Aug 6, 2014
“Get this—K just tried a 100 mile race, at altitude (no acclimation) in Aspen w/13,500 vertical. Missed a turn (and missed steepest dirt road in America, approx 2,000 vertical) and “only” did almost 90 miles and over 11,500 vertical. Hard day, eh?”
This was an email I received yesterday from K’s father-in-law. What makes the setting so fabulous is that K (I won’t use his full name) was in his mid 30’s two years ago and was so impaired by arthritis of his hips that he was investigating total hip replacements, unable to walk a full city block let alone pursue his riding passion. Incidentally,that picture at the top was taken of me by my eldest son after a long bike ride up and down the hills of Southwest Wisconsin yesterday.
“Orthopedic Surgery is going through a serious paradigm shift: instead of simply removing and replacing damaged tissues with artificial devices and materials, autologous patelet-rich plasma in orthopedics are aimed at triggering and enhancing the natural in vivo tissue morphogenesis and regenerative capacity of damaged tissue” from The Journal of the American Academy of Orthopaedic Surgeons, August 2014
We have taken it much further over the past two years morphing into Bone Marrow Aspirate Concentrate providing the Adult Mesenchymal Stem cells potential that not only has the anti-inflammatory possibilities of Platelet Rich Plasma; but introduces the possibility of replacing damaged cartilage and altering the natural history of degenerative arthritis. I am aware that we must continue optimizing the procedure at the same time that I continue to offer my patients the healing power of Bone Marrow Aspirate Concentrate. To this end, I am off to the yearly Regenexx Network meeting in Colorado later this week where I will present our outcomes data. What’s amazing is how favorably, the measurement of Activity level after a Stem Cell intervention compares with a joint replacement. As you can see from the results of the cyclist identified above as K, there is reason to pause and consider the question when dealing with an arthritic joint; Total Joint Replacement or try Stem Cells first?
Tags: activity level, arthritis, athletes, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Mature Athlete, Osteoarthritis, Regenerative
Jul 28, 2014
The Role of Activity Level in Orthopedics: An Important Prognostic and Outcome Variable
Every year, the members of the Regenexx network gather in Colorado to review their respective experiences in Regenerative Medicine, exchange ideas, and explore new possibilities for improving the various interventions. As one of the few orthopedic surgeons involved in the Regenexx network or in the entire scope of Regenerative Medicine for that matter, I feel my role is to apply the same standard of practice to Cellular Orthopedics that I followed as the head of a joint replacement program at a major medical center over a 39-year career. To that end, I will be presenting the outcome data of my Bone Marrow Aspirate Concentrate interventions in knee arthritis for which I have greater than one year of follow-up.
In addition to the customary outcomes data points I historically applied for monitoring the outcomes of a Total Knee Replacement including pain scores, subjective psychological and physical well-being responses, Range of Motion and Mechanical Axis measurements, 100 point knee surveys and Knee Society Scores; I will include, for the first time, the Activity Level changes following a Bone Marrow Aspirate Concentrate knee intervention and compare the results to those following Total Knee Replacements.
A patient’s activity level is increasingly being recognized as an important factor in establishing the success of a procedure be it surgical or as in the case of Bone Marrow Aspirate Concentrate, non surgical. We now have validated reliable activity measurement tools for the knee, hip, shoulder and ankle. The tool allows me to document whether the stem cell procedure restored function. Activity level is a powerful prognostic factor for outcomes in orthopedic procedures. It is a quantitative measure of how much, rather than how well, a patient performs certain tasks; thus it is distinct from symptoms or functional disability.
My presentation on August 7, will document the significant increase in percentage participation at a Very Active activity level one year after the stem cell intervention when contrasted to the patient cohort prior to treatment. The same holds at the Active category, at the Moderate level as well, and even more so at the Mild activity level. The same cannot be said when I compared the data with those who underwent knee replacements. The message, before you undergo a knee replacement, explore the new world of Cellular Orthopedics.
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Regenerative, Regenexx, stem cells
Jul 14, 2014
Beware of a company that treats everything from MS, to ALS, to arthritis with stem cells.
It is the obligation of anybody using stem cell therapy to track and report his or her data. I run a large registry with a designated medical researcher using the same outcomes criteria I used as director of a joint replacement program at a major university. I also have access to a full time bio-statician to analyze data. In August, I will report that data on-line and begin publishing the Outcomes in peer reviewed publications. My mission statement is musculoskeletal care of the aging athlete.
What prompted this tirade is the increasing marketing bombardment by Regenerative Medical providers offering false hope and information based on faulty science. Fat stem cells are not better than bone marrow stem cells for osteoarthritis In fact, for an osteoarthritis application, about 10 papers where fat and bone marrow cells were compared showed that the bone marrow cells were more suited to the application. The big issue with fat stem cells is that the closer the cell source is to the target tissue to be repaired or helped, the more likely it is that the cell will work. So bone marrow cells are involved in helping and maintaining joints and the fat cells from your stomach are not. I highly recommend the reading of a Blog written by Dr. Chris Centeno, the founder of Regenexx for a more complete explanation
http://www.regenexx.com/2014/07/checking-the-facts-about-fat-stem-cell-therapies-breaking-down-the-slick -marketing/
This is a common problem with clinics offering fat based stem cell therapies as there is scant evidence that this therapy is effective for arthritis at this point. Rather than conceding that fact, most clinics will -quote research that looks great on the surface but falls apart once you dig just a little deeper! So whom can you trust?
Prior to the dawn of contracted medicine, a patient had a doctor in whom they trusted and confided. When there was a need for a specialty referral, the family physician made the recommendation. Now that patient chooses health care based on a contract or even worse, an app. Perhaps in the evolving era of Cellular Orthopedics one might be guided by the message in Robert Browning’s classical poem Rabbi Ben Ezra…”Grow old along with me/The best is yet to be, The last of life, for which the first was made”. One of John Lennon’s final songs written “Grow Old with Me” appeared in the album Milk and Honey. For stem cell experience, updates and questions, make an appointment with this senior.
Tags: arthritis, athletes, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Orthopedic Surgeon, Osteoarthritis, Regenerative, Regenexx-SD, stem cells
Jun 26, 2014
If you are watching the World Cup Games in Brazil, and how could you not (even I have become a soccer fan), you are very much aware of Critiano Ronaldo and his sudden exit from Brazil because of “tendinitis´”of the knees. I have never examined him and whether it is tendinitis or something else that has caused the Portuguese star to leave the team is uncertain. What is certain is his impact on the game of Portugal against the US last Sunday. Now the question is whether his career is over or whether his knee tendinitis will respond to treatment and rehabilitation? At Wimbledon, Rafael Nadal is having a difficult time as well on a grass surface.
So what is the answer? Assume if you will that the X-ray and MRI of Ronaldo’s knees with the physical examination confirm tendinitis. Is it a matter of physical therapy and anti-inflammatories? Whether I am describing the plight of world class athlete or involved in the musculoskeletal care of an aging athlete, Cellular Orthopedics has a role. When the usual and customary regimen of rest, physical therapy, anti-inflammatory medication, and cortisone injections don’t do the trick, Regenerative Medicine modalities have a role. There are two basic approaches in Cellular Orthopedics. One is blood based Platelet Rich Plasma (PRP); the other, bone marrow aspirate concentrate derived Mesenchymal Stem Cells (MSC)
PRP contains cytokines and growth factors that both recruit your own stem cells circulating in your blood as well as influence the healing process. MSCs from your bone marrow initiate a robust regenerative process as well as provide the most effective anti-inflammatory physiologic influence known to medicine. It is all done with a needle as an outpatient and both significantly reduce the healing time for an injury and cause healing of soft tissue, cartilage and bone when it might not otherwise happen. Ronaldo and Rafa, the Regenerative Pain Center is waiting for your call; more important, we are there to help with the Musculoskeletal Care of any aging athlete.
Tags: arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Knee, Mature Athlete, Osteoarthritis, stem cells
Jun 23, 2014
The ability of stem cells to divide and become more specialized cells—such as bone, blood, or muscle—makes them attractive agents in many areas of medicine. Additionally, the ability to harvest stem cells from an individual and reimplant them in the same patient thus potentially reducing or eliminating the risk of infection makes stem cell therapy appealing to both patients and physicians.
What is a stem cell?
Although there are many different definitions of a stem cell, all share two common characteristics: In the body, the offspring of a single cell are able to reconstitute a functional tissue, also called potency, and these cells are able to proliferate or renew themselves.”
The development of stem cells starts with Totipotent cells developing from the fertilized egg and having the ability to divide and become all the different cells in an organism as well as the placental cells. Embryonic cells are pluripotent, meaning they can differentiate into various cell types. Multipotent fetal stem cells can develop into more than one cell type but are more limited than pluripotent cells.
One of the proven stem cell therapies is the use of bone marrow stromal cells for tissue replacement in building bone within focal cavities. The use of stem cells in a systemic way to strengthen bone or replace cartilage, is what we do at Regenexx and what we study
Regenerative medicine
Every second, 15 million blood cells ‘drop dead’ in your body (apoptosis)—and stem cell replacement keeps you alive. The source of those blood cells is bone marrow stem cells; without them, you die.”
Additionally, the pericytes located on blood vessels detach and become MSCs in the presence of inflammation or injury. “These MSCs, medicinal signaling cells, not only become the first line of defense against an auto-immune reaction by stopping an overaggressive immune response, they also make molecules that stop cells from dying from apoptosis.”
. A phase II study has found that using MSCs to treat degenerative disk disease results in lower mean pain scores, reduced opioid use, and fewer surgical and nonsurgical interventions for persistent pain at 12 months.
Stem cells and bone.
Cells may be taken from the bone marrow space and concentrated without any manipulation other than simple centrification. Because research found a positive correlation between the number and concentration of colony-forming units and the volume of mineralized callus at 4 months, we now apply the technique to treating nonunion (failure of bone to heal).
With regard to the use of stem cells in treating osteonecrosis of the femoral head, a prospective case series of patients with stage 1 or stage 2 osteonecrosis followed for one year demonstrated 75 percent significant symptomatic improvement; they did not require any further surgical intervention, and exhibited no further collapse.
Cartilage repair and regeneration
Concerning the use of stem cells to treat OA and delay total joint replacement. We have preliminary data to support our treatment approaches. While all interventions short of joint replacement to date are symptom modifying, stem cells introduce the potential to alter the natural history of the disease and regenerate the joint.
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, PRP, regenerative medicine, stem cells
