Sep 4, 2012
It is our first morning back at the office after the Labor Day Holiday. My assistant started her daily routine per habit by listening to her voice mail. The first message left by a patient was a description of his progress since undergoing a bone marrow aspirate stem cell procedure for Avascular Necrosis of his left hip and secondary osteoarthritis. “Yesterday was the first day in a year that I was able to flex and rotate my hip enough to put on my pants naturally and cut my own toe nails”. These are activities we take for granted but when a 40 year old requires assistance and adaptive measures to complete activities of daily living, the restoration of independence is a big deal. His next goal, return to senior hockey.
Might Bone Marrow derived stem cells eliminate or at least postpone a knee replacement?
We left for Wisconsin to enjoy a four-day holiday cycling and fly fishing. My wife planned to work on her lapidary and silversmith projects while B. and I would ride and test the Southwestern Wisconsin spring creeks. The county highways in The Driftless area below Lacrosse and just east of the Mississippi are pretty much free of traffic and the region has countless spring creeks loaded with trout. It is fairly common to log cumulative elevations of 2,000 feet over a three hour, 35 mile ride. On Thursday, Friday and Sunday, we rode; Saturday was set aside for fishing. When you wade the spring creeks, it is fairly arduous as you have to constantly climb up and down the stream banks or fight the silt build up in a particular stream. The biking was fabulous and the weather most cooperative; I am sorry to report it was fishing and not catching. The heat and draught in effect since late June have taken their tolls on what started out as a great season of trout fishing. What does all this have to do with stem cells and knee replacements? I have been looking after arthritis in B’s knee for many years. While he has “bone on bone” and occasional instability, the initial cortisone injections followed by several viscosupplementation series and then PRP when the latter became available have kept him cycling and skiing. The most recent approach has been a Concentrated-Stem Cell Plasma injection and there are few within 35 years of age who could keep up with us. I have age related, moderately arthritic knees, having undergone bilateral arthroscopic meniscectomy ten years ago but I have no problems as long as I watch my weight and do my fitness training. B. has an advanced osteoarthritis of a knee but I struggle to keep up with him. ( I do throw a better fly). He has no plans for surgery even though his X-ray couldn’t be worse. This fall after the weather curtails cycling, he will undergo a bone marrow aspirate stem cell procedure and we will start training for the ski season.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
312-475-1893
Tags: arthritis, Bone Marrow Concentrate, Hip Replacement, Knee, Orthopedic Surgeon, Osteoarthritis, stem cells
Jun 28, 2012
This past weekend, I had chance social encounters with two patients, not mine, unhappy with the outcome of their joint replacements. Their painful prostheses behaved no different than the patient with chronic osteoarthritis: swelling, limited motion, limp. Might stem cell management with an appropriate postoperative rehabilitation regimen have given the joint a better chance at remodeling and avoided a painful total joint?
We continually seek better mechanical and biologic approaches to osteoarthritis prevention and treatment. It is now known that following high-energy joint injury, articular remodeling can be promoted through distraction and motion of cartilage surfaces. Papers presented at the International Cartilage Repair Society -Montreal-May 12-15 confirmed that altered motion and loading might really make a difference in treating end stage osteoarthritis. Equally important though, what about the pain generators in OA?
- Loss of articular cartilage (bone on bone)
- Synovitis (chronic inflammation)
- Flexion contractures (loss of motion/capsular compliance)
It is paramount that the physician managing your arthritis try to understand all pain generators in a joint and optimize the joint environment prior to surgery, during the surgery or using stem cells in lieu of surgery. First, the joint volume and capsular compliance need be addressed. Second, the inflammatory burden need be minimized. Last, mal-alignment need be neutralized. I will stress over and over that the data to support my treatment algorithm must be increased via outcome surveillance. That data can only be gathered through clinical practice. Based on what we have learned in managing arthritis with stem cells over five years, there is data to support the reversal in loss of articlular cartilage, eliminate inflammation and increase range of motion.
Prior to undergoing a bone marrow aspirate concentrate procedure, the patient is directed to physical therapy. In the case of a knee, an offloading brace is prescribed. After the procedure, protected weight-bearing, range of motion exercising and gradual strengthening is introduced. The stem cells altering the bio-immune environment inside the joint might be the alternative at eliminating pain generators and postponing or even avoiding the joint replacement
Mitchell B. Sheinkop, M.D.
312-475-1893 or 312-475-1893
1565 N. La Salle Street . Chicago . Illinois . 60610
Tags: Hip Replacement, Interventional Orthopedics, Microfracture surgery, Orthopedic Surgeon, Orthopedics, Regenerative Pain Center, stem cells
May 9, 2012
Introduction and background
While the benefits of total hip replacements are numerous, there is a known incidence of associated pain leading to early revision. Have attempts at improving the prosthetic implant, shortened lengths of hospital stay, minimally invasive procedures and metal on metal bearings been a process of revolution or as in the case of Gulliver, devolution?
The goal of the surgeon has historically been pain relief and a 20-year plus satisfactory outcome when performing a total hip. More recently, survivorship prioritization seems to have been replaced by restoration of hip anatomical geometry, thereby optimizing muscle tension and strength, equalization of leg lengths, and enhancement of hip stability all via modularity. The newer generations of prostheses have been designed in an attempt to facilitate and accommodate the latest fads in surgical approaches so as to lessen the scar length, perhaps minimize muscle damage-still a matter of debate-and return the patient to full activity status in days or weeks rather than months.
I just received an AMA alert that by 2030, 42% of Americans will be obese. Short incision, less hospital stay, prompt return to activity, who are we kidding? Lets look more closely at the cost of supposed progress in the newest prosthetic designs.
Metal Fretting and Corrosion. This has been reported with cobalt chrome and cobalt chrome- titanium junctions. The more modularity and junctions between metals, the more potential metal debris generation. Metal on metal bearings produce small metallic wear debris. Furthermore, elevated blood serum ion levels and metal hypersensitivity resulting in an adverse local tissue reaction may occur with metal-metal articulate surface bearings causing premature failure due to osteolysis, aseptic loosening and pseudo tumor formation.
So what should you do and look for whether or not you are in pain after a total hip replacement?
Evaluation for infection-a screening serum ESR, C-Reactive Protein, and WBC. If any of these are abnormal, a hip aspiration need be performed.
Serum metal ion levels-serum chromium ion levels above 17ug/L and cobalt ion levels above 19ug/L suggest metallosis within the joint. Pseudotumors have been found at lower levels and are identified by ultrasound and CT scans. In the United Kingdom, the cut off level is 7 parts per billion (7ppb) chromium or cobalt.
Metal hypersensitivity-Nickel is the worst offender but chromium and cobalt may play a role. The problem is the area is still poorly understood with the only available testing including patch testing and the lymphocyte transformation test.
Radiographic analysis-Your physician will look for signs of loosening, osteolysis and pseudotumor formation
If you have a painful total hip replacement, you need an evaluation.
There is another consideration, postpone or avoid the replacement. Might Regenerative medicine and stem cell management, help control you pain and possibly postpone or even help avoid a total joint replacement?
Mitchell B. Sheinkop, M.D.
312-475-1893 or 312-475-1893
1565 N. LaSalle Street
Chicago, Illinois 60610
Tags: Hip Replacement, Osteoarthritis, Regenerative Pain Center, stem cells
