Jul 20, 2017
We now are approaching five-year outcomes regarding the use of Bone Marrow Concentrate for Osteoarthritis of the hip, knee, shoulder and ankle. Bone Marrow contains Adult Mesenchymal Stem (MSC) cells and Growth Factors. In the beginning, the entire informed consent process focused on the MSC in bone marrow as the agent responsible for diminishing pain, improving motion, stopping, at times reversing the progression of osteoarthritis, and potentially regenerating the joint itself. Now we know that equally important to the MSC are the growth factors produced and stored in the bone marrow. Some of the key proteins (Growth factors) include Interleukin-1 Receptor Antagonist Protein (IRAP), Alpha-2-Macroglobulin (A2M), fibrinogen, PDGF, VEGF, and TGF-B to name a few.
The reason we directed our clinical initiatives to Bone Marrow Concentrate is that while Amniotic Fluid contains Hyaluronic Acid, once harvested, sterilized and fast thawed for clinical application, there are no living stem cells left, so Amniotic Fluid Concentrate has no regenerative potential. When it comes to Adipose Derived Stem Cells, in order to liberate the stem cell from the adipocyte, an enzyme, collagenase must be employed. The latter is not approved by the FDA. Additionally, there is no evidence of Growth Factor content in adipose derived tissue.
While I have blogged about the superiority of Bone Marrow Concentrate over all other non-surgical approaches for arthritis, the introduction of the intraosseous adjunct, subchondroplasty, is resulting in even superior outcomes when compared to those who were treated prior to this contemporary version of Cellular Orthopedics. It has been nine months basically since I started injecting Bone Marrow Concentrate into the marrow adjacent to the joint in addition to the intraarticular approach. We already are seeing a better outcome in those who availed themselves of the Intraosseous adjunct. Up until eight weeks ago, my ability to offer contemporary and improved treatment options was limited by preexisting contractual obligations; but now unrestricted, I have expanded my scope of offerings including elevation of subchondroplasty from a clinical trial status to usual and customary adjunct standard of practice option. As well, I now offer an increased opportunity for participation in other clinical trials for the arthritic joint when a patient meets obligatory inclusion criteria determined by the trial sponsor.
If you want to postpone, perhaps avoid a major surgical replacement for an arthritic joint, call for a consultation 847 390 7666
You may visit my web site at IlCellulartherapy.com where you may watch my webinar.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Microfracture surgery, Orthopedics, Osteoarthritis, Pain Management, stem cells, treatment
Jul 13, 2017
Last week, we traveled to Israel to celebrate the wedding of our youngest son. Israel became the destination for the event as Eric and Judith had met there while his music business was subcontracting to Coke and Judith led the International Marketing initiatives for Coke. The event took place on July 5th, at an organic farm in the outskirts of Jerusalem. In such a majestic and historical setting prior to and after the ceremony, there took place several organized tours including one of Jerusalem, another at the Dead Sea and for several, a trip to Petra. It was a relatively small group of the attendees; one in particular, a very close and long-time friend has been the subject of my Blog in years past as I described his return to skiing, biking and fly fishing following a Bone Marrow Concentrate/Growth Factor Concentrate/Stem Cell concentrate intervention. Prior to those procedures, he had been forced to give up his athletic passions for several years because of the limitations imposed by arthritis of both knees.
Above is his activity score from Monday, July 3, when Bob and his wife toured Jerusalem’s Old City including a hike on the ramparts of the wall surrounding the Christian Quarter, the stop and prayer at the Temple Mount and a shopping spree at the Arab Suk (bazaar).
What Bob represents is the potential for continued improvement over several years following a regenerative intervention, a process of which I am continually reminded as time passes and I have a longer follow up of my patients. Our mission and ethos is to help patients with arthritic joints enjoy an active life style and postpone, perhaps avoid joint replacements when arthritic impairment ensues. The documentation from the patient above is one of improving outcome as time passes. While his is an anecdote, our data base increasingly reflects similar happenings for the majority of our patients.
There are now many providers for those with arthritic impairment seeking improved function and less symptoms; and who are not candidates for a joint replacement or who do not want to undergo the major surgical undertaking. In your choice of an Interventional Cellular specialist, inquire about her or his long-term outcomes; not just “will I get a free lunch if I attend a seminar?”
To learn more, call for a consultation 847 390 7666
You may watch my webinar and learn more by visiting my website at Ilcellulartherapy.com
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, joint replacement, Knee Pain Relief, Orthopedic Surgeon, Regenerative, stem cells
Jun 15, 2017
It was difficult for me to sit and listen to so many “show and tell” presentations not supported by scientifically overseen outcomes data. Too much anecdote about unproven methodologies; many not compliant with FDA guidance. Basically, it was frequently repeated false news. I was taken aback by what so called physicians are injecting into the joints of their patients. Florida seems to lead the way in the cook book approach to arthritis followed closely by California. Illinois is guilty as well but not the medical community. Despite my negativity about the absence of science, this gathering certainly did not begin to approach the science and integrity of presentation found in the discipline of orthopedic surgery; of particular interest to me was the universal agreement that there is no regenerative potential in Amniotic Fluid Concentrate. A matter of fact, there was not one outcomes paper presented concerning amniotic fluid. It becomes ever so important that a patient choose an experienced, scientifically oriented, regenerative medicine specialist when seeking a non-surgical option for an arthritic knee, hip, ankle or shoulder. The patient must bear in mind that the specialist’s goal is to improve function, diminish pain and postpone, possibly avoid a joint replacement for an arthritic joint. When the arthritis has reached end stage, there are those who should have a joint replacement; only a specialist is equipped to properly advise a patient.
In the orthopedic world, scientific papers are not considered to have significance unless the outcome results have been followed for a minimum of two years and more. Furthermore, the articles in order to be considered authoritative must have statistical significance. It seems that the charlatans and camp followers are offering patients an intervention that is neither FDA compliant nor for which there is scientific outcomes data. The one exception to all the fake news was the presentation by Dr. David Karli of Greyledge Orthobiologics who introduced The Method of Ratios for Assessing PRP and BMC Theraeutic Potential. This novel approach to quantitating and qualitating the injectate I am sure will soon become a standard of care for cellular orthopedics so I will quickly introduce into my practice. The Method of Ratios will allow the clinician to better understand what will be injected into a joint.
The appropriate method of advising an arthritic patient as to whether surgery may be postponed or even avoided begins with a specialty consultation including a comprehensive intake, a physical examination including functional testing, and review of images. Only those with specialty training, board certification and experience both in surgery and in regenerative medicine are able to properly advise the patient. I will again underscore the importance of choosing the Cellular Orthopedic expert and not determining what may be best for you by surfing the cloud.
If you want to become better informed, browse my website www.sheinkopmd.com.
You may watch my webinar at www.ilcellulartherapy.com or call to schedule a consultation (312) 475-1893.
Tags: Amniotic, amniotic fluid, arthritis, BMC Theraeutic Potential, bone marrow, cellular orthopedics, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Dr. David Karli, Greyledge, Interventional Orthopedics, Knee Pain Relief, OrthoBiologic Institute, Platelet Rich Plasma, Regenerative, stem cells
Jun 12, 2017
The lack of scientific foundation in stem cell marketing is all around us and negatively impacting those doing the right thing in the evolving discipline of Regenerative Medicine. Yesterday afternoon, a patient for whom I successfully completed a Bone Marrow Concentrate/Stem cell procedure presented to the office for a follow-up visit. She was accompanied by her husband who was experiencing progressive limitation attributable to an arthritic left knee. Because of my patient’s successful experience, her husband had determined now it was his turn. After the intake, I provided the customary explanation of what was to take place. During the question and answer follow-up, both husband, the new patient, and wife, the successful outcome, wanted to know why hers had worked whereas several of their friends had not enjoyed successful outcomes after amniotic fluid interventions.
The explanation is straightforward and based on a precedent, the fact speaks for itself. While Bone Marrow is full of Adult Mesenchymal Stem Cells and Growth Factors when harvested, processed, concentrated and reinjected into the symptomatic joint within 60 to 90 minutes after the harvesting; Amniotic Fluid has no living stem cells after sterilizing, freezing and fast thawing. Restated, Amniotic Fluid has little if any regenerative potential. Why am I able to make said statements in the face of such aggressive marketing claims regarding amniotic fluid? In addition to my work clinically and scientifically with Bone Marrow Derived stem cells and growth factors, I am the Principal Investigator in a clinical trial wherein amniotic fluid both frozen and fast thawed, and most recently, Lyophilized, has been used in lieu of hyaluronic acid to reduce or possible relieve the symptoms of osteoarthritis for six to 12 months. At no time did the largest amniotic product based pharmaceutical company in the United States suggest there are viable stem cells in amniotic fluid nor did they make any claim for regenerative potential. Returning to my office encounter, during our continued discussion, I learned that those who had opted for the amniotic fluid injection had paid more for the injections than I charge for the Bone Marrow intervention. So, think about the harm done to the “victims” as well as the public in general. The trusting patients paid for a regenerative procedure that they never received. The patients believing that the stem cell procedure didn’t work are now considering total joint replacements.
How might you protect yourself if you are considering a means by which you might postpone or avoid a joint replacement for arthritis? Make sure you choose a residency and fellowship trained interventional specialist. Second, ask the clinician to share his or her scientific outcomes data.
If you want to become better informed, browse my website www.sheinkopmd.com.
You may watch my webinar at www.ilcellulartherapy.com or call to schedule a consultation (312) 475-1893.
Tags: ACL Injury, arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mesenchymal Stem Cell, Orthopedic Surgeon, regenerative medicine, stem cell treatment
May 18, 2017
Also known as degenerative joint disease, osteoarthritis is the most common joint disorder, and continues to be the leading cause of impaired quality of life in the United Sates. While OA is defined as the progressive loss of cartilage structure and function; that definition has most recently been expanded to include changes to bone, tissues within and around the joint and changes in alignment.
While trauma, disease, infection, genetics, gout, and neuropathy may lead to secondary osteoarthritis, primary OA is the result of a degeneration that occurs with normal use. This wear and tear of the joint becomes more prevalent with advancing age.
Changes to Cartilage
The progressive loss of cartilage is a process that involves three overlapping stages: cartilage matrix (surroundings) damage, cartilage chondrocyte (cell) response to tissue damage, and decline of chondrocyte synthetic response (ability to maintain its environment)
Changes to Bone
As cartilage degenerates, there is increased exposure of the bone supporting the joint (subchondral bone). With time, the subchondral bone becomes dense (sclerosis) with cyst formation. Cartilage does not regenerate on its own starting about age 40. With time the aborted reparative process may result in osteophyte formation (spurs).
Changes to Periarticular Soft Tissues (in and around the joint)
Synovitis develops (inflammation of the joint lining) because of the release of inflammatory factors by the chondrocytes. A vicious cycle continues with further break down of cartilage followed by thickening of the joint capsule and shortening leading to loss of motion. Muscle undergoes atrophy (shrinkage and weakening) with the relative inactivity of the joint because of pain leading to instability
Changes to Alignment
Abnormal hip-knee-ankle alignment can accelerate structural changes; varus malalignment (bowed leg) increases medial compartment (inner side of the knee) disease fourfold, and valgus (knock knee) malalignment increases lateral (outer) disease twofold. Whether malalignment is associated with development of osteoarthritis or if malalignment is a result of OA is still a subject of debate. However, it has been demonstrated that malalignment can affect more than cartilage because malalignment predis- poses the patient to bone marrow lesions (nonhealing stress fractures).
Treatment of Osteoarthritis
Life style modification, rehabilitation (physical therapy), complementary and alternative therapy, pain relievers, intraarticular injections (cortisone, hyaluronic acid gels), arthroscopic and joint replacement surgery, and now, regenerative intervention.
Regenerative Intervention (an injection, not an incision)
Cellular intervention is what I do. Biologic solutions through cartilage regeneration is the goal of my practice. My stem cell source is the patient’s own bone marrow. Equally important are growth factors; the latter found in bone marrow and in platelets.
To learn more, visit my web site www.sheinkopmd.com
You may watch my webinar www.ilcellulartherapy.com
Then schedule an appointment 312 475 1893
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Knee Pain Relief, Orthopedic Care, Osteoarthritis, regenerative medicine
