Cartilage Regeneration versus Joint Restoration, what’s the difference?

Cartilage Regeneration versus Joint Restoration, what’s the difference?

I swear to tell the truth, the whole truth, so help me G_d. Injured cartilage in a skeletally mature adult typically doesn’t heal on its own; surgical techniques are needed in an attempt to repair and replace cartilage. These latter procedures are appropriate for specific cartilage injury, rather than the widespread cartilage changes found in the osteoarthritic joint. That is not to say that someday soon, we may have the ability to regenerate cartilage. Research is ongoing in regenerative medicine with continual progress as evidenced by preliminary success in spinal cord injured patients:  

StemCyte gets FDA green light to continue studying spinal cord injury treatment stem cells.  

Now for the bad news. In spite of false news generated by the charlatans, parasites, camp followers and hucksters in their Regenerative Medicine seminars, print media and television adds; there is no scientific evidence to support their claims of cartilage regeneration, hair restoration, cure of erectile dysfunction, so on and so forth.

Stem cell fraud? Couple says therapy gave them ‘false hope’

“Unfortunately, what I had hoped to be a hard-hitting expose turned into limp-noodle babbling. Another missed opportunity.” Continuing the commentary about regenerative medicine clinic charlatans and fraud started by NBC, when a patient showed me a brochure from yet another group that holds itself out to treat every abnormal medical condition from A to Z with “Stem Cells”, I suggested that he request data regarding their successes. Please bear in mind the self- contradicting adage that Always and Never statements are always false and never true. They are frequently used by people who suffer from personality disorders.  On Friday he sent me the response to his inquiry regarding outcomes at a one of the national stem cell clinics.

“success rates per our clinical research network are VERY encouraging:  Orthopedic: knee 83%, hip 80%, back (cervical, thoracic, lumbar, sacral 80% ave., ED 77%, Cataracts 100%”  Remember what I just wrote about Always and Never?

The good news though is that there is emerging scientific evidence to justify Joint Restoration with a cellular orthopedic procedure. While an image of an arthritic joint allows for identification of cartilage and meniscal changes, that same image will frequently be consistent with bone marrow edema, and thickening of the bone adjacent to a joint (subchondral sclerosis) as well as loose bodies within the joint. As cartilage does not have a nerve supply, the pain generation in Osteoarthritis more probable than not is the result of inflammation of the synovial joint lining and the subchondral bone. While there is no scientific means of re-growing cartilage after age 40 at this time-defects may be filled by surgery-orthopedic surgeons focusing on Cellular Orthopedics have developed methods to restore the joint function by blocking the pain generators, restoring healthy subchondral bone, and reversing bone marrow edema.

To schedule an Evidence Based Consultation, call (847) 390-7666

You may read my Blog and explore my published research articles on the website www.sheinkopmd.com

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Patient Online Resources for Biologic Therapies

Patient Online Resources for Biologic Therapies

As interest in biologic therapies for arthritis-a needle, not a knife-continues to expand; patients increasingly are turning to the ads in newspapers or searching the Internet to gather information on this topic. While there is still a lack of scientific consensus on the use of biologics, it is most important for those seeking information not to be misled. My own analysis of resources for patients seeking on line information about biologic therapies for arthritis is that the overall quality is very poor and anything but scientific. Even worse, is a seminar, neither a reliable or credible source of scientific evidence.

Biologic therapies consist of stem cells, platelet rich plasma product and bone marrow aspirate concentrate. New research, I co-authored and that was published last month in The American Journal of Orthopedics:  Safety and Efficacy of Micro-Fractured Adipose Tissue for Knee Arthritis, is indicative of the ever-evolving nature of Regenerative Medicine. Biologic therapies and their use in arthritis or musculoskeletal injury in general are an area of vast research and interest within the medical field. Understanding the information online and the misinformation provided at seminars pertaining to biologics allows me to tailor my conversation and address commonly found inaccuracies.

The use of Biologic Therapies is expected to significantly increase in the coming years as our knowledge advances on the use of such. That initiative will be led by well informed, well-educated Board Certified, and Fellowship trained specialists. Unfortunately owing to the relative lack of oversite at present, every type of charlatan, parasite and camp follower can buy an ad for a seminar or produce a web site on the internet. How then should a patient with pain and limited function from arthritis seek to postpone or avoid surgery without becoming a victim of the cord blood or amniotic fluid hoax?

  1. Your physician must complete a comprehensive medical history, physical examination and review of diagnostic studies.
  2. Explain the disease process and grade of progression,
  3. Discuss possible treatment options,
  4. Present a balanced assessment of the current scientific evidence.

Woe, while writing this Blog, I was just notified about acceptance of yet another scientific article by a peer reviewed medical journal in which I am the senior author: A Specific Protocol of Autologous Bone Marrow Concentrate and Platelet Products Versus Exercise Therapy for Symptomatic Knee Osteoarthritis; a Randomized Control Trial with 2 Year Follow-up.

Hopefully some time soon, a Biologic Arthroplasty will be possible; but until then, a Total Joint Replacement is still a necessary option for those not meeting specified inclusion criteria for biologics. To see what treatments may be possible for your arthritic generated pain call (847) 390-7666 to schedule a consultation. Visit my website www.SheinkopMD.com for additional information. 

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Osteoarthritis of the hip

Osteoarthritis of the hip

Hip osteoarthritis (OA) exerts a significant burden on society, affecting 3% of Americans aged >30 years. Recent advances in the understanding of the pathoanatomy and pathomechanics of the hip have led to treatment options for young adults with hip pain. Femoroacetabular impingement, specifically cam-type femoroacetabular impingement, hip dysplasia, and the sequelae of pediatric hip disease can predispose the hip to early OA. However, many patients with abnormal anatomic findings do not develop early OA, suggesting that there exist other patient characteristics that are protective despite abnormal bony anatomy. Outcome studies show that arthroscopic and open hip procedures improve pain and function in patients with symptomatic hips. However, there is currently limited evidence that these procedures extend the life of the patient’s natural hip. Additional studies are needed to determine protective or adaptive factors in patients with abnormal anatomy who do not develop early OA and to determine whether joint preserving hip surgery extends the life of the native hip joint.

Review Article:Natural History of Structural Hip Abnormalities and the Potential for Hip Preservation
James D. Wylie, Christopher L. Peters, Stephen Kenji Aoki

What makes the article so interesting to me is first, I played a role in training one of the authors in my earlier academic career. More important is the role I am now playing in helping to preserve the life of the hip joint with a needle instead of a knife and extending the life of the “native hip joint”. The latter is done via Cellular Orthopedics. By introducing Stem Cells, Platelets, Precursor Cells, and Growth Factors, I am now able to address arthritis at a Bio-Immune level, possibly regenerate cartilage, potentially influence healing of the torn acetabular labrum, certainly reverse the secondary inflammation and thereby diminish pain and improve function in the abnormal hip joint.

It takes an evaluation in my office including the history, a physical examination and my review of your hip images after which I am able to customize the Cellular Orthopedic intervention that will help with joint preservation and potentially, joint regeneration. Our Outcomes studies continue and it is the result of ongoing data collection that allows me to extend the life of your native hip. Call (312) 475 1893 to schedule a consultation. You may visit my web site at www.sheinkopmd.com

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Looking back to see the future of Cellular Orthopedics

My regenerative and restorative Cellular Orthopedics practice is for the most part, evidence based. By that I mean, the outcomes data collected over these past five years regarding the several thousand patients with skeletomuscular afflictions that I have treated with a selection of alternatives using a needle and not a knife is generally based on regenerative and restorative interventions. While not everyone has experienced a dramatic change in symptom relief and functional improvement, many have. The statistical outcomes evidence follows a bell shaped curve with some experiencing immediate improvement as I have in both my hips and knees, while most take several weeks or longer with a continuing improvement up to 18 months post intervention. While it is true that five percent of patients are not satisfied after several years and have gone on to a joint replacement, 95% of my patients are well satisfied and have returned to, or never quit doing what they love.

At the onset of my cellular orthopedic initiative, the interventions were solely based on Platelet Rich Plasma options and Bone Marrow Concentrate; today, our menu of services can be customized so as to meet the needs of all seeking to improve the quality of life and avoid a major surgical procedure. Not only can I concentrate PRP as needed, I can customize the concentration to meet a patient’s particular needs using hemo-analysis. Bone Marrow Concentrate rich in Adult Mesenchymal Stem cells, Platelets, Growth Factors and Precursor Cells is still the foundation of my practice, however for the past year, I am able to offer a Platelet Concentrate derived Growth Factor and Protein Solution option when indicated.

Then there are those whose co-morbidity or prescription medication dependency excludes them from the aforementioned autologous choice of options. As of this upcoming Tuesday, I have acquired an intervention technology that will help patients seeking to a void a total joint replacement who are not candidates for existing regenerative medial offerings. There are many reasons to explain a 5% failure rate including genetic cartilaginous variations, any bell shaped curve will have a small number who don’t pass the final examination. Incidentally, if and when such occurs, I offer another intervention frequently at no charge or certainly at a discounted rate.

Should you want to learn more or schedule a consultation, call
(312) 475-1896. You may visit my web site where you will find the webinar at www.Ilcellulartherapy.com.

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“My doctor told me that I have bone on bone”

It is the most banal, recurring, boring, ordinary and meaningless phrase that my assistant and I have to listen to on the phone or at every office setting. Osteoarthritis is a disease that affects almost all persons to some extent as they age. It may affect one joint, some joints or many joints. The causes may include genetic predisposition, trauma, or any of varying diseases at different ages. No matter the causation be the arthritis primary or secondary, the presentation is progressive pain and decreasing function. The X-ray is diagnostic in most cases: loss of cartilage joint space, subchondral sclerosis and osteophyte formation. The pain generator is inflammation and not bone on bone. Images help with diagnosis; but the degree of arthritic change on X-ray does not necessarily correlate with the severity of the symptoms or the functional impairment.

A normal joint has a bony support, a cartilage interface, a synovial lining, a capsular envelope, stabilizing ligaments and surrounding muscle. All these anatomic structures are affected by the inflammation associated with degenerative changes on a bio-immune basis. When a physician undertakes the care of an arthritic joint, the management is based on addressing the inflammatory pain generators and not until the subchondral bone is severely altered and the cartilage gliding surface has been severely destroyed is a joint replacement indicated (Grade 4 OA). Until that time the classic approach has been weight loss, anti-inflammatories either by mouth or via injection, bracing, strength training, range of motion therapy; that is, until the new world of cellular orthopedics came into being.

My initial approach in my practice is to address pain and altered function from inflammation of osteoarthritis, not “bone on bone”. By a combination and concentration of platelets and growth factors, I now have the ability to reverse the pain generating arthritic inflammation and alter the bio-immune basis for degeneration of the joint; this is called joint preservation. On the other hand, my initiative for joint regeneration is based on autologous bone marrow concentrate; the latter containing in addition to platelets and growth factors, adult mesenchymal stem cells, precursor cells, hemopoietic stem cells and more. The attempts at joint regeneration are directed both to the joint itself by intraarticular injection and subchondral injection; the latter to help repair the supporting bone.

There is a lot to process here so let me address your needs best and answer your questions following an office assessment and a review of images. Call (847) 390-7666 to schedule a consultation. You may learn more on my website www.Ilcellulartherapy.com where you will find our webinar

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Special Announcement - Now Enrolling for FDA Approved Stem Cell Study
Dr. Mitchell Sheinkop has completed training and is credentialed for the first of its kind FDA approved stem cell clinical trial for knee arthritis. Our clinic is now enrolling patients in this trial. Contact us at 312-767-5761 for details. Click here to learn more.