Bone Marrow contains Growth Factors, the anti-inflammatory protein Cytokines that restore a joint by minimizing pain and improving function. Over the last eight years, we have accumulated the evidence that Bone Marrow Concentrate works for arthritis via stem cells, growth factors, or all of the above. Recently we have taken a major step forward by filtering high concentrations of Growth Factors from the Platelet Poor Plasma, previously discarded, that remained after we centrifuge the bone marrow and add the filtrate to that which is injected into the painful joint. Stem Cells maybe, highly concentrated Growth Factors that act to block pain and improve function, for certain.

You may learn more by visiting my web site at www.sheinkopmd.com  or call for a consultation (847)390-7666

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Masterful Care of The Aging Athlete

I consider myself an aging athlete who still skis, cycles, dedicates five days a week to fitness, plans to soon plant a garden, and walks up a spring creek with a fly rod. When my arthritic hips and knees began to limit my recreational profile several years ago, I chose the regenerative medicine option rather than joint replacements. Having performed joint replacements for 37 years and studied the benefits and limitations of such, I elected to postpone, perhaps avoid major surgery with the inherent risks and limitations. First it was Platelet rich plasma, next came PRP with Growth factor Proteins; and next came stem cells. At the get go, I did not expect to regenerate cartilage; but I did hope to restore joint function, minimize pain, and maintain the highest possible activity potential. Even with Grade 4 osteoarthritis of my major joints, I can report that I skied for a week in Vail this past February as I did a year ago, recently spent three days wading though spring creeks in Southwestern Wisconsin with a fly rod in pursuit of trout, and cycled 30 miles last Saturday. I am not alone as my biking, skiing and cycling buddy with similar knee issues returned last week from his yearly helicopter skiing adventure. I have been managing his knee arthritic issues with regenerative medicine interventions for over five years.

Then there are the athletes in their 50s. Certainly, the option is there for a joint replacement for a grade three arthritic joint but what If? What if there is a complication, an adverse event, a failure to regain motion, or residual pain? The fall back potion after a failed joint replacement is another joint replacement and the outcomes of revision surgery are frequently not satisfactory. Several weeks ago, I described the recreational pursuits of a 58-year-old volleyball enthusiast who had initially considered a joint replacement when 15 years after an arthroscopic partial meniscectomy, the predictable post traumatic arthritis had forced him to suspend his activities. He chose a regenerative medicine stem cell option; and eight weeks thereafter, he is back to playing volleyball three times a week. While on occasion, a booster follow-up injection is needed; we are in the process of developing a manuscript for scientific publication focusing on the successful outcomes of 20 patients followed for one to two years after a combined injection of bone marrow concentrate containing stem cells into the knee and the bone adjacent to the knee. These are recreational athletes between ages 45 and 60 who won’t quit.

On May 4, I am one of three invited faculty to present at The Regenerative Medicine Training Institute (RMTI). On June 7 and 8, I have been asked to participate in the Workshop and Lab Faculty at the largest Regenerative Medicine program in North America (TOBI). Owing to our integration of patient care with scientific outcomes monitoring, we have been able and continue to provide masterful and evidence-based care to aging athletes. To continue to remain in the forefront of Regenerative Medicine, I dedicate a good deal of time reviewing the future while monitoring the outcomes of patient care. Several new treatment options are soon to be launched including expanding my scope of care to those with inflammatory arthritis.

To learn more, call for a consultation (312) 475-1893. You may visit my website: www.sheinkopmd.com

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Should All Meniscal Injuries Undergo Operative Treatment ?

Should All Meniscal Injuries Undergo Operative Treatment ?

A patient presents to the office because of pain in the knee with or without a history of injury. An examination is performed followed by an X-Ray. Osteoarthritis may or may not be seen on the X-ray. If there is an altered range of knee motion when compared to the “normal” side, then a preexisting condition is considered. Whether or not the physician considers arthritis, an MRI is requested. The MRI report 48 hours after imaging is consistent with a torn medial meniscus. Should all patients with a torn medial meniscus undergo surgical intervention? If surgery is undertaken, should the procedure be a repair or a partial removal? The management of meniscal injuries must be influenced by the knowledge that meniscal integrity is important in load distribution across the joint. Meniscal injury causes altered joint mechanics and is related to the onset of arthritis.

According to a recently published online article in the British Journal of Sports Medicine, arthroscopic partial meniscectomy (APM) may not be the best option for all patients with knee pain and meniscal tear. Researchers investigated patients with meniscal tears that compared Arthroscopic Partial Meniscectomy to nonsurgical intervention, pharmacological intervention, and no intervention. At six to 12 months, APM patients had a slight improvement in knee pain, knee-specific quality of life, and knee function compared to physiotherapy patients. When excluding osteoarthritis (OA) patients, the aforementioned outcomes exhibited small to moderate improvement. Knee pain, function, and quality of life did not improve for APM patients compared to placebo surgery patients at six to 12 months regardless of OA status.

There may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis and who have mechanical or obstructive signs. Arthroscopic partial meniscectomy (APM), a keyhole surgery where loose and fragmented pieces of a torn meniscus is removed, is one of the most common orthopedic procedures performed. Over half of these are performed to treat a meniscus tear in a degenerative knee; however, several recent randomized trials have shown that Arthroscopic Partial Meniscectomy is not superior to conservative treatment or placebo treating meniscus tears associated with a degenerative knee. On the other hand, there is universal agreement that the traumatic meniscus tear, the result of a knee injury in a younger patient with otherwise healthy knee (with no degeneration), should be treated by surgery.

Then what is the downside of meniscal injury and surgery? The medial and lateral meniscus together provide shock absorption, establish a broad base of contact surface and help provide stability to the knee. Those who have undergone total or partial meniscectomy should understand that in five to 15 years, they will develop degenerative arthritis. The long-term outcomes of those whose tears were treated by repair rather than removal has not been established. My Regenerative Medicine practice in part, is the result of those seeking to postpone or avoid a Total Knee Replacement years after a meniscal injury followed by arthroscopic surgery. As long as the arthritis has not progressed to a Grade 4, I am able to assist the patient with joint restoration, at times joint regeneration, it is matter of age and health. While I am able to offer joint restoration, on occasion, joint restoration for those who sustained meniscal and Anterior Cruciate injury in the past, is there anything that could be used as an adjunct at the time of the meniscal injury to promote healing without surgery or postpone, perhaps avoid future postraumatic arthritis?

To learn more. Schedule a consultation (312) 475-1893.You may view my web site at www.sheinkopmd.com.

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