Feb 12, 2014
Previous advances in orthopedic surgery have centered largely on surgical technique and surgical implants. I should know having dedicated almost 40 years of my orthopedic career to developing the cement-less prosthesis and refining the minimally invasive knee and hip surgical approach. The cement-less movement was the result of a clinical trial in which I was a co-investigator from 1979 to 2004 and the MIS approach was something I popularized in conjunction with a partial knee replacement (See News Releases-Rush University Medical Center April 28, 2000). I still am involved with the Prospective Multicenter Post Approval Study of the LPS-Flex Mobile Bearing Knee. Yet it is my new world, biologics-including platelet-rich-plasma (PRP) and bone marrow aspirate concentrate (stem cells) that is emerging in orthopedic surgery due to their regenerative properties.
From a sports medicine standpoint, biologics are playing an increasing role in treating rotator cuff, meniscal, and cartilage injuries. For example, PRP is a growth factor therapy that is increasingly being used to augment healing after a partial tear of a tendon. My particular clinical practice and integrated clinical research is directed to helping patients with osteoarthritis of large joints manage symptoms, increase motion, and restore functional capacity both in the aging athlete or for those experiencing limitations in activities of daily living.
Stem Cells-cells that are harvested from bone marrow when aspirated and concentrated, have multiple capacities that make them unique. They can reproduce. They can differentiate into different types of cells such as cartilage and bone. They can release growth factors and other cell signaling molecules. As readers of this Blog are aware, I have implemented PRP and Bone Marrow derived stem cells into my clinical practice in the setting of osteoarthritis and I continue to collect data confirming positive results. The anti-inflammatory effect and pain reduction with increase in range of motion and functional capacity are no longer based on anecdote but rather statistically significant numbers. In the next several months, those who underwent stem cell intervention 18 months ago will be asked to complete quantitative MRI evaluation; and I will confirm in addition to all the benefits of stem cells as to how stem cells influence cartilage regeneration in my patients. It will be several years to confirm as to whether the Bone Marrow Concentrate will alter the natural history of the arthritic joint by bio-immune modulation as believed; and I will continue to monitor patients so as to assist an arthritic patient in possibly postponing or avoiding a joint replacement. Of particular interest is the feedback from several patients concerning the fact that their previous orthopedic surgeons are now undergoing training in how to become stem cell providers.
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee Pain Relief, Orthopedic Surgeon, Osteoarthritis, Platelet Rich Plasma, Regenerative, stem cells
Dec 30, 2013
What prompted the subject matter for this blog is the article appearing in the December 25, 2013 issue of the New York Times by Pam Belluck: Common Knee Surgery Does Very Little for Some, Study Suggests. What the writer is citing is a scientific article that appeared in The New England Journal of Medicine “suggesting that thousands of people may be undergoing unnecessary surgery”. The study reported from Finland recognized that about 80% of tears seen on the MRI of patients develop from wear and aging. In the study patients were randomized with some undergoing arthroscopy and the others having a sham operation. All received physical therapy. A year later, most patients in both groups felt the same.
Assume if you will that you are seen in my office for knee pain without a history of a major athletic trauma. My first question, “ Are you having mechanical symptoms; that is clunking, locking or giving way? Before I write the prescription for the MRI, a complete orthopedic history and a physical examination is performed. Our research at Regenexx has documented that the treatment recommendations for adult non-traumatic knee pain should be based on the history and the physical findings, not on the MRI alone. The physical findings of significance include the range of motion and the mechanical axis. Is the patient developing inability to fully straighten, symmetrically bend, bow leg or knock-knee? Next comes the request for the imaging.
Based on the results of history, physical examination and imaging, I propose a therapeutic approach almost always beginning with physical therapy. I might suggest an ultrasound guided cortisone injection to control discomfort for more effective PT. When the X-rays and MRI are reviewed, I more often than not will discover a torn meniscus of some type with degenerative arthritic changes elsewhere in the joint. The treatment will be directed to the entire arthritic process and not targeted to the frayed meniscus. That’s what I have been doing over the last ten years and that’s what the Finnish study confirmed is the correct approach. More likely than not, the next step will be a visco-supplementation program.
With an emphasis on advancing the care of the aging athlete, you will receive an informed consent regarding cellular orthopedics based on stem cells, should the aforementioned measures not succeed. While Regenerative Medicine is not presently indemnified by Medicare or the private insurer, compared to your anticipated out of pocket expenses in the new world of affordable insurance, your costs for symptomatic relief from arthritis while actually reversing the degenerative process will be comparable to that which you will have to pay for hospitalization or out of network care starting in 2014.
Having introduced the New Year, what are so exciting will be the next initiatives taking place in the processing of Bone Marrow Aspirate Concentrate. We now have the technology to increase the number of stem cells available by a 7X to 200X multiple via a revolutionary development of how we manage the bone marrow in the laboratory prior to injection into your arthritic joint. Have a happy and healthy 2014 and just call to learn more about advances in the aging athlete.
Tags: arthritis, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, Knee, medicine, Orthopedic Surgeon, Regenerative Pain Center, stem cells
Dec 10, 2013
That’s what we are trying to achieve and it has been successful in over 85% of the patients I have treated since June of 2012 when I joined the Regenexx network. As readers of this Blog have learned, I undertook the sojourn into Cellular Orthopedics after having enjoyed a 40-year surgical career centered on Adult Reconstructive Orthopedic Surgery (Joint Replacements). As I reached the milestones where I had achieved my goals in surgery, I recognized an opportunity to take on a new challenge; avoiding, certainly postponing the need for a joint replacement by embracing a new world of Regenerative Medicine. Basic science researchers had identified the pain relieving, joint restoration and chondrogenic possibilities of the adult mesenchymal stem cells readily available in bone marrow. As I had played a role in pioneering cementless hip and knee replacements in the 1970s, I decided to take on the challenge of advancing the care of the aging athlete with those stem cells.
In looking back over the past 18 months, I have played a very active role in not only developing a very gratifying clinical presence in the world of Regenerative Orthopedics, I have contributed significantly to the Regenexx initiative in clinical research. The reason for reflection is two recent scientific articles that underscore the appropriateness of my decision-making. Three weeks ago, an article was published by Norwegian Orthopedic Surgeons describing their success in postponing hip replacements by five years in more than 50% of patients who would have probably undergone a hip replacement had they lived in America. More significantly though is the article published earlier this month documenting all the potential of cellular orthopedics in a laboratory setting. What is significant about the paper is not the restatement of what we already know but rather the authors themselves. As I have suggested to you in the past, the orthopedic surgical community has been totally opposed my notion of helping a patient postpone, perhaps avoid a joint replacement by stem cell intervention. A co-author of the scientific endeavor describing all the virtues of cellular orthopedics juts happens to be one of the previous nay- sayers. Certainly there have been several patients who have not responded long term to my clinical attempts at avoiding a joint replacement. It turns out that the four patients had advanced arthritis of the hip when I undertook their care. Regenexx and I are busy this week trying to better identify those arthritic hip joint candidates where in stem cells would not be of benefit, by statistically analyzing our hip outcomes database. What makes our Regenerative Cellular Orthopedic clinical practice different is the fact that I have incorporated the same integration of Clinical Research and Clinical Practice in my Cellular Orthopedic endeavors as I did when serving as Director of the Joint Replacement Program at Rush for many years. Ours is not just a procedure; it is a dynamic integration of outcomes observation and clinical advances.
Tags: arthritis, cellular orthopedics, Hip Replacement, joint replacement, Knee, Mature Athlete, Osteoarthritis, stem cells, treatment
Mar 20, 2013
Advances in the care of the aging athlete
I have written several blogs in 2012 and 2013 pertaining to my foray into Cellular Orthopedics and the use of Stem Cells recruited from Bone Marrow Aspirate Concentrate in an attempt to avoid or at least delay a joint replacement. As readers know, I am Emeritus Professor of Orthopedic Surgery at Rush University and former Director of the Joint Replacement Program having performed over 20,000 hip and knee replacements over 38 years; and at the same time was involved in introducing newer innovations to the joint replacement world. Several years ago, I looked at my contemporaries, my patients as well as myself and determined to do everything possible to delay or avoid joint replacements so as to maintain a high performance level as an aging athlete. The scientific data is clear; a joint replacement recipient ends athleticism in the majority of cases as a trade off for pain relief.
I have been repeatedly criticized within the orthopedic community for having advocated Stem Cell intervention in lieu of a joint replacement in spite of the growing evidence that a Bone Marrow Concentrate intervention for arthritis should be seriously considered as it is allowing patients to return to sports. Incidentally, there is a difference between the demands of fitness machines and those of skiing, cycling, fly-fishing, hockey, tennis, etc. Just as I innovated joint replacements, it looks like the entire orthopedic community is gradually embracing my graduation into cellular orthopedics. Listed below are some the seminars scheduled at the annual meeting of the American Academy of Orthopedic Surgeons being held in Chicago this week.
Tues, 3/19, 10:30am-12:30pm
PRP, BMP and Stem Cells: What Surgeons Need to Know
Tues, 3/19, 4-6pm
Cell-Based Strategies for Regenerating Musculoskeletal Tissues
Thurs, 3/21, 10:30am-12:30pm
The Synovial Joint: Structure, Function, Injury and Repair, Osteoarthritis
Fri, 3/22, 8:00-10:00am
Biologic Augmentation of Tendon-Bone healing: Where are we now?
Tags: Bone Marrow Concentrate, Hip Replacement, Knee, Orthopedic Surgeon, stem cells
Sep 26, 2012
Doctor,
So I rode about 85 miles with about 8,500 vertical feet of climbing around Lake Tahoe on Friday, and then another 50 or so miles with 4,000 feet on Saturday, and the hip didn’t bother me once. I’m still doing big stretches in the mornings. Even as I type this, I’m shaking my head, since it doesn’t seem possible and I have to pinch myself. Thank you a million times over. I feel so lucky to know you and to be blessed with your help and care.
The above was received last Sunday from a patient who is now 16 weeks post bone marrow aspirated concentrate to his right hip. He had presented to me at age 40 with chondrolysis (as part of the progression of osteoarthritis) more likely than not attributable to developmental hip dysplasia. By the same token, I could not rule out Femoral Acetabular Impingement. The patient was not only an avid bicyclist; he makes his living through the cycling industry. Over the previous year, the symptoms in his right hip had progressed to a point that he couldn’t swing his leg over the center post of his bike. He sought medical help when he could no longer walk a city block without pausing from the pain.
My patient’s story is of particular interest because there is little published evidence concerning the effect of stem cells on the hip. To date, most attention has been directed to stem cells and the knee. Several weeks ago, I wrote a blog focused on the outcome of stem cells for a marathon runner assigned a diagnosis of a torn acetabular labrum.16 weeks following a bone marrow aspirate concentrate procedure to her problematic hip, she returned to marathon running. The cyclist returned to cycling in a similar time. Imagine, 16 weeks ago, he had difficulty walking and now he is riding up mountains for almost unlimited distances. We don’t have statistical data yet pertaining to outcomes of stem cells for the hip; but I believe these patients stories are the start of a new approach to the arthritic hip and possibly preventing the progression to the need for a joint replacement. Only outcomes studies will confirm if we are postponing or preventing a surgical procedure. To that end, I have introduced an outcomes clinical study initiative based on the model I used for joint replacement publications and scientific presentations over 35 years of surgical practice. I am recruiting several Regenerative Medicine based practices to pool data so our number of patients under observation will lead to statistically meaningful clinical science. Since the introduction of stem cell management of the hip, I am continually amazed at the early results.
Tags: arthritis, bone marrow, Hip, Hip Replacement, medicine, Osteoarthritis, stem cells
