Aug 27, 2015
In a more recent understanding of the arthritic joint, science now tells us that it is not only loss of cartilage that leads to pain, loss of motion, altered function and a progressive downhill course; but rather an involvement of the entire joint as well as the bone supporting the joint. The mechanism is probably bio-immune in nature and the reason for our success in treating the arthritic joint with orthobiologics is based on addressing molecular changes within the joint. The Europeans however have taught us that almost as important as intervention inside the joint is addressing the bone supporting the joint. In a recent scientific meeting, Spanish and French Orthopedic Surgeons demonstrated improved overall results within the arthritic joint by treating the changes outside of the joint as seen in an MRI. These changes are frequently described as bone contusions or bone marrow lesions. When followed, it becomes apparent that the altered bone fails to support or protect the cartilage within the joint. By drilling into the subchondral bone, one stimulates a healing process and by adding orthobiologics, one hastens the healing of those bony lesions.
Subchondroplasty is accomplished with a specially designed drill bit and the orthobiologic is introduced through a specially designed trochar needle that slides over the drill bit serving additionally as a guide wire. The entire process is accomplished through a small skin puncture with accuracy enhanced through fluoroscopy, real time X-ray. Because the drill bit causes little structural damage, there are few alterations in the rehabilitation process when compared to the joint intervention alone. While Orthopedic Surgeons have been addressing these bony lesions by a macro system for several years with documented success, our work, as was seen on the Fox News airing last Thursday night, is based on minimally invasive means thereby eliminating the need for prolonged restriction of weight bearing and crutch dependency. Additionally, by introducing Bone Marrow Aspirate Concentrate in addition to the present Calcium Phosphate adjunct, the patient should anticipate healing in weeks, not months. The first target was the knee but we have expanded subchondroplasty to the ankle and soon to the hip and shoulder.
Tags: arthritis, athletes, Benefits and Risk, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, stem cells, treatment, Ultrasound Guided Injection
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
Jul 23, 2015
When a patient presents with advanced arthritis of the knee as confirmed by physical assessment and radiographic findings classified as Kellgren/Laurence 3 or 4, the standard approach has been a Total Knee Recommendation (TKR). Inherent in the outcome of any large group of patients who have undergone a Total Knee Replacement is a 40% dissatisfaction rate because of continued pain and failure to restore a functional range of motion. In addition, there is the risk of infection, blood clot (check the source) and repeat (revision) surgery starting at three years. The Regenerative Medicine alternative carries with none of the adverse potential consequences and unsatisfactory potential outcomes when compared to the surgical option. By using a needle and syringe rather than a scalpel, implant and complex surgical intervention, Cellular Orthopedics offers the patient a minimally invasive outpatient solution with virtually no risk. No bridges are burned and instead of a complex and costly revision associated with failure of a knee replacement ,the Regenerative Medicine recipient has the option at some time in the future of repeating the minimally invasive procedure or crossing over to a primary Total Knee Replacement. Our research data while tracking patient outcomes with other regenerative medicine options documents superior outcomes when compared to the result of a knee replacement. What we offer is the stem cell option for patients with advanced osteoarthritis for whom here-to-fore there have been few choices.
At our Center, we offer a range of minimally invasive options starting with cross-linked hyaluronic acid. Should the result of such prove unsatisfactory or not long lasting, the next step may fall under the world of Amniotic Fluid Concentrate. There is then the Platelet-Rich-Plasma series of options followed by the Bone Marrow Aspirate Concentrate intervention process. What is new and very exciting is the concept of Subchondroplasty (SCP). This latter intervention has proven a marvelous adjunct in Europe and now is available to us in the United States. The role of SCP is to improve outcomes of intervention for arthritis and to extend the indications for Regenerative Medicine. We are now introducing the latter in our treatment algorithm. Wherein we will differ in incorporating Subchondroplasty into our Minimally Invasive approaches is that we will use orthobiologics rather than synthetics to help rebuild the bone supporting the joint while addressing the arthritis with Bone Marrow Concentrate. To learn more, schedule a consultation.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
Jul 13, 2015
Cartilage is known to be damaged by Interleukin-1B (IL-1B), a cell signaling protein responsible for blood-induced cartilage damage. When there is trauma to a joint and a hematoma ensues, the faster the hematoma is evacuated, the less damage to cartilage long term. The blood in the joint now provides an explanation as to why some years after an injury, a patient will present with an osteoarthritic joint. An example is the tear of the Anterior Cruciate Ligament. Findings in the research laboratory also indicate that the faster the blood is removed from the injured joint, the less damage to the cartilage. To emphasize the harm from IL-B1, we are experiencing increased number of patients with a history of an ACL tear who are in need of intervention for post traumatic arthritis at younger ages than in the past even when the ACL has been successfully repaired.
Turning our attention to fractures within the joint, it is important for orthopedic surgeons to realize the impact of blood on cartilage. There is an upregulation of cartilage-degrading enzymes suggesting that the indications for surgical repair of an intra-articular fracture should be expanded and the surgery considered urgent and not delayed. There is an additional adjunct that should be introduced into the algorithm of care of the joint injury and resulting hematoma; namely, Bone Marrow Aspirate Concentrate. Interleukin-1B Receptor Antagonist Protein serves as a dose- and time-dependent protection from blood-induced damage. The higher the concentration and the earlier the introduction, the less cartilage damage sustained. When Bone Marrow is aspirated, recovered with the Mesenchymal Stem Cells (MSCs) are those cells in the bone marrow that produce Interleukin-1 Receptor Antagonist Proteins (IRAP). When the aspirate is concentrated, included in the centrifugate along with the MSCs is a therapeutic quantity of IRAP and that means stopping the degradation of cartilage by the harmful blood born Il-1B.
So what is my take home message? The swollen joint after trauma needs to be aspirated as quickly as possible to remove blood. The intra-articular injury to a joint must be addressed either by surgery or non-operative means on an urgent basis; intervention should not be considered elective. Bone Marrow Aspirate Concentrate should be increasingly used as an adjunct in the care of a joint injury. Should you experience that joint injury, discuss using Bone Marrow Aspirate Concentrate as an adjunct. If your orthopedic surgeon is unfamiliar, once the damage is acutely addressed, call us to see if there is a place for Cellular Orthopedics as a means of improving your long term outcome.
Tags: ACL Injury, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Interventional Orthopedics, Knee, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, stem cells, treatment
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
