For those unfamiliar with the designation, it is for the one who makes public pronouncements though I don’t dress elaborately by tradition nor do I carry a handbell saying “Oyez, oyez” (hear ye, hear ye)
“Twenty percent of knee replacement patients are not happy with their total knee replacements.” –Orthopedics, This Week Tuesday, June 12, 2018
“Arthroscopy for knee OA did not reduce or delay the need for a TKA” – Journal Arthroscopy. Sept 23, 9 2017
“Dr. Atul Gawande, a surgeon who was named this week to head the company being formed by Amazon, Berkshire Hathaway and JPMorgan Chase to trim employee healthcare costs, on Thursday cited surgery as the single biggest U.S. healthcare cost and said there are ways to both cut costs and improve patient care” “We need to act through data tracking … to see when treatments are benefiting and when they are not,” Gawande said. – Headline News Now June 25, 2018
There is an appropriate time and place for a joint replacement; a symptom such as pain in the knee should not be the solitary indication. Neither should every patient with a joint complaint be told by a surgeon “you have bone on bone and need a joint replacement”. My office evaluation before I make an evidence-based outcomes recommendation includes a history and physical before I look at the images. Joint range of motion is equally important as is the review of symptoms prior to reviewing your images for determining if I can help you postpone a joint replacement though my menu of Regenerative and joint Restoration alternatives or whether you should proceed to a total joint replacement. Please be reminded that before I evolved into my present approach to musculoskeletal afflictions, I was an orthopedic surgeon at a major medical center where I headed the joint replacement program for many years. Every patient who goes to a physician is not necessarily an automatic candidate for a procedure offered by that physician. Yesterday, I submitted an application for an FDA monitoring of one of our newest offerings and a good deal of the application was not only based on the scientific basis but the inclusion and exclusion criteria.
There is a time and place for doing something or doing nothing. To determine what is in your best interest, call for a consultation (312) 475-1893 or visit one of my two websites; www.sheinkopmd.com or www.Ilcellulartherapy.com
Tags: Arthroscopy, Dr. Atul Gawande, Headline News Now, joint pain, joint replacement, knee arthroscopy, knee pain, knee replacement, knee replacement failure, Orthopedic Surgeon, Orthopedics, Restoration alternatives
It came to pass over the last several weeks that I had contact with two separate patients; one in my office and one by e-mail inquiry. Both individuals had, prior to treatment, roughly the same levels of arthritic impairment. Both with grade three arthritic knees, were similar in age, weight, height and previous levels of activity. The e-mail contact presented with a history of having undergone a total knee replacement two years earlier. The outcome was a swollen, painful and stiff knee leading to a repeat surgery (revision) one year later. Because of persistent pain, swelling and stiffness, a recent knee aspiration had been completed leading to the diagnosis of an infection. The email inquirer indicated that his orthopedic surgeon and infectious disease consultant had recommended surgical removal of the prosthesis, placement of an antibiotic impregnated cement spacer for three months during which time a pic line would allow for a three-month continuum of intravenous antibiotics. There after assuming repeat cultures of the joint would be consistent with elimination of the infection as well confirmed by a normal Erythrocyte Sedimentation Rate, C-Reactive Protein and White Blood Cell Count, yet a fourth surgery would allow for another attempt with a Total Knee Prosthesis. All this assuming the infection had been eradicated. Space does not allow for the options if all of the above measures were to fail.
Turning our attention to the second patient who had undergone a Bone Marrow Concentrate/Stem cell intervention as contrasted to the surgical approach, he had recently returned from a second week of helicopter skiing. While it is true that he couldn’t ski eight hours a day for seven straight days, he had enjoyed a great week with friends and his daughter even if he had skied only two full days and four half days. This is his third consecutive year of helicopter skiing made possible by the Bone Marrow Concentrate/Stem Cell intervention he had undergone three and a half years ago.
Certainly, there is a time and place for a joint replacement; but the saga in my first paragraph reviews only some of the risks inherent in said surgery. On the other hand, a Cellular Orthopedic intervention in my experience carries a very minimal risk. In over seven hundred procedures in the last four and a half years, I have not found an infection. Certainly, every patient doesn’t go helicopter skiing after the procedure; our outcomes data clearly documents a return to or continuation of a very active lifestyle after a cellular procedure for an arthritic joint.
To schedule an appointment call (312) 475-1893
To visit my web site go to www.sheinkopmd.com
To watch my webinar visit www.ilcellulartherapy.com
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, knee arthritis, knee injury, knee pain, knee replacement, knee revision, Orthopedic Surgeon, Osteoarthritis, regenerative medicine
The FDA again held a meeting to address issues pertaining to Regenerative Medicine. At the conclusion of the meeting, an updated set of guidelines was developed for patient protection in the use of stem cells, growth factors, and platelet rich plasma. While still being interpreted by the Regenerative Medicine community, what becomes clear is the call for better self-regulation. It is not ethical or acceptable for anyone holding themselves out to be practicing cellular medicine to hold a seminar, recruit a patient, inject some substance into a joint and request payment. Equally important are the credentials of that practitioner.
For the past four and a half years, I have followed the outcomes of all my patients using the same subjective and objective parameters in my practice of Interventional Orthopedics that I used to follow the results during my joint replacement career. Over that 37-year span, because of my data collection initiative, many new generations of Hip and Knee Prostheses were introduced into adult reconstructive orthopedic surgery. Statistical analysis of data allows for progress in care and development of new product. Today, I still gather outcomes data for each patient. That initiative has led to refinement and advances in the emerging subspecialty of Regenerative Medicine; both in my own practice and around the globe.
Anticipating the future, I am headed off this upcoming weekend to join a small group of those looking to the future in advancing the practice of cellular medicine. Up until now, our data collection and Outcomes registry was clinical in nature; in a short time, that data will also include cellular data. This latter is the next way to refine the practice of regenerative medicine.
By having tighter control over the composition of autologous PRP and BMC preparations for use in my practice of regenerative medicine, through comprehensive analysis of autologous patient samples, I will have a chance to see what levels of important constituents like Stem Cells, Growth Factors, Platelets, RBCs, WBCs, and so on are present in the preparation.
How might I take advantage of the data? The most obvious use would be for me to record values of your sample analysis in a spreadsheet and enter in demographic and clinical outcomes data. I will continue to enter your results of outcomes assessments obtained during follow-up visits that I routinely use to monitor your recovery. By applying this strategy to all patients I treat, an internal database will inform me about optimization strategies for treating my patients, allowing me to modify and customize the make-up of that which will be injected. Why go to the trouble, you might be asking yourself? Having a detailed knowledge of what I am injecting into my patient puts me in a position to refine my practice of regenerative medicine. And that is a good thing, since you the patient ultimately will benefit from my optimizing the use of autologous materials like PRP and BMC.
To schedule your appointment call 312 475 1893
Tags: arthritis, BMC, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, knee replacement, Osteoarthritis, Pain Management, Platelet Rich Plasma, platelets, PRP, regenerative medicine, stem cells, Ultrasound Guided Injection
I recently received the yearly publication from the Orthopedic and Rheumatology Institute of the Cleveland Clinic; the latter recognized as one of the 10 most prestigious orthopedic centers in the nation. Every year the publication, a marketing exercise by the Cleveland Clinic, focuses on certain subspecialty areas within the discipline of the care and treatment of the musculoskeletal system. The obvious purpose of such a yearly event is to recruit referrals from practicing orthopedic surgeons and rheumatologists as well as the medical community in general.
This year the focus was on Adult Total Hip Arthroplasty for Osteoarthritis and Adult Unilateral Total Knee Arthroplasty for Osteoarthritis. I will summarize the results; let’s start with the hip:
“Hip-Related Pain 1 Year After Surgery: “on average, 92% of patients reported clinically important improvement in hip-related pain after 1 year, while 1% reported worsening (7% showed no detectable change in hip-related pain).”
“On average, 90% of patients reported a clinically important improvement in hip-related function after 1 year, while 1% reported worsening (9% showed no detectable change in hip-related function).”
The knee doesn’t fare as well:
“On average, 85% of patients reported a clinically important improvement in knee-related pain after 1 year, while 2% reported worsening (13% showed no detectable change in knee-related pain).”
“On average, 82% of patients reported a clinically important improvement in knee-related function after 1 year, while 2% reported worsening (16% showed no detectable change in knee-related function).”
The data was derived from patient self-reported scores collected during office visits up to 6 months before and 1 year after surgeries performed.
In my practice, every patient who undergoes a Bone Marrow Concentrate intervention is entered into an outcomes data base with both subjective and objective data points measured. It is quite comprehensive and numbers over 500 patients extending over a span now of 4 and ½ years. While the Cleveland Clinic report is based on subjective parameters and ours on both subjective and objective scores, I am able to extract subjective measures alone. I am pleased to report that in the case of the hip and the knee, our outcomes with a needle are equal to or better than those of the major surgery with a scalpel. Then factor in the prompt rehabilitation of a stem cell procedure compared with the prolonged rehabilitation inherent in a joint replacement. Lastly, consider the relative absence of complications of a stem cell intervention compared to the morbidity and mortality of a joint replacement.
Perhaps of greater significance to the stated advantage of a Bone Marrow Concentrate procedure for Osteoarthritis is the fact that no bridges are burned. If the patient is not satisfied at one year or five, a stem cell procedure may be repeated with a needle. If the arthritis progresses to an advanced stage, the fall back option is a joint replacement. The only choice following an unsatisfactory joint replacement is to accept the surgically induced impairment or undergo a risky revision surgery with a high likelihood of a complication or less than satisfactory outcome. Call 312 475 1893 to schedule an appointment today.
For more information watch my Regenerative Medicine Webinar Video
Tags: arthritis, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, joint replacement, knee replacement, Orthopedic Care, Orthopedics
Tags: joint replacement, knee replacement