Sep 29, 2014
In seeking to continually improve results of Bone Marrow Concentrate Stem Cell interventions, we review our data base to try and better understand how to improve the success of a stem cell procedure both from the standpoint of pain control and the length of success. When it comes to the knee, I have looked at age and that isn’t as significant in anticipating a successful outcome as I had previously anticipated. Next it was the weight issue and Body Max Index but that hasn’t proved to have as significant an adverse influence on outcomes as I once had predicted although it does have a relation to the difficulty of the harvest. . There is no question that certain prescription medications have a very negative effect on stem cell performance; so much so that dependency on certain pharmaceuticals has caused me to seek an alternative approach to Bone Marrow Aspirate Concentrate. The pre-treatment range of knee motion is as reliable predictor of the outcome as is knee stability. If a patient has an unstable knee or less than 110 degrees of motion, the chances of stem cell success are problematic.
What influenced me to write this Blog is the correlation I am seeing between knee deformity and the degree of success and the length of success If a patient has a mechanical bowing of five to seven degrees or more or a knock knee over seven degrees, the results of stem cell intervention are less predictable and carry with a shorter length of success than might otherwise be the outcome. Knowing that your knee which still allows you to be active is worth saving in spite of the X-ray, will provide a higher certainty of maintaining an active functional capacity than a knee replacement affords; the stem cell route before considering a joint replacement is one worth serious consideration. In order to improve candidacy and long term success, I am now recommending correction of mechanical deformity via a procedure termed an osteotomy in conjunction with the stem cell intervention. The concept of correcting a mechanical knee axis for arthritis has over 50 years of history. With the advent of knee replacement, osteotomy alone fell out of favor; but with the short term success of stem cell intervention in avoiding or postponing the joint replacement while maintaining or returning an individual to a very active profile, mechanical axis correction makes a lot of sense. My initial goal when I undertook this Cellular Orthopedic initiative was to assist in postponing a joint replacement; now I seek to influence avoidance of a joint replacement
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, stem cells, treatment
Sep 15, 2014
Well, there we were again over the Labor Day three day weekend, cycling up the elevations and over the roads of Southwest Wisconsin. In between, I was able to spend several hours wading in several of my favorite creeks that meander through the Driftless Area. As far as the fly fishing was concerned, it was with a hopper and dropper but I met with little success as I fished during the heat of the day. When it came to cycling though, that was very successful as on three consecutive days, my wife joined me after her cycling sabbatical of 15 years. Our group went out on long rides and two of the wives, mine included, joined us for part of the venture. Why this all becomes important is that two years ago, I was experiencing a major problem with my left knee. The symptoms, arthritis related, had caused me to stop running, decrease my cycling mileage, and alter my skiing agenda. One day, I decided it was time and I underwent a Cellular Orthopedic intervention in my left knee. It was either that or change my entire recreational agenda and limit myself to swimming.
I am happy to report that the musculoskeletal care via Cellular Orthopedics for this Mature Athlete worked and here I am, living a totally unrestricted life. My winter ski trips to the west are being planned so as not to interrupt my work schedule this winter. The absence of knee pain allows me to look forward to another long weekend in pursuit of the 20 inch Brown Trout before the end of the season in Wisconsin..Two years ago, I wasn’t sure if there would be any more skiing in my life or wading up the spring creeks because of the arthritic knee. Sure, I could always fish from a drift boat but it isn’t the same and the Wisconsin spring creeks are for wading, not drifting while seated in a boat.
OK, you get the message; the role of Bone Marrow Aspirate Concentrate derived Stem cells in Musculoskeletal Care of the Mature Athlete. Now if you will excuse me, I am off to the fitness center to stretch, run and row; all made possible by that Cellular Orthopedic Intervention, two years ago.
Tags: arthritis, athletes, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Knee, Mature Athlete, Osteoarthritis, Regenexx-SD, stem cells, treatment
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
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
May 13, 2014
I feel your pain along with the pain of the several patients who called the office this past Monday morning seeking assistance after the usual weekend warrior outburst. If you overdo it on a weekend or on a vacation, you will pay the price on Monday and for the rest of the week as well. Consistency is the best prevention, that and cross training. Much of the aging population seeks to continue to be active, and many are weekend warriors who compress moderate to vigorous activities into a few days.
As you age, all individuals experience declines in functional body systems and decrease in muscle mass, but the rate and extent of the changes are affected by factors besides chronologic age. Injuries to tendons and joints are mostly affected by athletic consistency. While a single traumatic event may contribute to decline, so might wear and tear. All athletes must base their approach to injury prevention on several basic principles: 1) stretching 2) strength training 3) proper nutrition 4) adequate hydration 5) aerobic and anaerobic training and 6) a day or two a week of rest.
Most supplements that claim to “reverse” aging are not supported by reliable scientific evidence of effectiveness, yet, there is an increasing core of data supporting the use of cellular orthopedics for repair of acute or chronic injury to the musculoskeletal system.
The Regenexx Web site presents the ongoing results of clinical research and the effectiveness of Regenerative Medicine. While I hear from uninformed professionals that stem cell intervention for arthritis is still ten years away, in fact, I am completing work on a scientific paper with the intent of a presentation at a Regenerative Medicine meeting this mid summer reviewing the comprehensive results of 60 patients who underwent stem cell intervention to an arthritic knee and 40, who underwent stem cell intervention for an arthritic hip more than one year ago. While the number of patients do not at first seem significant, this is the largest outcome database in Regenerative Medicine of which I am aware wherein the same scrutiny has been used as I had used in my joint replacement clinical outcomes research during my academic lifetime. I am able to support my statements with research data. Active and athletic patients, regardless of their age do not have to quit nor do they have to undergo a joint replacement. Stem Cells have the potential to stop pain in an arthritic joint, they have the potential to reverse the arthritic process and even influence regeneration of the joint, ligament, and tendon.
Tags: arthritis, athletes, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Knee Pain Relief, Orthopedic Surgeon, Osteoarthritis, Regenerative, stem cells
