Aug 13, 2015
You have presented with a painful joint and imaging is compatible with an arthritic process and/or a bone marrow lesion (contusion/bruise). Bone supports the joint and when damaged either by injury or as part of the arthritic process, contributes to pain and the progression of arthritis. The bone marrow lesion is seen on the MRI while the change of bone, subchondral sclerosis, is seen on the routine X-ray.
Patients with Bone Marrow Lesions are known to have increased pain, less function, faster joint cartilage destruction and reduced benefits from present forms of intervention. By addressing not only the arthritis but the bone surrounding the joint, it is anticipated that the results of intervention for the arthritic or injured joint will be markedly improved.
Subchondroplasty is a minimally invasive procedure targeting and treating subchondral defects that is the altered bone adjacent to and responsible for supporting the joint. During the treatment phase of injecting Bone Marrow Aspirate Concentrate for the arthritic joint, the subchondroplasty adjunct is completed under the fluoroscope. In conjunction with delivering the BMAC into the joint itself, additional Bone Marrow Aspirate Concentrate is placed into the surrounding bone through small drill holes created with a special canula. Up until now, the subchondroplasty drill holes were filled with a synthetic substance manufactured from Calcium Phosphate. The theory was that the Calcium Phosphate granules when placed into the bone defect would eventually be resorbed and replaced by bone. Using Bone Marrow Aspirate Concentrate is a much more physiologic stimulus for effecting bone healing in a much shorter time and by a means that more closely approximates bone healing after injury.
Our goal is to assist the patient in delaying or possibly avoiding a joint replacement through Regenerative Medicine (Cellular Orthopedic) approaches. The Bone Marrow Aspirate Concentrate intervention has proven extremely successful in meeting those goals. The introduction of Subchondroplasty will allow us to offer the possibility of increasing the success rate and the longevity of effect in appropriate settings and in any joint; hip, knee, ankle or shoulder.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment, Ultrasound Guided Injection
Aug 6, 2015
In both the shoulder and the hip, there is a structure called the Labrum that since the introduction of the MRI and the arthroscope, has received exponential surgical attention. In the hip, the acetabular labrum is a ring of cartilage that surrounds the socket of the hip joint. Its function is to deepen the acetabulum and make it more difficult for the head of the femur to slip out of place. At the shoulder, the Glenoid Labrum is soft fibrous tissue that surrounds the socket to help stabilize the joint. Injuries to either structure may occur from acute trauma, repetitive impingement or as part of the degenerative osteoarthritic process. Symptoms of a tear in either location include pain, may be mechanical in nature (catching, locking, popping, or grinding), a decreased range of motion and loss of strength.
Herein is the diagnostic and therapeutic dilemma; does the orthopedist address the history and physical examination, the results of imaging, all of the above or some of the above? On the one hand, it has been clearly established both at the shoulder and at the hip, labral injury as demonstrated on the MRI or CT arthrogram may not be the source of the pain. If the problem is pain and there are arthritic changes in the joint, the results of arthroscopic surgery are poor. Even when there are mechanical symptoms such as catching, locking, grinding and popping, arthroscopic clean outs do not succeed in the presence of arthritis. When it comes to the shoulder, the arthroscopic attempt at repair of the labrum as part of the rotator cuff injury has only a 50% success rate. Even when done correctly, poor patient selection and complications can be devastating resulting in injury to cartilage, injury to bone, and chronic irritation of the joint lining.
Assume if you will that a 45 to 55 year old or even older patient presents with pain in the shoulder or hip. The MRI is interpreted as compatible with a labral tear. There is an option which may very well eliminate the pain and affect healing of the torn structure, Bone Marrow Aspirate Concentrate followed by physical therapy. The procedure is done with a needle and not a scalpel; the complication rate in my experience is extremely low and the success rate extremely high. Let me cite an example of a patient who presented at age 67 with bilateral chronic shoulder pain for which he had undergone multiple prior attempts at arthroscopic surgical remedy. Four months after having undergone bilateral Bone Marrow Aspirate Concentrate Stem Cell intervention, he is off his chronic opiate containing pain medication and playing golf while having returned to his unlimited fitness routine. This is only one success story, there are many more. If you want to learn more about the potential options for your painful shoulder or hip, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, shoulder, stem cells, treatment, Ultrasound Guided Injection
Jun 29, 2015
As written a week ago, I attended a Regenerative Medicine International Conference in Las Vegas for the purpose of presenting a scientific paper that has generated a lot of interest and may influence how others practice Regenerative Medicine for arthritis. The meeting also served as a vehicle of continuing Cellular Orthopedic Education. The science of cellular biology is dynamic. It has been a major undertaking for me these past several years not only to have exchanged the scalpel for a trochar needle when managing arthritis but to reeducate in the basic science cellular biology.
Three years ago, the Adult Mesenchymal Stem Cell was thought of as a precursor cell directly responsible for replacing cartilage in the arthritic joint. The thought at the time was that the Stem Cell would take on the characteristics of whatever environment into which it happened to be placed and morph into that tissue or organ. In just three years, scientists have changed their thinking based on continuing research. The Mesenchymal Stem Cell (MSC) is no longer looked at as a progenitor but rather, a Medicinal Signaling Cell directing the body’s response to injury. When placed into a joint, it signals molecules and cells from the local environment and from distant locations to alter the bio-immune response of osteoarthritis, act as an anti-inflammatory, relieve pain, improve function and perhaps regenerate cartilage. We have also learned that while one Bone Marrow Aspirate Concentrate intervention causes improvement, several may be the answer over an 18 to 36 month period. In addition, there is increasing evidence that not only should the joint itself be addressed but the bone immediately adjacent to the joint as well. In the orthopedic community, Subchondroplasty has been applied over the past several years for the patient with a painful joint, relatively “normal” X-ray and an MRI compatible with bone marrow changes in the bone adjacent to the painful joint. That core decompression might be visualized as a dentist relieving the pain and pressure of a cavity by drilling. In the case of the dentist, the resultant void is filled with a synthetic material. In the case of the orthopedic surgeon, the cavity created by drilling is filled with calcium phosphate. At Regenexx Chicago, – my practice, I will introduce the subchondroplasty, a minimally invasive needling for the bone adjacent to the joint in addition to the joint itself filling the voids created in the bone as I fill the arthritic joint with Bone Marrow Aspirate Concentrate. The Europeans have documented success and I will be able to improve results and extend indications with Bone Marrow Aspirate Concentrate for the arthritic joint and now the surrounding bone.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Osteochondritis Dissecans, Pain Management, stem cells, treatment
Feb 16, 2015
Well OK, maybe a week, unless you work from your home or have a sedentary job; then you may go back to productivity in days. What caused me to call your attention to the minimal inconvenience and the potential major benefit when Bone Marrow Aspirate Concentrate/Stem Cell is selected as the treatment of choice for an arthritic joint as contrasted with a Total Joint replacement is the minimal need to take time off from work. In addition to the superior athletic performance inherent in a stem cell procedure along with the almost complete absence of complication is the fact that you won’t miss days from your job.
I was reminded of the minimal and short term impact on your life when choosing Bone Marrow Aspirate Concentrate /Stem cells for an arthritic joint this past Friday when a busy Podiatrist sought consultation because of an arthritic knee. She had experienced progressive impairment from advancing arthritis of her knee and three months ago had undergone a Cellular Orthopedic intervention for that arthritic knee. A week later she was on her way to Europe for a long anticipated vacation. She came to the office looking for a long term plan of action as the patient realized as a mature adult, Cellular Orthopedics is a continuum of care and not a onetime experience. That continuum is something I will focus on next time; but for now, let’s focus on the “No Time Off” theme. Inherent in a Total Joint Replacement is obligatory six to 12 week convalescence; that may become a six-month ordeal if a complication such as an infection is experienced. The patient about whom I am writing made it clear that she did not wish to take time away from her profession nor did she wish to risk complication, hence she was planning six or 12 month boosters to keep her working and active. Incidentally, please don’t forget that a total joint replacement may not be a onetime surgical event either. They wear, they fail, they get infected and need to be revised. That revision never is a happy event nor does the outcome come close to the results following an uncomplicated first procedure.
When comparing the potential benefits of a Bone Marrow Aspirate Concentrate/Stem Cell procedure for an arthritic joint to the lost productivity, financial obligation in the new world of high deductibles, and risks of a total joint replacement, the balance sheet speaks for itself. Speaking of balance sheets, I am off to Vail this week for a ski week with family and friends. On Monday, the 23rd, I will be visiting Regenexx to review our Outcomes Data and set forward several interventional protocols. While I seem to Blog mostly about stem cells and arthritis, there is unlimited possibility in the world of Sports Medicine for you to avoid surgery should trauma put you on “Injury Reserve” Check out Sports Illustrated and Stem Cells- that is for injury, not bathing suits.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Regenerative, Regenexx, stem cells, treatment
Jan 29, 2015
From a Patient in Canada
On January 20, 2015
“Thank you, Doctor,
How are you today? Hope well.
My Mom is very grateful for your kind help, mentions your name frequently and wants to schedule the 3rd Rx-SD visit to your office in 2-3 months.
Please provide us with the special 50% discounted price for the procedure similar to the last time in July and the time convenient for you if possible.
Thank you for your help.
My Mom is currently almost free of pain, walks around the house with a walker. The 2nd Rx-SD procedure on July 9,11, 2014 went really well and with the anesthesia was painless. My Mom trusts you, wants to see you every 8-12 months and to start walking without a walker this summer.”
This was the Holiday greeting last month
“Thank you, Doctor,
We wish you a merry Xmas and all the best in 2015.
Thanks to your kindness and knowledge, we found you when we were in real pain and needed you the most and you saved us. My Mom is very gratefull to You, calls you God and mentions your name daily, she’s feeling better only because of your help. My Mom and I both wishing you good health and all the happiness, many years ahead and a Happy New Year 2015.
Thank you for your help
Kind Regards,”
On Oct 7, 2014, at 8:32 AM
“Thank you, Doctor,
3 months passed after the 2nd SD procedure (9 July).
My Mom feels a better improvement now vs right after the 1st procedure.
We have no words to express how grateful we are.
She still uses a walker but occasionally tries a bit on her own with a cane. The pain is almost gone, just occasionally when its rainy or she stands for too long. She didn’t find a great improvement after the PRP refill (2 May), followed by the 1st SD procedure (4 Dec).
What do you think, Doctor, should she just do the 3rd SD procedure in 6-11 months or is it better to do the PRP refill now prior to this. I was surprised to learn the latest Rx SD 2013-14 data show the result doesn’t depend on age (74), OA severity (3), BMI (35).
With BMI=35 what’s the average total hrs per day should she stand/walk?
Thank you for your help.
Kind Regards, “
On Aug 9, 2014, at 12:16 PM
“Thank you, Doctor,
The 2nd SD procedure on 9 July went well and with the knees anesthesia was very painless. After 1 month my Mom feels good, no pain, just a little bit of pain when its humid and raining, still can’t walk without a walker.
My Mom is really grateful for your help and hopes to start walking one day.
Thank you for your help.
Kind Regards,”
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
