May 28, 2015
Osteoarthritis of the knee is one of the leading causes of functional limitation and progressive deterioration in the quality of life. Nonsurgical treatment of the osteoarthritic knee has been the usual and customary weight reduction directive, recommendation for physical therapy, prescription for non-steroidal anti-inflammatories, followed by injections with corticosteroids and hyaluronic acid. The goal is to reduce pain and improve function but the classical non operative approach is not universally successful or long lasting. Alternatives are continually sought to provide pain relief and improve functional outcomes.
Recently, there has been a major initiative to introduce Amniotic Fluid in the treatment of the osteoarthritic knee. Allograft (from a third party) amniotic tissues have a long history of clinical use having been first reported in 1938. It is thought to be a homologue to synovial fluid, acting as a cushion to protect and lubricate in the closed environment of the knee. A recent study measured the safety and efficacy of processed allograft amniotic fluid in treating osteoarthritic knees using common, validated outcomes measurement tools. In the registry review, early outcomes suggest that the use of processed amniotic fluid allograft may offer a safe and effective treatment for OA of the knee for 90 days. The suggestion is that this treatment may be more durable than single corticosteroid injections and perhaps hyaluronic acid treatments. The study providing the background for this blog is still in progress. Of interest is the fact that no claim is made in the article supported by the pharmaceutical company that amniotic fluid is chondrogenic or contains stem cells. The latter is an extremely important consideration; beware of those who promote amniotic fluid on their web sites as providing viable stem cell content. As of this time, while amniotic fluid may contain cytokines (anti-inflammatories) and growth factors, it is only to be considered in the same category and comparable, perhaps longer lasting than a corticosteroid injection or a hyaluronic acid intervention.
The standard of Regenerative Medicine and Cellular Orthopedics remains Bone Marrow Aspirate Concentrate as the best source of anti-inflammatory cytokines, growth factors and only FDA approved source of viable adult mesenchymal stem cells. In spite of the FDA approval mandate, as recent as this morning, I received an invitation to attend a course that would teach me how to use adipose derived stem cells in my practice. Let me emphasize two points, Amniotic Fluid does not have viable stem cells until proven otherwise and adipose derived stem cells are illegal for use in the musculoskeletal system. That being said, even if adipose derived stem cells were FDA approved and thus available; bone marrow aspirate concentrate provides the Cytokines and the growth factors not found in fat while bone marrow aspirate concentrate provides stem cells not found in processed amniotic fluid.
Tags: Amniotic, arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, FDA, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, stem cells, Synvisc, treatment
May 21, 2015
Headline on page 14 of the Wednesday, May 20, 2015 edition of the Chicago Tribune. The Associated Press journalist, Matthew Perrone then goes on, “But critics point to dangers of a largely unregulated trade.” This is a well written article in which Perrone highlights the charlatans doing the wrong thing, breaking the law, and doing harm. He did his home- work and focuses on the quackery, false claims and almost wholly unregulated mushrooming adipose derived business not unlike what Pope Brock did in his 2008 novel, Charlatan. Perrone brings into focus the quacks that prey on desperate patients seeking miracles in treating progressive neurologic disorders and the like. As my good friend opined after having read the article, “when ever a new avenue opens, the easy money guys stream in.”Incidentally, the exposure of those who state” if I am breaking the law, how come I haven’t been arrested yet?” isn’t new; 60 Minutes exposed those who seek to enrich themselves no matter the price to society several years ago. Last night, at the Goodman Theater, my wife and I saw Lillian Hellman’s The Little Foxes; very timely. The play takes place circa 1900, in a small Alabama town where the accumulation of wealth by the Hubbard family takes precedence over family, loyalty, decency, honor and morality. Toward the end of the play, the crowning statement in my mind was something to the effect that there are many Hubbard families out there in the mainstream America.
This lack of professional integrity and opportunism is engrained in our society so how do you protect yourself as a patient, be it Bone Marrow Aspirate Concentrate to postpone or avoid a joint replacement or any other area of medical care? The list of reasons to seek out Cellular Orthopedics and Regenerative Medicine is really the lengthy list of contraindications to surgery because of co-morbidities that preclude a total joint replacement surgical procedure. In addition, there are those patients who want to maintain or return to the highest level of recreational endeavor. The answer is quality assurance by your Regenerative Medical specialist assuring you the recommendations and the intervention are evidence based. That evidence comes from ongoing clinical research integrated with clinical care, not just completing a procedure and handing out a bill. You will find that level of evidence based care within the Regenexx Network of physicians located now thoughout the United States. These are not doctors who took a weekend seminar offered by a training company. At Regenexx, we do not treat anything outside the realm of orthopedic diseases. I partake in many week-long courses over the calendar year in which I not only learn but present my data collected on an ongoing basis. Next month, I am off to present my data at TOBI; a four day international program limited to arthritis and sports related injuries. That’s what I do and that’s your assurance that what I do is based on clinical outcomes research and is evidence based.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, FDA, Hip Replacement, Interventional Orthopedics, Knee, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
May 7, 2015
Prolotherapy
In spite of what you may read and hear about repeated injections of 12 ½ % dextrose into your joint or in the soft tissues surrounding your joint, there is no scientific evidence to support the claims regarding a regenerative influence from Prolotherapy. That is not to say it might or could lessen pain around a joint; but the benefits, if any, are anecdotal in nature and fall under the realm of homeopathy. It belongs under the same classification as Acupuncture; there are followers, anecdote and practitioners but an absence of scientific proof as to how it works. Yet, even with paucity, if not absence of scientific evidence, there is no end to web sites extolling the regenerative nature of Prolotherapy.
From science to tabloid
This week, my office and email were inundated following the headline in the Monday Wall Street Journal concerning a 3D printing of a medial meniscus lattice into which stem cells had been injected. A total of one patient was featured who had an experimental meniscus surgically introduced to replace a previously torn medial meniscus. While in years to come, this may become common place, there are limited indications and many more years of clinical trial ahead before an artificial meniscus becomes a standard of practice. After age 40 or so, meniscal injury as documented on an MRI is more often than not accompanied by arthritis. Post traumatic arthritis and degenerative arthritis are contraindications to meniscal replacement and even are associated with a less than satisfactory outcome to existing arthroscopic interventions. I must remind the reader that degenerative and post traumatic knee arthritis may be reflected on the MRI as an abnormal meniscus but in addition, physical examination is compatible with an altered range of joint motion and mechanical axis deformities.
A Regenerative Medicine Offering with emerging Scientific Evidence
I am finishing up my statistical analysis concerning 170 patients with degenerative and post traumatic knee arthritis who have undergone Bone marrow Aspirate Concentrate/Stem Cell knee care in preparation for my presentation at the June meeting of The Orthopedic and Biologic Institute. After two years of follow-up, there is a statistically significant improvement in diminishing pain, increasing range of motion, enhancing well-being, and facilitating return to or maintenance of a highly active recreational profile. This is scientific evidence and the basis for my Regenerative Medicine approach to helping a patient manage arthritis.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Apr 30, 2015
“Dwight Howard dominated the paint during Tuesday’s series-clinching victory, finishing with 18 points, 19 rebounds, four steals and four blocks.” (From Yahoo sport) Three months ago, the following appeared in the Press/News from ESPNDallas.com “Dwight Howard Out Indefinitely. There is no timetable for Houston Rockets center Dwight Howards return.” There are many other athletes who undergo Regenerative Medicine-Cellular Orthopedic interventions during the course of the year, they are not as public about it but there is successful return to sports, more often than not. If you imagine the forces generated across the knee in a 6’11’’, 265 lb. professional basketball player, you must conclude that his regenerative medicine intervention is a success for a continually painful knee.
Cellular Orthopedics is here to stay and is rapidly gaining a foothold as the non-operative treatment regimen for skeletal muscular trauma and the progressive restrictions imposed by degenerative arthritis. This past weekend, I was in Southwest Wisconsin fly fishing and cycling. Wading up a spring creek and climbing up and down the cliffs is as demanding as playing center on a professional basketball team. Cycling for three hours up 1500 foot climbs depends not only on conditioning but on functional knees. It was possible for my buddy and me in part because of the several cellular orthopedic procedures I have completed on him in the past three years. We have many more similar trips planned.
Bone Marrow Aspirate Concentrate-Stem Cell treatment is only one of the possibilities available for helping a patient postpone or avoid a joint replacement, diminish pain, increase motion and assist in returning an injured or arthritic individual to well being and a full recreational profile. From Concentrated Platelet Rich Plasma to Bone Marrow Aspirate Concentrate-Stem Cells, there are several alternatives for altering the natural history of post traumatic and degenerative arthritis. Many more offerings are in the works and I will continually update you as to when these latest interventions become available. In the meantime, please understand that while I don’t have to break a bone to best understand how to treat a fracture, my treatment recommendations for Cellular Orthopedic intervention concerning both post traumatic arthritis and degenerative arthritis in part are influenced by my own experiences so I will continue to report on such. To learn more about what is available in Regenerative Medicine and what clinical trials are in the works, make an appointment for a consultation.
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, C-SCP, Clinical Studies, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Pain Management, PRP, Regenexx, Regenexx-SD, stem cells, treatment
Feb 2, 2015
The world of Regenerative Orthopedics began in the United States with the publication of a scientific article reporting the results of platelet rich plasma in the treatment of knee arthritis. That took place about six years ago. No one really understood at the time of the publication why something so important in the clotting cascade of the human body would be beneficial in the treatment of an arthritic joint.
The next step in improving results of Platelet Rich Plasma injections for an arthritic joint was the understanding that whereas one injection would help, three injections over a three month period would improve outcomes. Scientists began further efforts at understanding why the platelet, so critical in the clotting cascade, would be beneficial in treating arthritis, and soon a better understanding of how platelets function came to be appreciated.
Platelets are the primary source of bioactive tissue growth factors. When concentrated they are potent. When activated, they release their growth factors and cytokines in clinically active quantities. Regenexx has developed a formula for superior concentrations and immediate activation. Whereas most Platelet Rich Plasma is created at bedside, we create ours in a laboratory with maximum concentration and prompt activation. Our research supports better stem cell growth following the Regenexx SCP procedure. Although the Regenexx Stem Cell Plasma formula is part of the Bone Marrow Aspirate Concentrate algorithm, we now are able to offer it when indicated as an independent intervention when Bone Marrow Concentrate is not possible. In addition, it is a wonderful “booster” when anticipated milestones with Bone Marrow Aspirate Concentrate are not met. Let me cite two patient examples.
Two years ago, an 83 year old man was selling his condo in Palm Springs because his arthritic knee would no longer tolerate a round of golf and his co-morbidity posed a very high risk for a joint replacement. He sought consultation and I recommended a Regenexx SCP intervention. Three weeks after the procedure, he took his condo off the market and returned to Palm Springs for the winter migration from Chicago. I spoke with him via phone in August and he had purchased his tickets for the return migration to the desert this winter.
36 weeks ago, I performed a Bone Marrow Aspirate Concentrate/Stem Cell intervention into the right hip of a 29 year old man with early onset degenerative arthritis. At six weeks, he was 25% symptomatically improved. At 12 weeks, he was 50% improved. At 18 weeks, he was still 50% improved so I administered a C-SCP booster. At 36 weeks he is 80% improved and thrilled. Cellular Orthopedics requires a continuum of monitoring and possibly more than one intervention.
Contact us to learn more.
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
