Since we practice in an emerging discipline of Regenerative Medicine, how is regeneration determined? Cartilage repair should be evaluated with use of a scoring system that considers the volume of the defect that becomes filled with repair tissue, the integration of repair tissue with adjacent cartilage, and the macroscopic appearance and biomechanical properties of the repair site. The macroscopic assessment is particularly important in evaluating cartilage repair because it provides information about the quality of the full repair site compared to the incidental histological assessment which only evaluates a biopsy of the repair site.
If the aforementioned answer to my introductory question may seem scientifically oriented, that is purposeful on my part; because only those able to explain Regenerative Medicine on a clinical, technical and scientific basis should be caring for your arthritic joint.
While an arthroscopic evaluation provides the best opportunity for a determination of joint regeneration 18 months or greater following a Bone Marrow or Platelet Rich Plasma or other cellular orthopedic intervention for arthritis, an invasive surgical evaluation is not realistic. For a quantitative MRI to assist in the assessment requires availability of a specialized imaging center and there are just too many variables to allow for dependable quantitation; expense is prohibitive. The most dependable and reproduceable means of measuring the arthritic or injured joint response to a cellular orthopedic intervention is a history and physical examination, the latter completed with a tape measure and goniometer as well as an activity assessment. By comparing a baseline measurement prior to an intervention and at serial intervals following the procedure, one may determine if regeneration is indeed taking place and thus establish clinical practice guidelines and determine Evidence Based Quality and Value.
Now for the real question, does cartilage regeneration need to take place on a macroscopic level for cellular orthopedics to succeed? New therapies such as bone marrow derived stem cells, growth factors and cytokines; platelet-rich plasma (PRP); and IRAP (interleukin-1 receptor antagonist protein) first and foremost address the bio-immune basis of degenerative arthritis. By controlling the pain and eliminating inflammation; stopping the progression (at least slowing) of Osteoarthritis; reversing scarring, thus improving motion and function; and lastly, possibly regenerating cartilage for those in whom regeneration is possible. From the editors of the Encyclopedia Britannica: “Interleukin (IL), any of a group of naturally occurring proteins that mediate communication between cells. Interleukins regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation.”
Should our future blogs and discussions address not cartilage regeneration but rather reversing the proinflammatory cytokine production from the synovial lining of the inflamed knee? One such possible pharmacological treatment of OA is anticytokine therapy. Interleukin-1 (IL-1), as a main inflammatory and catabolic cytokine in the pathophysiology of OA, represents one of the possible treatment targets. Koby Bryant was one of the first highly visible professional athletes who travelled to Germany over eight years ago for Interleukin-1 Receptor Antagonist Protein intervention for an arthritic knee. Many, have followed including golfer Fred Couples for his problematic back.
If this Blog has introduced new considerations and questions, then let me clarify. Call 312 475 1893 to schedule an appointment. You may watch my webinar at www.Ilcellulartherapy.com
Tags: arthritis, bone marrow, Hip Replacement, Interleukin, Interleukin-1 Receptor Antagonist, IRAP, Knee Pain Relief, Osteoarthritis, stem cell treatment, stem cells, Subchondroplasty
I am being forthright; based on my review of data, while 80% or more of my patients continue to enjoy
satisfactory outcomes at four years or more following a stem cell intervention, there are those whose
symptoms and functional limitations recur. Please be aware that when I undertake the care and
treatment of a patient with a symptomatic and function limiting joint, it is with the notion of
regeneration and long-term benefit. It doesn’t always happen; there are may possible explanations.
Most important though is the need to identify possible causes of potential failure at the beginning, and
that is why we have recommendations before and after a procedure as to how to manage alcohol, diet,
supplements and a rehabilitation protocol. We also review your past medical history to identify any
possible indication that your stem cells have been adversely affected by co-morbidity or prior
Assume if you will that you adhered to the initial pre-and post-intervention protocol but now returned
to my office months or years later with recurring symptoms. First and foremost is an updated medical
history and physical examination. That is followed by repeat images including X-rays and an MRI.
Mechanical progression of joint injury may result from aggravation of the preexisting damage by
subsequent trauma. Then there is the reality of identifying new processes within or adjacent to the joint.
This morning, I returned the phone call of a southwest Wisconsin dairy farmer; not the same patient I
wrote about last week. He has been a patient for over four years with a full restoration of work related
activities and recreational pursuits following several regenerative interventional options. After three
hours of basketball, three weeks ago, his knee pain returned. I called him back while he was milking his
cows and it was the first time I have been “mooed” at over a cell phone. I requested that the patient
update his X-rays, MRIs and then allow me to reevaluate him. A repeat stem cell intervention with a
more advanced technology, a subchondroplasty in addition to the stem cell intervention of his joint?
The recommendations will be based on an updated evaluation. In my practice of cellular orthopedics, it
isn’t one and done. Additionally, some of the more advanced techniques are being covered in part by
health care insurance
If you want to learn more, call for an appointment (312)475 1893
You may access my web site at www.Ilcellulartherapy.com and watch my webinar
After I completed writing this Blog, I opened the Bone and Joint Newsletter.
Lead article: Study Suggests Knee Replacement Be Reserved for Those More Severely Affected by Osteoarthritis. A recent analysis found that the current practice of TKR as performed in the USA had minimal effects on quality of life and quality adjusted life years
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mesenchymal Stem Cell, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, regenerative medicine, stem cell treatment
As regular readers of this Blog are aware and as well, those patients who seek consultation in my office, my cellular orthopedics practice is based on clinical evidence. While the largest marketer of stem cells in the Midwest, bases a recommendation for a product without scientific evidence or even anecdote, my practice is evidence based. While it is true that I can site anecdote after anecdote about a successful outcome, the scientific process requires that I provide statistical support for what I do. The subject of this particular blog is to share with you how far I will go to gather that evidence.
About six months ago, I completed a combined Bone Marrow Concentrate Intra-articular (into the joint) /Subchondroplasty (into the bone) in the right knee of a dairy farmer, in his early 60s, living in Southwest Wisconsin. He was able to follow up at my office in Des Plaines twice following the intervention; but owing to the fall harvest, he had been unable to return for the third follow up in a timely manner. My desire is to assure the success of the procedure, rather than having completed a telephone interview, my wife and I headed out this past weekend to Dodgeville, Wisconsin, where I completed the full evaluation in a booth at the local Culvers. In addition to the usual historical review of progress, I completed a Physical Examination of the patient including circumferential measurement of the thigh, knee and calf using a tape measure and an assessment of his range of motion using a goniometer for accuracy. I think that the diners at Culvers were just as fascinated at what was taking place in our booth as I was watching the customers in the drive through ordering an early lunch while carrying a recently harvested buck in the back of their pickups. It is deer season in Wisconsin.
Suffice it to say that my patient was thrilled at my willingness to save him a trip to Chicago but he was even happier about the outcome in his arthritic knee. I was thrilled at his response to care. Whereas prior to the right knee intervention, he had constant pain and limitation in function, at six months, the pain and swelling are gone and he has unlimited function be it on stairs, kneeling or climbing in and out of the tractor. What separates me from the madding crowd is the data and evidence for which my recommendations are advanced. Incidentally, two blogs ago, I listed our clinical trials, the basis for our evidence based practice. Below is the trial in which my Wisconsin patient is enrolled and for which I sought follow up:
- Stem Cell Counts and the Outcome of Bone Marrow Concentrate intra-articular and intra-osseous (subchondroplasty) interventions at the knee for grades 2 and 3 OA. (supported in part by Celling). Ongoing
His results are so good that his wife decided to be next in line for her knee that did not respond well to arthroscopic surgery two years ago.
Whether you didn’t respond to surgery or haven’t had surgery, call 312 475 1893 to schedule an appointment or watch my webinar on the website www.ilcellulartherapy.com
This Thanksgiving week, let me give thanks to those who read this Blog
Tags: arthritis, bone marrow, Bone Marrow Concentrate, cellular orthopedics, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Knee Pain Relief, Mesenchymal Stem Cell, Osteoarthritis, regenerative medicine, stem cell treatment
Well, it is really an internal debate as to whether I should have a concentrated platelet rich plasma procedure or a bone marrow concentrate procedure as I get ready for the upcoming ski season. While it is true that I exercise five to six days a week rotating between outdoor cycling, strength training and rowing, the demands of skiing on the knees are such that I need to rethink my approach. I share this personal flow of conscience to provide guidance and council for readers of this blog. As for so many of us senior recreational participants, each activity has unique demands so we must anticipate each activity from a separate approach. While generalized fitness improves the quality of life and even well-being, maybe even prolonging life, if you want to ski with arthritic knees, now is the time to plan ahead.
Let me share with you my plan based on an observation of the outcomes in over 1500 patients in whom I have intervened with Cellular Orthopedic alternatives over the past five years. In the next several weeks, I will undergo a concentrated PRP intervention ultrasound guided into both of my knees. I will be using the upgraded methodologies for preparation of injectate and customize the PRP with our soon to be activated cell counter. This will provide me with a 20x dosage over that which has been available up until the present; and yes, I too have to pay for the methodology. I will then wait until mid-December, and if I am not satisfied, I will undergo a Bone Marrow Cell Concentrate procedure for both of my knees.
Below are two reasons received in the last 48 hours as to why I believe Cellular Orthopedic is exciting:
“My uber-condensed version, though, is that on almost all days in the last 8 months, I’ve had virtually no knee pain with daily activity. That’s a massive improvement from even the 12-month follow-up visit. I first started to suspect things were improving at about 10 months post-op. At 12 months, I was hopeful but still skeptical. At 14 months things, rapidly improved and have mainly remained there ever since. So, on the whole, I’m vastly improved. I suppose any number of factors could have contributed to that improvement, but Regenexx certainly seems to have helped tremendously.”
“Attended the company golf outing this past weekend. Last year I was concerned so I took an Advil before we started and ended up taking another halfway through the 18 holes. The last four holes I didn’t even leave the cart (to sore/tight to get in and out).
This year I fully intended to bring the Advil again but forgot it. Turned out I did not need it. Finished the 18 holes like nothing. Felt fine after and the next day.
Believe we can consider this a win!!!!”
Do you want to enjoy relief from arthritic symptoms and limitations?
Call 312 475 1893 to schedule a visit or visit my website to watch my webinar www.Ilcellulartherapy.com
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Knee Pain Relief, Orthopedics, treatment
Patients receiving either Hyaluronic Acid (HA- Synvisc, Supartz, Euflexxa) or Platelet Rich Plasma (PRP) injections will experience modest-term pain relief according to an article appearing in Orthopedics Today, August, 2017. In the study reviewed, Ultrasound Guided injections were given weekly for three weeks and patient-reported outcome measures (PROMS) were recorded for up to one year. “Both the PRP and HA groups demonstrated an improvement in PROMS at 24 weeks that declined to near baseline levels at one year” according to the article. “Patients with lower grade Osteoarthritis and lower weight responded more favorably to intra-articular injections”. The effect of both Hyaluronic Acid and Platelet Rich Plasma appeared to be modest and temporary.
Why I chose this topic this week for my Blog has to do with my preparation for the upcoming talks I am invited to give September 21st and 22nd in St. Petersburg, Russia at the meeting of 1200 orthopedic surgeons from Russia, Ukraine and neighboring countries both in Europe and Asia. As I indicated last week, this will be the first time a non-operative intervention of a cellular orthopedic, regenerative nature, as I practice, will have been introduced into this region of the world. While Hyaluronic Acid and Platelet Rich Plasma may offer short term pain diminution for individuals limited in function by the symptoms of Osteoarthritis, it becomes clear by scrutinizing my data base that not only does concentrated bone marrow afford long term relief, the Mesenchymal Stem Cells and Growth Factors found in bone marrow when concentrated participate in regenerative possibility thereby delaying and perhaps even avoiding a joint replacement. My presentations will be evidence based without the false news and unsupported marketing claims ever present in the media.
What we have learned about Amniotic Fluid (AF) from my role as principal investigator in several multisite studies is that AF does have concentrated Hyaluronic Acid and therein may offer six to 12 months decrease in symptoms and increase in function, the effect is limited in duration; and with no viable stem cells in Amniotic Fluid Concentrate, there is no regenerative potential. Owing to the absence of inherent absence of stem cells and hence regenerative potential, I will not include amniotic fluid in my presentations.
As a scientific invitee, my responsibility is to introduce that for which we have scientific support and clinical evidence. If you want to gain a better understanding of Regenerative Medicine and Cellular Orthopedic and learn how you may postpone or perhaps avoid a joint replacement for the symptoms and limitations imposed by osteoarthritis, make an appointment, visit my web site and watch my webinar.
Tags: arthritis, hyaluronic acid, Interventional Orthopedics, Knee Pain Relief, Orthopedics, Osteoarthritis, PRP, Regenerative, stem cells