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
Apr 29, 2014
We do not quit
Playing because
We grow old;
We grow
Old because
We quit playing.
– Oliver Wendell Holmes first half of 19th century
Last Monday, I took my first early morning, outdoor, cycling ride of the spring along the Chicago lakefront. It was a perfect morning and with so few on the bike path, I was able to let my mind wonder. I thought about this past Saturday and Sunday spent on the spring creeks of Wisconsin wading up a stream in search of the brown trout with a fly rod in hand. I thought about my on going training days in the health club where I run on the treadmill, row on the Concept 2 ergometer, and mix in some strength training. I thought about the several weeks of skiing this past winter in the fabulous powder I found in Colorado. Why the reminiscence? It’s my birthday this month.
That Oliver Wendell Holmes Sr. certainly got it right. Yet everyday I read about and listen to the diabetic epidemic in the world and the associated obesity, hypertension, renal failure, vascular dysfunction, etc., etc., etc. You don’t have to be a diabetic to be a victim of all the above. There is something though you can do about it: loose weight, get fit.
While there might or could be a congenital or inherited contribution to your arthritis, and while you may have sustained a trauma, the vast majority of arthritis in the hip and knee is either caused by or worsened because of the extra weight you carry.
My professional ethos is the Musculoskeletal care of the aging athlete. Your world is weight reduction and getting fit; my world is enabling you to improve your well being through Regenerative Medicine/ Cellular Orthopedics and I have professional company. The professional company is illustrated by an article published April 17: Growth Factor May Help Arthritic Knees. In the Swedish study, Fibroblast Growth Factor was used to stimulate cartilage repair in arthritic knees. A significant difference was found when compared with placebo when Sprifermin, an agent that specifically activates fibroblast-growth-factor-3 receptors in cartilage to promote chondrogenesis, cartilage matrix formation and cartilage repair was injected at high dose. While at 12 months, the cohort receiving Sprifermin didn’t show an increased joint space, when compared to the placebo group, they didn’t loose thickness.
We do more with our Bone Marrow Aspirate Concentrate stem cell intervention than inject one agent though our bone marrow derived Mesenchymal Stem cell preparation certainly contains the agent used in the Swedish study. The point, while stem cells may not regenerate the joint after a yet to be determined age, there is continuing evidence that the stem cells will alter the arthritic progression.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee, Mature Athlete, Regenerative Pain Center, stem cells
Apr 2, 2014
Last week, an article appeared in the orthopedic peer reviewed literature reporting reasons for failure of Knee Replacement Prosthetic reconstruction within two years of the procedure. It is though such review and publications that we surgeons gain knowledge so as to offer the patient with arthritis, the most comprehensive informed consent. At the same time, it is only by reviewing our technology and surgical techniques that the surgeon is able to minimize unsatisfactory results and short lived outcomes. Understanding the cause of failure and type of revision knee arthroplasty procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in Knee Replacement surgery. The most common cause of revision surgery is infection followed by implant loosening. Next comes malpositioning of components and failure of soft tissue balance leading to pain and limited motion. Patellar instability was also identified as a reason for patient dissatisfaction leading to an early revision. The average length of hospital stay associated with a knee revision was 5.1 days; this does not take into account, the rehabilitation center stay or time lost from work. The average total charges were $57,600; again, this does not take into account the costs of rehabilitation, outpatient antibiotics and ongoing physical therapy.
As readers of this Blog are aware, I maintain a Data Base containing outcome measures for every patient I have treated since joining the Regenexx Network and the Cellular Orthopedic initiative 22 months ago using Bone Marrow Aspirated Concentrate derived Mesenchymal Stem Cells for the care and treatment of Grade two and three knee arthritis instead of a knee replacement procedure. Last July, I presented a comparison of patients one year following stem cell intervention for an arthritic knee with historical data for those who had undergone a knee replacement one-year prior. At one year after a procedure, the stem cell cohort had more functional outcomes than those patients who had undergone a knee replacement. The two populations studied had one thing in common, an arthritic, symptomatic, life-style altering arthritic knee. My interest was peeked by the scientific article published last week concerning why Total Knee Prostheses had failed at two years; so I decided to review the complications of stem cell interventions for an arthritic knee and report them here:
Nothing is listed because there are no adverse outcomes to report. To date, to the best of my knowledge, no stem cell recipient for an arthritic knee in my practice has undergone a knee replacement. That may not be the case after another year of follow-up; but there has not been an infection or reportable complication in 22 months. The only “revision” procedures I have had to perform were three patients with repeat stem cell interventions to achieve a higher outcome score and several patients who requested booster PRP between four and nine months. The rescue of a failed stem cell intervention is a primary knee replacement; but to date, none have been reported. For your arthritic knee, Total Knee Replacement or try Stem Cells first?
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Surgeon, Osteoarthritis, stem cells, Ultrasound Guided Injection
Mar 25, 2014
Several months ago, I was reading a scientific article in the orthopedic literature and I realized that much has changed in the field over the four years since I stopped doing joint replacement surgery. Then I wondered how much has changed in the other sub specialties within orthopedic surgery since I completed my residency training and received my orthopedic board surgical certification. After contacting, the American Academy of Orthopedic Surgery to determine the best way to assure that I was offering contemporary skeleto-muscular care to my patients, be it for regenerative medicine or the occasional second opinion for which a patient seeks consultation, I committed to the thousand page Orthopedic Knowledge Update, (OKU) dedicating several hours a day to each of the 64 chapters. Best stated in the Preface, “ We orthopedic surgeons face a challenging conundrum: we are driven to sub-specialize because of rapid technologic advances and patients seeking very specific expertise, yet we must remain knowledgeable across the full spectrum of orthopedics in order to deliver optimum patient care and pass certifying and recertifying examinations.”
Last week, I took the 200 question multiple-choice examination to measure competence and whether I had mastered the contents of the Orthopedic Knowledge Update initiative. Yesterday, I received notice of having passed the exam with flying colors. The material reward is 70 Continued Medical Education credits. The emotional and self-satisfaction reward is beyond description. The last multiple-choice test I had taken was when I passed my Boards in 1974. What does this have to do with Regenerative Orthopedics?
Again and again, the patients come to the office with pain, limited activity and altered life style with a diagnosis of osteoarthritis. An orthopedic surgeon has told them: ”you have bone on bone; I am scheduling you for a joint replacement.” In my office, a full history, physical examination, and review of X-rays and MRIs are completed. It has been well established that the indication for surgery in arthritis is not an altered X-ray. The patient with Grade 2 or 3 osteoarthritis is then given an informed consent regarding Bone Marrow Aspirate Concentrate derived Stem cells.” I will call you to schedule” is a common response when the patients are really telling me that they intend to discuss stem cell intervention with their primary care physician or orthopedic surgeon. Why the subject matter of this Blog? I can tell each and every patient that my recommendation is based on my knowledge, experience, credentialing, research and database. Ask your second opinion “expert” concerning Regenerative Orthopedics for his or her experience, credentialing, research, and data base after you receive the “it’s too early”; “that stuff doesn’t work”;” it’s ten years away” before making your decision.
Tags: arthritis, Hip Replacement, Interventional Orthopedics, Knee, Orthopedic Care, Osteoarthritis, stem cells
Mar 6, 2014
Who doesn’t want a joint replacement for arthritis? For one, count me out as long as there are other options for dealing with my symptoms. As you will learn, I was head of a joint replacement program at a major medical center for the last 15 years of my orthopedic surgical life and performed over 20 thousand hip and knee replacements over my 38-year surgical career. Yet, every orthopedic surgeon has an ethical and professional obligation to stay abreast of the accelerating knowledge expansion occurring in the musculoskeletal sciences. The covenant that exists between surgeon and patient requires acceptance of this obligation; that’s why I am sharing with you these advances in the care of the aging athlete.
Let’s start with Patient Education and lifestyle modifications
1) Participate in self-management educational programs such as those conducted by the Arthritis Foundation, and incorporate activity modifications (e.g. walking, swimming, and biking, instead of running) into your lifestyle.
2) Those overweight (as defined by a BMI>25) should lose 5% of body weight and maintain their weight
3) Participate in low-impact aerobic fitness exercises
4) Yoga is great for your joint mobility
5) Strengthen your thigh muscles with a physical therapist and maintain such with regular visits to a health club
Mechanical Interventions
1) Use a patellar stabilizing knee brace available in any pharmacy
2) Shoe Orthotics do not benefit your knee
Complimentary and Alternative Therapy
1) The American Academy of Orthopedic Surgeons recommends that we do not prescribe such for symptomatic osteoarthritis
Pain Relievers
1) Acetaminophen (not to exceed 4 grams per day)
2) Non-steroidal anti-inflammatory drugs (NSAIDS)
Intra-Articular Injections
1) Corticosteroids three times a year may offer short-term relief
2) Hyaluronic acid may offer longer-term relief
Recognizing that Arthritis is a normal physiologic effect of aging and assuming you have applied all of aforementioned non-operative treatment plans, what is the current state of cartilage regeneration before considering a joint replacement? Allow me to introduce you to the new world of Cellular Orthopedics (Regenerative Medicine). By using your own stem cells normally present in your bone marrow, we are now able to control the symptoms of osteoarthritis, improve joint mobility, increase your functional capacity, possibly reverse the progression of the arthritic changes, delay or eliminate the need for the joint replacement and perhaps, regenerate your cartilage. Those are a lot of goals; how might your adult stem cells make it possible? Bone Marrow Concentrate contains mesenchymal stem cells that serve both an anti-inflammatory and bio-immune modulating function. They can facilitate regeneration of tissue and cartilage damaged by arthritis. Following aspiration of bone marrow from your pelvis, the marrow is centrifuged and available for a same –day procedure with minimal manipulation of cells following FDA Guidelines. The fundamental science supports great potential of stem cells. Over the past 18 months, I have used this approach in over 200 arthritic patients with no adverse affects. There has been over 75% patient satisfaction at the knee, hip, shoulder and ankle including two wrist interventions as well. That was in the first year. The numbers improved in the second year as we gained experience and insight into those who would most likely benefit. To see if you might benefit from Cellular Orthopedics, schedule an appointment
Tags: arthritis, Hip Replacement, Knee, Platelet Rich Plasma, stem cells
