Feb 6, 2014
There are several reasons behind the subject matter of this Blog. First, recent scientific studies have indicated that 2% of patients who have a joint replacement will have undergone a corrective revision within the first three years. Two percent isn’t a large number until it affects you. Approximately 20% of knee replacement recipients have significant pain and another 30 % fail to regain the desired motion confirming an earlier Canadian study in addition to those who fail outright at three years or less. Lastly, clinical studies at Regenexx have documented an average 15-point pain score improvement following a second stem cell intervention. Assume if you will that 100 points indicate a patient is pain free and prior to the Bone Marrow Aspirate Concentrate procedure, that patient had a score of 60. The average improvement after a stem cell procedure is to about 80 points. If you assume an additional 15 points will be gained by the second stem cell intervention, you will understand why I am writing this Blog.
We in the Regenerative Medicine world have been waiting a ruling by the DC Circuit Court regarding stem cell expansion and manipulation. The FDA allows Stem Cell intervention as long as those cells are not cultured or manipulated with external adjuncts. That is why we follow the Same Day Procedure in its present format. The Regenexx algorithm is FDA compliant. On February 5th, The DC Circuit sided with the FDA regarding stem cell culturing and manipulation with external agents. If you go stem cell “surfing” on the web, watch out for those sites marketing stem cell expansion and use of Adipose Derived Stem cells (SVF). I expect the FDA to go after several new SVF clinic networks within the year.
Meanwhile let’s return to the issue of a second stem cell intervention. If we can’t culture, we certainly may repeat. The Regenexx Data clearly support an average 15-point increase in a patient’s pain score when that second intervention is completed within a year of the index procedure. As many of my patients have experienced, to date, I have offered a booster PRP injection within three to six months when that patient wants more from the Same Day Stem cell undertaking. My approach has been helpful; although as of this time, I don’t know to what degree and for how long? For those contemplating a Bone Marrow Aspirate Concentrate minimally invasive treatment of an arthritic joint, be aware that there is now a way to predictably improve the ultimate outcome at 18 months with a second Stem Cell procedure.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, FDA, Mature Athlete, Microfracture surgery, Platelet Rich Plasma, Regenerative Pain Center, Regenexx, stem cells
Dec 10, 2013
That’s what we are trying to achieve and it has been successful in over 85% of the patients I have treated since June of 2012 when I joined the Regenexx network. As readers of this Blog have learned, I undertook the sojourn into Cellular Orthopedics after having enjoyed a 40-year surgical career centered on Adult Reconstructive Orthopedic Surgery (Joint Replacements). As I reached the milestones where I had achieved my goals in surgery, I recognized an opportunity to take on a new challenge; avoiding, certainly postponing the need for a joint replacement by embracing a new world of Regenerative Medicine. Basic science researchers had identified the pain relieving, joint restoration and chondrogenic possibilities of the adult mesenchymal stem cells readily available in bone marrow. As I had played a role in pioneering cementless hip and knee replacements in the 1970s, I decided to take on the challenge of advancing the care of the aging athlete with those stem cells.
In looking back over the past 18 months, I have played a very active role in not only developing a very gratifying clinical presence in the world of Regenerative Orthopedics, I have contributed significantly to the Regenexx initiative in clinical research. The reason for reflection is two recent scientific articles that underscore the appropriateness of my decision-making. Three weeks ago, an article was published by Norwegian Orthopedic Surgeons describing their success in postponing hip replacements by five years in more than 50% of patients who would have probably undergone a hip replacement had they lived in America. More significantly though is the article published earlier this month documenting all the potential of cellular orthopedics in a laboratory setting. What is significant about the paper is not the restatement of what we already know but rather the authors themselves. As I have suggested to you in the past, the orthopedic surgical community has been totally opposed my notion of helping a patient postpone, perhaps avoid a joint replacement by stem cell intervention. A co-author of the scientific endeavor describing all the virtues of cellular orthopedics juts happens to be one of the previous nay- sayers. Certainly there have been several patients who have not responded long term to my clinical attempts at avoiding a joint replacement. It turns out that the four patients had advanced arthritis of the hip when I undertook their care. Regenexx and I are busy this week trying to better identify those arthritic hip joint candidates where in stem cells would not be of benefit, by statistically analyzing our hip outcomes database. What makes our Regenerative Cellular Orthopedic clinical practice different is the fact that I have incorporated the same integration of Clinical Research and Clinical Practice in my Cellular Orthopedic endeavors as I did when serving as Director of the Joint Replacement Program at Rush for many years. Ours is not just a procedure; it is a dynamic integration of outcomes observation and clinical advances.
Tags: arthritis, cellular orthopedics, Hip Replacement, joint replacement, Knee, Mature Athlete, Osteoarthritis, stem cells, treatment
Mar 26, 2013
PRP and Stem Cells: More advances in the care of the aging athletes
How Might I Need Stem Cells in 2013
PRP / Platelet Rich Plasma for Hamstring Injuries
PRP can be used in proximal hamstring injuries, which are common in athletes and frequently result in prolonged rehabilitation, time missed from play, and a significant risk of re-injury. For example, reports of acute hamstring strains in dancers have suggested recovery times ranging from 30 to 76 weeks. The Physical Examination is compatible with tenderness on palpation localized to the buttocks, and aggravated by resisted knee flexion. The hamstring strength is reduced while sensory and vascular examination is normal. Radiographs are “normal” and the MRI is diagnostic. Treatment consists of placing the patient prone, scrubbing and prepping the area of tenderness, and injecting Platelet Rich Plasma directly into the area of tenderness. A two-week period of relative rest is recommended. At week three, the patient is allowed to gradually resume full activities over eight weeks. The MRI usually demonstrates healing after four months.
Platelet Rich Plasma for Plantar Fasciitis
The customary explanation describes plantar fasciitis as being due to repeated micro-trauma associated with over use. Yet there are a significant number of patients who don’t respond to strengthening/stretching, orthotics, anti- inflammatories and corticosteroid injections. The injection of Platelet Rich Plasma into recalcitrant, symptomatic plantar fasciitis has been shown to cause a reparative effect leading to resolution of symptoms in six weeks or less after months of pain and suffering from the entity.
PRP for Partial rupture of the Achilles Tendon or Posterior Tibial Tendon
The patient will present with either heel pain or pain on the inner aspect of the mid-foot and a loss of the arch. Rest of the part, anti-inflammatories and a heel lift or arch support relieves symptoms in 50% of cases. On physical examination, the concerned tendon is quite tender to palpation. An ultrasound evaluation indicates partial rupture of the tendon. Platelet Rich Plasma matrix has a high probability of complete resolution of symptoms as well as tendon repair when followed by ultrasound
PRP for Symptomatic Rotator Cuff Tendinopathy and Partial Rupture
Ultrasound guided injection of an autologous preparation rich in growth factors within the injured muscle or tendon enhances healing and functional recovery. This relatively simple procedure is recommended to patients considering surgery for partial rotator cuff tears and in patients who are not surgical candidates due to medical co-morbidities
Stem Cells for Patellar Tendinitis and Jumper’s Knee
As in Achilles Tendinitis, the patellar tendon and the tendons above the knee may be rendered asymptomatic with healing enhanced by administration of growth factors via Stem Cells. Might Stem Cells be used to treat a bad patellar tendon problem? A recently published paper out of The Hospital for Special Surgery suggests they can.
“Keep going my friend”
Tags: Achilles Tendon, athletes, hamstring inuries, Interventional Orthopedics, Mature Athlete, Patellar Tendinitis, Plantar Fasciitis, Rotator cuff, stem cells
Dec 4, 2012
Athletics following a Total Joint Replacement is a controversial topic within the orthopedic community and varies by region and comfort level of the orthopedic surgeon. The scientific literature on the subject is quite limited. Returning to exercise after a joint replacement does not necessarily imply a return to sports. The predictors of whether a patient will return to sports after a joint replacement were the subject of an article appearing in Clinical Orthopedics and Related Research by Williams et al., in 2012:Prior high level participation in a given sport 2) Male gender, 3) Low BMI, 4) Under 50 years of age. Be informed that return to sports after a TJR may not be feasible.
Stem Cells and Joint Replacement in Sports Medicine
In a recent study, of a population that underwent a Total Joint Replacement, only 32% were active after five years. Recipients of hip prostheses were twice as active as those who had undergone a knee replacement. The limits of our knowledge in part are based on the absence of a joint replacement registry in the United States. As a result, we are dependent on New Zealand, Australia, the United Kingdom and Scandinavia for our data. Basically, your participation in sports after a total joint replacement is at your own risk. What is that risk? A revision surgery in less than five years; one out of every 75 total knee replacements undergoes revision in 3 years.
Turning our attention to sports after Bone Marrow Aspiration Concentrate for an arthritic joint, there is no available scientific data to allow for generalizations. It is just too soon. The other problem is that I am one of the few orthopedic surgeons involved in Regenerative Medicine and the Anesthesiologists and Physiatrists who pioneered this modern approach to the non-operative care of arthritis do not use the same outcome criteria as that used in orthopedic surgery. Theirs is of a subjective measurement while ours is both subjective and objective. The net result is that, while I am gathering data on the patients I treat, at this time the best I can do is anecdote. In each and every Blog, I strive to feature the outcomes of my patients. You may read about those outcomes in my Blog Archives; but let me leave you with several observations drawn from my database to date as well as the findings of a scientific study in which I was the senior author:
1) The best outcomes for BMAC (Stem Cells) in arthritis have been seen in patients with class two to three arthritis and those with a low BMI
2) Studies including Knee Joint Biomechanics During Cycling in Patients with Total Knee Arthroplasty indicate the best sport and fitness routine for hip and knee osteoarthritis whether pretreatment, treatment with BMAC or a TJR is cycling
3) Swimming works as well (personal observation)
Tags: Mature Athlete, Orthopedic Care
