Jun 9, 2014
Thickening and increase of area of cartilage have been proposed as two alternative mechanisms of cartilage functional adaptation. The latter has been reported in endurance sportsmen. In weightlifters, extreme strain applied to the articular surfaces can result in other forms of adaptation. The aim of this research is to determine whether cartilage thickness is greater in elite weightlifters than in physically inactive men. Weightlifters (13) and 20 controls [age and body mass index (BMI) matched] underwent knee Magnetic Resonance Imaging (MRI). A single sagittal slice of the knee was taken and cartilage thickness was measured in five and six regions of the medial and lateral femoral condyles, respectively. The analyzed segments represented weight-bearing and non-weight-bearing regions. The tibia cartilage in the weight-bearing area was also measured. The time of training onset and its duration in the weightlifter group were recorded. The cartilage was found to be significantly thicker in weightlifters in most of the analyzed regions. The distribution of cartilage thickness on the medial and lateral femoral condyles was similar in both groups. The duration of training was not associated with cartilage thickness, but the time of training onset correlated inversely with cartilage thickness. It is possible that in high-strain sports, joint cartilage can undergo functional adaptation by thickening. Thus, mechanical loading history could exert a postnatal influence on cartilage morphology. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.”
Although, many physicians warn against jogging, to the best of my knowledge, there is no scientific evidence that running or jogging injures cartilage. Now there is evidence that loading cartilage is beneficial. Certainly, there is still much to be learned about maintaining joint health when it comes to the musculoskeletal care of the aging athlete. Remember, as I have stated many times in my Blogs, cartilage is only part of what makes up the joint. The cartilage joint space as determined by the space between bones is hyaline in nature. Then there is meniscal cartilage that is of a different cellular and chemical makeup. The lining of the joint is synovium and this can become a source of chronic inflammation. Next are the ligaments and capsule so injury and arthritis affect the entire joint and not just what is seen or not seen in an X-ray; arthritis is the result of a bio-immune response and not simply mechanical injury. That’s where stem cells may come to the rescue along with weight loss and strength training. Stem Cells seem to have a place in influencing the well being of the joint at any age; first as an anti-inflammatory, then as an immune modulator. What about cartilage regeneration? I don’t know for sure yet, there is probably an inverse relationship with the potential for cartilage regeneration and age. On the other hand, if a bone marrow aspirate concentrate intervention in an injured or arthritic joint helps maintain the well being of the mature athlete, I am not concerned about the MRI 18 months later.
Tags: arthritis, Cartilage, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, Knee, Osteoarthritis, Regenerative Pain Center, stem cells
May 27, 2014
Last week, I performed Bone Marrow Aspirate Concentrate Stem Cell Interventions on two patients; one was 76 and the other 79. The outcomes research at Regenexx has shown that age is not an obstacle to a successful Mesenchymal Stem Cell procedure for postponing or avoiding a knee replacement. Both patients were healthy and wanted to remain active. Both patients met Body Mass Index requirements for inclusion in our clinical stem cell interventions; most important, the nucleated cell count in both patients exceeded 400 million. Nothing I have described guarantees success; but I have to pause and congratulate both patients for their respective attitudes and desire to not become victims of a particular age category.
Aging is something we can’t control but the aging process may be modified by diet and exercise. When injury or arthritis intervenes, the options are to succumb, undergo a joint replacement or possibly postpone or avoid a joint replacement with Cellular Orthopedic intervention (Bone Marrow Aspirate Concentrate containing your own stem cells). As I have indicated, in recent Blogs, the research at Regenexx suggests that it isn’t your birthday that influences a successful outcome but rather the number of nucleated cells found in your marrow, an indirect indicator of the number of Colony Forming Units (mesenchymal stem cells).
Last weekend we celebrated Memorial Day by giving pause to remember. I received my commission as a First Lieutenant in the United States Air Force on the sixth day of November, nineteen hundred and sixty-seven. Times have changed and we age but there is little reason not to try and stay active. Over the years when there were no alternatives, I sought to improve the quality of a patient’s life by replacing an arthritic hip or knee with a prosthesis. Now I myself have aged but believe that the higher you climb the more you can see. You are never too old to stay active. The outcomes data continually documents the patient satisfaction now up to five years at Regenexx with our own objective data base indicating, not only patient satisfaction, but return to or continuation of a high level of athletic activity and fitness participation following a cellular orthopedic intervention for a musculoskeletal injury or impairment from an arthritic joint.
Stay Active My Friend.
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee, Mature Athlete, Osteoarthritis, Regenerative Pain Center, stem cells
May 3, 2014
Much of what I write in this Blog is about the musculoskeletal care of the aging athlete. From time to time, I am reminded though that the arthritic changes in a joint may start before the usual aging process ensues. This week, I received an inquiry from a 23-year-old man as to whether he might be a candidate for stem cells based on advanced arthritic changes in his knee. An orthopedic surgeon had just told him that there was little alternative than a joint replacement in the foreseeable future.
Then came the following e-mail greeting from a patient in whom I had performed a stem cell right and left knee intervention about 18 months ago.
Hello Dr. Sheinkop,
While on my way to the health club today walking through the parking lot I marveled how wonderful my knees felt carrying me and my 20 lb. bag of equipment strapped on my shoulder. I felt I was walking a very natural gate with no sign of limp. Was it all in my head ? No way… I was with ” happy knees ” and I feel good.
Inside the health club I met an old friend that I have not seen since the first of the year he was still on crutches since last fall caused by an infection somewhere in his body that wound up on his needing a second knee replacement , the original he has had over ten years. In March he had his replacement. He told me about the surgery ordeal that he had undergone which resulted with a two hour knee replacement, and then an eight hour procedure with another surgeon to do tendon ” whatever”. He is still on crutches and a leg length brace…looking forward to June when he feels things will be better.
I remember him as a tall, massive muscular strong handsome man who was quite an athlete. His physical appearance today seems to be a shell of his former self…his whole body seems to atrophied….. I wish him the best.
We had met 18 months ago, and I discussed the Regennex procedure and my decision to go ahead with this…. I got the impression from him it was “hocus pocus” as he pounded his fist into his artificial knee and proclaimed “these are the best , they can last forever” !
R.R.
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, joint replacement, Knee, Mature Athlete, Osteoarthritis
Apr 21, 2014
Taken from article published in the Journal of Bone and Joint Surgery, April, 2014
Background:
The volume of total knee arthroplasties, including revisions (second procedures), in young patients is expected to rise. The objective of this study was to compare the reasons for revision and re-revision total knee arthroplasties between younger and older patients, to determine the survivorship of revision total knee arthroplasties, and to identify risk factors associated with failure of revision in patients fifty years of age or younger.
Methods:
Perioperative data were collected for all total knee arthroplasty revisions performed from August 1999 to December 2009. A cohort of eighty-four patients who were fifty years of age or younger and a cohort of eighty-four patients who were sixty to seventy years of age were matched for the date of surgery, sex, and body mass index (BMI).
Results:
The most common reason for the initial revision was aseptic loosening (27%), in the younger cohort and infection (30%) in the older cohort. Cumulative six-year survival rates were 71.0%.
Conclusions:
The survivorship of knee revisions in younger patients is a cause of concern, and the higher rates of aseptic failure in these patients may be related to unique demands that they place on the reconstruction. Improvement in implant fixation and treatment of infection when these patients undergo revision total knee arthroplasty is needed.
Restated, almost 30% of all Total Knee Recipients undergo a second procedure termed a revision by the sixth year following the initial replacement. The risk of failure is greater in patients under 50 years of age; but infection is the serious problem in those over age 50. When the revision is needed, the survivorship of the second procedure is again about six years with infection accounting for the majority of those failures. Regenexx has an ongoing statistical analysis of its Data Base of patients, mine included. To date, in over five thousand patients followed five years, there have been no deep infections. To date, approaching two years in my practice, not one of the several hundred knee patients has elected to undergo a Total Knee Replacement. Patients with stem cell interventions for knee arthritis are actively pursuing their sports interests. Total knee replacement patients who resume a sports interest are at risk of failure by six years from the procedure. A revision in stem cell parlance is a second Bone Marrow Aspirate harvesting and concentration at two to five years. A revision in total knee talk is an invitation to yet another failure and infection. Total Knee Replacement or try Stem Cells first?
Tags: Clinical Trial. Mitchell B. Sheinkop, joint replacement, Knee, Revision Total Knee Replacement, Total Knee Replacement
Apr 16, 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 toti-potent 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 centrifugation. 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.
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 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, relieve pain and regenerate the joint. The number of patients at Regenexx and Regenexx Chicago are ever increasing. You decide, joint replacement or try stem cells first.
Tags: arthritis, athletes, Clinical Trial. Mitchell B. Sheinkop, Osteoarthritis, Regenexx, stem cells
