Jan 12, 2015
That quote comes from University of Chicago Economist and Nobel Laureate, Gary Becker, who died in 2014. Central to his work was the concept that economics can help explain behavior. As seems to be happening more and more, this Blog will expand on the evidence concerning Bone Marrow Aspirate Concentrate/Stem cell outcomes for intervention in the arthritic joint. The Data and my experience clearly document success at all stages of arthritis in a major joint for some period of time. What I am unable to conclude is in whom we are actually regenerating cartilage or in whom we are seeing pain relief and improved functional capacity owing to concentrated Growth Factors and Cytokines. Whereas my initial interventions two and a half years ago were limited to a “younger” arthritic demographic, the successes resulted in my expanding the inclusion criteria last year without age exclusion as I observed Outcomes success in those approaching 80 years of age. What I don’t know yet is in whom the improvements are related to the stem cells in the Bone Marrow Aspirate Concentrate or whether to the Growth Factors influencing your own stem cells or the Cytokines acting as anti-inflammatories, accompanying the stem cells in the Bone Marrow Aspirate Concentrate. What the evidence does indicate is that the older the patient or the more advanced the arthritis at the time of BMAC intervention, the better the outcome with a second or even third procedure. What I don’t know yet is a predictor of the survivorship of an outcome. I do know that the best chances of long-term benefits are in those with less than Grade 4 arthritis. For those who experience something less than hoped either in the initial result or extent of benefit, let’s explore the economics.
Just as our health care indemnification is undergoing change, so is my understanding of the scope of services that may be beneficial in this evolving discipline of Cellular Orthopedics. The good news is that unlike the insurance world where less health care coverage seems to be associated with greater cost for indemnification to the patient, I have identified a means of decreasing the economic burden to a patient for a repeat Bone Marrow Aspirate Concentrate/Stem cell intervention or related Regenerative Medicine injection, if a single procedure doesn’t provide the degree of relief or survivorship of outcome desired. It may well be that Cellular Orthopedics involves a range of approaches and not a single intervention. My office will work with you to provide you a scope of Evidence Based Care with an economic approach that allows the patient to avoid or at least delay a joint replacement.
Tags: arthritis, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, Hip, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
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
Jun 12, 2012
Orthopedic Care of the Mature Athlete
Will stem cells work in relieving the pain from an arthritic joint; that is the question? A patient read my blog and called to discuss his experience with the orthopedic surgical community. Since his is not the first time I came across opposition to Regenerative Medicine, I thought I would focus on that resistance this week.
An orthopedic surgeon is just that, a surgeon. Usually trained with a major emphasis on surgical technique and evidenced based medicine, it is difficult to foster change within the orthopedic community. I should know as I practiced orthopedic surgery for 38 years developing that surgical technique in the joint replacement sub specialty and doing the clinical research that led to the evidence forming the basis of modern hip and knee replacement surgery. During that era, I also noted the failures of joint replacement and other adverse outcomes so I started seeking an alternative to joint replacement, basically a biological arthroplasty.You better believe the orthopedic community has not rapidly adopted this latter concept in theory. Yet, orthopedic surgeons have been attempting cartilage restoration for over seven years and actually informing the surgical candidate about stem cell treatment of arthritis every time they performed an arthroscopic micro fracture. The Arthroscopic Package for the injured or arthritic joint includes micro fracture. The explanation behind the technique of micro fracture is that one is allowing a patent’s own adult mesenchymal stem cells to migrate from within the bone marrow to the joint by creating multiple small holes in the diseased cartilage communicating with the marrow. The only problem with the hypothesis, no matter how enticing, is that by time a patient reaches the age of 40 to 50, there is no active marrow remaining near the knee and very little remaining at the hip or the shoulder. Why not then, harvest bone marrow from the pelvis where it is plentiful at any age, filter out the stem cells and concentrate them followed by reinjection after the micro fracture? It makes all the sense in the world, is worthy of clinical trial and outcomes surveillance, and does not make the Arthroscopic Package much more complex.
In my attempt to overcome the negative reaction of the orthopedic clinical community to my Regenerative Medicine initiative increasingly made known to my patients, I sought the guidance of the leader of a think tank and a mentor, Chef.
Dr Sheinkop: “How do I overcome resistance to my procedure of the future when the orthopedic surgeon has been using it for over five years?”
Chef: ” Forget all that genetic engineer whoosa-fudge…….if you want to combine a pig and an elephant, just get them to make sweet love”
Dr Sheinkop: “The orthopedic surgical community will never accept a non operative approach to the management of arthritis if it threatens a decrease in the number of procedures.”
Chef: “Sure they would but you’re gonna have to get’em in the mood”
In August, I have been invited to speak before an orthopedic audience for the first time to share my earliest observations regarding response to stem cell management of arthritis. Two weeks ago, I did my first case; last Wednesday, I did three. It won’t be a series on which to report but I certainly will have something new to share. The Reality show to be continued.
Tags: Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, Knee, medicine, Orthopedic Surgeon, Orthopedics, Pain Management, Regenerative Pain Center, stem cells
