Better stated, how do you bridge the gaps in the continuum of joint care from early intervention to joint replacement?
Arthritic Joint Pain Management
First and foremost, our goal is functional restoration and maintenance, relieving symptoms, and postponing, perhaps avoiding joint replacement. In the beginning, conservative measures might include non-steroidal anti-inflammatory medications, weight reduction, physical therapy for strengthening muscles and preserving or restoring a full range of joint motion. At times, an unloader brace may be of benefit in settings where a joint shows early signs of mechanical changes such as a knock knee (valgus) or bowed leg (varus). In addition to the aforementioned measures, joint preservation is a major goal using such measures as Platelet Rich Plasma, Highly Cross-linked Hyaluronic Acid and Acellular Amniotic Fluid.
Within the Preservation Classification, there are multiple options available. Our evidence-based practice concentrates on those options in which we have done outcome research; as well as published our results in scientific journals. Only using evidence-based options allows us to provide the patient the highest chance of a successful outcome.
Cellular Therapy to Treat Joints
There are times in the continuum of care that the patient will present further along in the arthritic process so that Conserve and Preserve are no longer indicated. Joint Restoration is the next consideration that might or could go a long way in postponing or even avoiding a joint replacement. Autologous Growth Factor Solutions contain proteins circulating in your blood that potentially stops pain, and reverses the arthritic process at the molecular level in the joint. The ultimate Regenerative Orthopedic approach is stem cell mediated and bone marrow concentrate is the only FDA approved source of mesenchymal stem cells at this time. Your bone marrow is recovered by an outpatient aspiration procedure, the recovered bone marrow via a specially designed needle, (troachar), contains adult mesenchymal stem cells, exosomes, platelets, growth factors and precursor cells. When concentrated, your bone marrow is the richest source of joint restoration potential available to date. It is FDA approved as long as guidelines are adhered to; has no potential for disease transfer; and offers pain relief, return of motion and function, and postponement, perhaps avoidance of a joint replacement. Please note that I indicated “at this time.”
The Personalized Stem Cell trial in which I played a major role just concluded. The results are being analyzed. In the PSC Trial, the source of stem cells was adipose tissue, abdominal fat. When approved, Personalized Stem Cells will allow abdominal fat to serve as an alternative source of stem cells in addition to bone marrow on a clinical basis. The next advance will come following the FDA approval for the PSC trial of stem cell culturing. To stay informed, read my weekly blog. To schedule a consultation call (847)390-7666. You may visit my web site and attend a webinar at www.sheinkopmd.com
Tags: arthritic joint pain, arthritis, cellular therapy for arthritic joints, joint, joint pain, preventing joint replacements
Nonobstructive meniscal tears
There is increasing evidence to suggest that patients with meniscal tears at the knee that do not cause “clunking”, giving way, or locking; hence nonobstructive, may benefit from Cellular Orthopedic intervention coupled with physical therapy. Previous studies involving patients over 45 years of age comparing arthroscopy with physical therapy for nonobstructive meniscal tears as seen on an MRI justify an initial conservative approach; but patient satisfaction may require 24 months to achieve. For those patients who undergo arthroscopic surgery, there is a significant increased risk of repeat knee surgery. In our practice, those patients electing to use the Physical Therapy option without surgery but with a Cellular Orthopedic intervention minimized the length of time needed to return to full activity.
Number of stem cells in amniotic fluid
The functionality of stem cells in amniotic fluid as sold today is a myth. Research shows that 250cc of fresh C-section delivered amniotic fluid, when introduced immediately into culture, only yields 40 stem cells. This means there are 0.16 stem cells per 1 cc of full-term amniotic fluid. Scientific literature referred to by the amniotic fluid marketing forces is based on amniotic fluid collected early in pregnancy.
Acetabular Labral Tear
A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. In some cases, it causes no symptoms. In others it causes pain in the groin. Just because a tear is seen in the hip labrum on an MRI, it does not mean the tear is necessarily the cause of the pain. Before initiating treatment, the orthopedic surgeon must exclude that an underlying arthritic condition within the hip is not the real pain generator. More recently recognized is predisposition for a tear in those with abnormal acetabular architecture.
On biologics for knee osteoarthritis
Orthobiologics may become a mainstream treatment for knee osteoarthritis. While Platelet-rich plasma and hyaluronic acid injections are the most established biologics-based treatments for knee osteoarthritis so far, it’s not too early to make confident use of stem cells. At the same time, I must continually warn patients to be particularly careful about claims for these substances. All recommendations for intervention must be FDA compliant and evidence based. (To learn about my contributions to the cellular orthopedic scientific evidence, visit www.sheinkopmd.com. Under the information bullet on the top, you will find published articles)
Eventually, I believe the science and FDA will triumph over quackery and orthobiologics will become an essential part of every knee surgeon’s armamentarium. Available orthobiologics, include:
- Hyaluronic acid
- Platelet-rich plasma
- Cytokine modulation
- Stem Cells
- Adipose tissue
To learn more or to schedule an evidence based consultation, call (847) 390-7666
Tags: adipose tissue, amniotic fluid, biologics, bone marrow, cytokine modulation, Exosomes, fat, hyaluronic, joint, labral tear, Micro-Fractured Adipose, orthobiologics, Osteoarthritis, pain, Platelet Rich Plasma, PRP, renovation, stem cell, torn meniscus