May 27, 2014
Last week, I performed Bone Marrow Aspirate Concentrate Stem Cell Interventions on two patients; one was 76 and the other 79. The outcomes research at Regenexx has shown that age is not an obstacle to a successful Mesenchymal Stem Cell procedure for postponing or avoiding a knee replacement. Both patients were healthy and wanted to remain active. Both patients met Body Mass Index requirements for inclusion in our clinical stem cell interventions; most important, the nucleated cell count in both patients exceeded 400 million. Nothing I have described guarantees success; but I have to pause and congratulate both patients for their respective attitudes and desire to not become victims of a particular age category.
Aging is something we can’t control but the aging process may be modified by diet and exercise. When injury or arthritis intervenes, the options are to succumb, undergo a joint replacement or possibly postpone or avoid a joint replacement with Cellular Orthopedic intervention (Bone Marrow Aspirate Concentrate containing your own stem cells). As I have indicated, in recent Blogs, the research at Regenexx suggests that it isn’t your birthday that influences a successful outcome but rather the number of nucleated cells found in your marrow, an indirect indicator of the number of Colony Forming Units (mesenchymal stem cells).
Last weekend we celebrated Memorial Day by giving pause to remember. I received my commission as a First Lieutenant in the United States Air Force on the sixth day of November, nineteen hundred and sixty-seven. Times have changed and we age but there is little reason not to try and stay active. Over the years when there were no alternatives, I sought to improve the quality of a patient’s life by replacing an arthritic hip or knee with a prosthesis. Now I myself have aged but believe that the higher you climb the more you can see. You are never too old to stay active. The outcomes data continually documents the patient satisfaction now up to five years at Regenexx with our own objective data base indicating, not only patient satisfaction, but return to or continuation of a high level of athletic activity and fitness participation following a cellular orthopedic intervention for a musculoskeletal injury or impairment from an arthritic joint.
Stay Active My Friend.
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee, Mature Athlete, Osteoarthritis, Regenerative Pain Center, stem cells
May 3, 2014
Much of what I write in this Blog is about the musculoskeletal care of the aging athlete. From time to time, I am reminded though that the arthritic changes in a joint may start before the usual aging process ensues. This week, I received an inquiry from a 23-year-old man as to whether he might be a candidate for stem cells based on advanced arthritic changes in his knee. An orthopedic surgeon had just told him that there was little alternative than a joint replacement in the foreseeable future.
Then came the following e-mail greeting from a patient in whom I had performed a stem cell right and left knee intervention about 18 months ago.
Hello Dr. Sheinkop,
While on my way to the health club today walking through the parking lot I marveled how wonderful my knees felt carrying me and my 20 lb. bag of equipment strapped on my shoulder. I felt I was walking a very natural gate with no sign of limp. Was it all in my head ? No way… I was with ” happy knees ” and I feel good.
Inside the health club I met an old friend that I have not seen since the first of the year he was still on crutches since last fall caused by an infection somewhere in his body that wound up on his needing a second knee replacement , the original he has had over ten years. In March he had his replacement. He told me about the surgery ordeal that he had undergone which resulted with a two hour knee replacement, and then an eight hour procedure with another surgeon to do tendon ” whatever”. He is still on crutches and a leg length brace…looking forward to June when he feels things will be better.
I remember him as a tall, massive muscular strong handsome man who was quite an athlete. His physical appearance today seems to be a shell of his former self…his whole body seems to atrophied….. I wish him the best.
We had met 18 months ago, and I discussed the Regennex procedure and my decision to go ahead with this…. I got the impression from him it was “hocus pocus” as he pounded his fist into his artificial knee and proclaimed “these are the best , they can last forever” !
R.R.
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, joint replacement, Knee, Mature Athlete, Osteoarthritis
Apr 29, 2014
We do not quit
Playing because
We grow old;
We grow
Old because
We quit playing.
– Oliver Wendell Holmes first half of 19th century
Last Monday, I took my first early morning, outdoor, cycling ride of the spring along the Chicago lakefront. It was a perfect morning and with so few on the bike path, I was able to let my mind wonder. I thought about this past Saturday and Sunday spent on the spring creeks of Wisconsin wading up a stream in search of the brown trout with a fly rod in hand. I thought about my on going training days in the health club where I run on the treadmill, row on the Concept 2 ergometer, and mix in some strength training. I thought about the several weeks of skiing this past winter in the fabulous powder I found in Colorado. Why the reminiscence? It’s my birthday this month.
That Oliver Wendell Holmes Sr. certainly got it right. Yet everyday I read about and listen to the diabetic epidemic in the world and the associated obesity, hypertension, renal failure, vascular dysfunction, etc., etc., etc. You don’t have to be a diabetic to be a victim of all the above. There is something though you can do about it: loose weight, get fit.
While there might or could be a congenital or inherited contribution to your arthritis, and while you may have sustained a trauma, the vast majority of arthritis in the hip and knee is either caused by or worsened because of the extra weight you carry.
My professional ethos is the Musculoskeletal care of the aging athlete. Your world is weight reduction and getting fit; my world is enabling you to improve your well being through Regenerative Medicine/ Cellular Orthopedics and I have professional company. The professional company is illustrated by an article published April 17: Growth Factor May Help Arthritic Knees. In the Swedish study, Fibroblast Growth Factor was used to stimulate cartilage repair in arthritic knees. A significant difference was found when compared with placebo when Sprifermin, an agent that specifically activates fibroblast-growth-factor-3 receptors in cartilage to promote chondrogenesis, cartilage matrix formation and cartilage repair was injected at high dose. While at 12 months, the cohort receiving Sprifermin didn’t show an increased joint space, when compared to the placebo group, they didn’t loose thickness.
We do more with our Bone Marrow Aspirate Concentrate stem cell intervention than inject one agent though our bone marrow derived Mesenchymal Stem cell preparation certainly contains the agent used in the Swedish study. The point, while stem cells may not regenerate the joint after a yet to be determined age, there is continuing evidence that the stem cells will alter the arthritic progression.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee, Mature Athlete, Regenerative Pain Center, stem cells
Apr 7, 2014
Total Knee Prosthetic sales rose almost 7% in the fourth quarter of 2013. When Wall Street analysts sought to find out why and asked physicians-73% of those surveyed reported that patient behavior had changed during the quarter; 35% attributed the changes in behavior to the Pull –Forward theory resulting from concerns about Obamacare. While it is very difficult to differentiate between aging demographics, seasonal variations, and an increase of those covered by insurance, or patient angst about health care changes; my question is what is the hurry? Before surgery, there are a large number of possibilities for Non-Arthroplasy treatment of Osteoarthritis of the Knee. I have reviewed those options and they are archived in my Blogs. Remember, once you have a total knee, the only salvage for dissatisfaction is a very life altering revision procedure. Last week, I focused on the reasons for early failure of a knee replacement (early is defined as two years). What has not been addressed is the life altering impact of revision knee prosthesis. While a surgeon might change the X-Ray at the time of the revision knee surgery; what are the chances of returning to the quality of life enjoyed with arthritis prior to the initial procedure two years earlier? “ Doctor, Can I have my arthritis back and the life I enjoyed prior to the knee replacement?” The latter is not an infrequent question that I have heard over my professional career.
Aging has normal physiologic effects and they affect sports for mature athletes. That aging also affects the activities of daily living of non-athletes. Basic Science principles now allow us to address age-related changes in bone, meniscus, articular cartilage, and the muscle tendon complex without surgery. What is the appropriate non-operative management of stages 2 and 3 arthritis owing to traumatic, degenerative and arthritic conditions? There is little question concerning a joint replacement for stage four debilitating arthritis when there is limited motion, instability and deformity. As well, there is an Appropriate Use Criteria to analyze the impact of arthroplasty and cartilage restoration/stem cell intervention. When there is no alternative, have a joint replacement; but failure results in a revision surgery at two years. There is an alternative for most; it is called Bone marrow Aspirate Concentrate/ Stem Cell intervention. The failure of such might lead to a primary joint replacement. To date, not one of my several hundred knee stem cell recipients have gone on to a knee replacement.
Tags: arthritis, bone marrow, Knee, Knee Pain Relief, Mature Athlete, Pain Management, Regenerative Pain Center, stem cells
Apr 2, 2014
Last week, an article appeared in the orthopedic peer reviewed literature reporting reasons for failure of Knee Replacement Prosthetic reconstruction within two years of the procedure. It is though such review and publications that we surgeons gain knowledge so as to offer the patient with arthritis, the most comprehensive informed consent. At the same time, it is only by reviewing our technology and surgical techniques that the surgeon is able to minimize unsatisfactory results and short lived outcomes. Understanding the cause of failure and type of revision knee arthroplasty procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in Knee Replacement surgery. The most common cause of revision surgery is infection followed by implant loosening. Next comes malpositioning of components and failure of soft tissue balance leading to pain and limited motion. Patellar instability was also identified as a reason for patient dissatisfaction leading to an early revision. The average length of hospital stay associated with a knee revision was 5.1 days; this does not take into account, the rehabilitation center stay or time lost from work. The average total charges were $57,600; again, this does not take into account the costs of rehabilitation, outpatient antibiotics and ongoing physical therapy.
As readers of this Blog are aware, I maintain a Data Base containing outcome measures for every patient I have treated since joining the Regenexx Network and the Cellular Orthopedic initiative 22 months ago using Bone Marrow Aspirated Concentrate derived Mesenchymal Stem Cells for the care and treatment of Grade two and three knee arthritis instead of a knee replacement procedure. Last July, I presented a comparison of patients one year following stem cell intervention for an arthritic knee with historical data for those who had undergone a knee replacement one-year prior. At one year after a procedure, the stem cell cohort had more functional outcomes than those patients who had undergone a knee replacement. The two populations studied had one thing in common, an arthritic, symptomatic, life-style altering arthritic knee. My interest was peeked by the scientific article published last week concerning why Total Knee Prostheses had failed at two years; so I decided to review the complications of stem cell interventions for an arthritic knee and report them here:
Nothing is listed because there are no adverse outcomes to report. To date, to the best of my knowledge, no stem cell recipient for an arthritic knee in my practice has undergone a knee replacement. That may not be the case after another year of follow-up; but there has not been an infection or reportable complication in 22 months. The only “revision” procedures I have had to perform were three patients with repeat stem cell interventions to achieve a higher outcome score and several patients who requested booster PRP between four and nine months. The rescue of a failed stem cell intervention is a primary knee replacement; but to date, none have been reported. For your arthritic knee, Total Knee Replacement or try Stem Cells first?
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Surgeon, Osteoarthritis, stem cells, Ultrasound Guided Injection
