The scientific facts do not support one “stem cell” treatment for all. Osteoarthritis is a complex process and we now know for what there has been recently identified two distinct genetic subgroups. OA is a joint disease with variable causes, symptoms and outcome. It is estimated that genetic makeup accounts for about 50% predisposition while major risk factors also include aging, trauma and obesity. Disease changes in most joint tissues include cartilage, bone, synovium, ligaments, and adjunct tissues, secondarily muscle, leading to pain and altered function. The progression of OA leads to abnormal intra-articular failure of repair as a result of biochemical, biomechanical and aforementioned genetic factors.
Over the last several days, three patient related encounters have captured my attention and I thought it would be worth examining in this blog. I received a phone call from the husband of a patient who had undergone a regenerative procedure in California some months earlier on both knees; and while the procedure had benefitted one side, the other knee was actually worse than prior to the procedure. He was looking for an explanation. Not ever having assessed the patient in my office, it is most difficult to opine as there are multiple possibilities including the genetic subgroup stratification factor. Most recently, I have observed that patients with swelling (effusion) at the time of an intervention do not do as well as those without effusion. There are several reasons behind the negative influence, but I now make sure to remove the unwanted fluid prior to the delivery of cellular product.
The second patient related issue called to my attention was the result of a question “may I use a cane?” If ever there were an uncomplicated adjunct for an osteoarthritic hip or knee, the tried and proven benefit of a walking stick needs to be reemphasized. There are no side effects from a cane; no ulcers, strokes, heart attacks, kidney failure, etc., and so forth. The cane or walking stick has no downside. They enhance pain relief while walking, assist in stability, prevent falls and are readily available, should it be needed as a defensive facilitator. When you watch the annual screening of the movie classic Moses, Prince of Egypt next Passover and Easter weekend, you may be reminded about the history of the use of a walking stick. The Pharaohs did it, Shepherds used them, Moses did, Jesus did and so do I (when I fly fish or I used to).
Finally, let’s relive my own personal weekend experience. It was Saturday afternoon in the Driftless area of Southwest Wisconsin on Tainter Creek. I parked the car and walked down a gravel road, semi vaulting a barbed wire fence, thus gaining access to a very long stretch of the creek. Though the cow pasture was fenced off, the posted DNR sign indicated that public fishing was legal. I walked for 20 minutes down the uneven, rocky trail until I decided it was time to enter the stream. As a climbed down the embankment, I reached back for my walking stick and immediately realized it in the trunk of the car. This marks the first time in seven years I was able to do what I had just done without my walking stick. The event took place 12 weeks after my cellular orthopedic right and left knee procedures and 10 weeks following those in my hips.
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