Jan 5, 2015
This time of year always brings with retrospection, reviews and prophecy, no matter what area of interest. As my area of professional concern is arthritis and assisting a patient avoid or at least delay a joint replacement, I thought it would be helpful to look at what Outcomes we recorded in our Data Base. Unlike the majority of Regenerative “experts” marketing themselves on the internet, I don’t cite the results of others or make unsupported claims, I document what I learn from having treated patients with Bone Marrow Aspirate Concentrate over two and a half years. Imagine if you would the complexity of having integrated patient care with clinical research using all the parameters I applied to development of new generations of total hip and total knee prosthetics during my almost 40 year joint replacement career. That’s why there are few if any involved in musculoskeletal care via Regenerative Medicine who are able to provide a patient the comprehensive experience I offer.
As of this morning, we have registered over 525 patients in our comprehensive Data Base with measurement pre and post Bone Marrow Aspirate Concentrate/Stem Cell intervention in 125 hips and almost 400 knees. Of the hips, three have gone on to a joint replacement; of the knees, two have gone on to a total knee replacement to the best of my knowledge. What I have defined from my experience is who will benefit from a BMAC intervention and who should undergo a joint replacement. Note the absence of reference to adipose derived stem cells. The explanation is simple; the FDA views such as a drug and hence does not approve the use of fat in the management of arthritis. I am also beginning to get a better understanding about how long the benefits of the intervention will maintain and how to best manage and extend those benefits. In the joint replacement world, the benchmark parameter is survivorship, how long until the prosthesis fails? In the stem cell world, I am interested in observing and prolonging the pain relief and functional improvement after the Bone Marrow Aspirate Concentrate Stem Cell procedure.
Evidence Based Medicine and Best Practices require maintenance of an outcomes data base; not an injection without ongoing follow-up. As I perused the internet this morning, other than Regenexx, I find a paucity of clinical data and a predominance of unsupported claims. In my lifetime of joint replacement surgery, there were many others performing large numbers of procedures around the country. We would meet periodically and present our own scientific outcomes and the evidence and learn from each other, all leading to the best possible clinical practices of total joint replacements. When it comes to the seductive claims from Stem Cell clinics found all over the Web, my challenge this year: Show Me Your Evidence
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, FDA, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
Dec 22, 2014
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
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Dec 8, 2014
The majority of patients I see with knee pain either tell me “my doctor told me I have bone on bone” or “I have a torn meniscus”. They usually have already seen a physician and come in with the MRI. In a day and age when almost everyone over age 55 has MRI changes consistent with meniscal disease or has some joint space narrowing on the X-ray, I am still amazed as to how quickly a patient is willing to sign the informed consent for either arthroscopic meniscal surgery or a total knee replacement. “Referring patients to other physicians is one of the most fundamental and frequently performed tasks in clinical practice” according to an opinion in VIEWPOINT, an opinion section in The Journal of The American Medical Association appearing in the November 12, 2014 edition. The article concludes that the single most important factor for making the referral should be based on scientific evidence; not the usual and customary.
So what is the evidence supporting cellular orthopedics and not invasive surgery for meniscal pathology? The very essence of the response is to be found in the scientific evidence; you need the meniscus now so as to avoid degenerative joint disease later. It is one thing to have a “clunking” meniscus causing giving way and knee buckling; that’s the positive MacMurray sign. That’s a mechanical problem and not a pain problem usually resulting from trauma. The issue I am referring to is the almost every day patient presenting with knee pain The scientific evidence clearly documents worsening of a condition wherein surgical meniscectomy, be it open or arthroscopic, will worsen the symptoms and hasten the need for the knee replacement. Even in the younger population presenting with knee pain and devoid of mechanical symptoms, evidence based scientific orthopedics emphasizes saving the meniscus. For a better understanding check out http://www.regenexx.com/
By chance, while I was writing this Blog, the Radiologic Society was meeting in Chicago and here is an excerpt of a scientific presentation. “A popular surgery to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.”
“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function,” said Frank W. Roemer, M.D., from Boston University School of Medicine in Boston and the University of Erlangen-Nuremberg in Erlangen, Germany. “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”
“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before,” Dr. Roemer said.
All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59 percent) of the knees with meniscal damage that didn’t have surgery. In addition, cartilage loss was much more common among knees that had undergone surgery: 80.8 percent of knees with surgery showed cartilage loss, compared with 39.5 percent of knees with meniscal damage and no surgery.
Cellular Orthopedics offers the alternative to surgery, preserving the critical meniscus with Bone Marrow Aspirate Concentrate and Mesenchymal Stem Cells
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Interventional Orthopedics, medicine, meniscus injury, Osteoarthritis, Pain Management, Regenexx, stem cells, treatment
Nov 3, 2014
From time to time, I consult with patients who just don’t meet the inclusion criteria regarding Bone Marrow Aspirate Concentrate intervention for arthritis. At the same time, some of those patients are so pharmacologically dependent owing to medical conditions demanding maintenance that I am unable to offer them autogenous hope from their own Platelet Rich Plasma or that which may be created from a patient’s own platelets. While in the minority, as an orthopedic surgeon offering Cellular Orthopedic interventions for arthritis in those unable to undergo a joint replacement wherein the internist deems the procedure unsafe or who seek to avoid or at least postpone a joint replacement; weight loss, physical therapy, cortisone injection and visco-supplementation are short term fixes and not necessarily without potential risks. The real damage to stem cells from cortisone injections became the subject matter of several recent scientific publications. First no harm is what I was first taught in my orthopedic training.
Over the past several months, I have sought treatment alternatives for patients as described above; not candidates for current interventions with standard autogenous procedures. Enter the new alternative, allograft. Derived from Amniotic Fluid, the intervention is FDA approved, safe, and in some cases, even covered by third party indemnification. There are many companies offering this treatment alternative and I am investigating the multiple options. Please be aware, amniotic fluid alternatives are not a substitute for Bone Marrow Aspirate Concentrate derived stem cells ; but there may be a place for this anti-inflammatory alternative when established Cellular Orthopedic options can’t be used in an arthritic because of medical co-morbidities such as heart disease, chemotherapy, kidney disease, liver disease, obesity, Diabetes, etc, etc, etc. Amniotic Fluid usage in Orthopedic is not new; there are publications dating back to 1938 in the orthopedic scientific literature. It wasn’t though until the last five years evidently that allograft investigation led to the development of currently available products.
If you fall into the category of patients who do not meet the inclusion criteria for Bone Marrow Aspirate Concentrate or in whom your Platelet Rich Plasma would not be a suitable alternative, you may be a candidate for Amniotic Fluid Concentrate intervention. Under certain circumstances, the allograft may be covered by your insurance. To learn more, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Osteoarthritis, Pain Management, Regenerative, stem cells, Synvisc, treatment
Oct 27, 2014
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?
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx-SD, stem cells, treatment
