Nov 30, 2015
The title of the Blog this week is taken from a review article appearing this month in The Journal of Osteoarthritis and Cartilage focused on reviewing the state of the art and perspectives, authored in Montpellier, France. As I have indicating over the past several months, the original regenerative medicine concept had been that we would take your bone marrow via aspiration, concentrate it in our laboratory and inject the concentrate into an arthritic knee thereby introducing adult mesenchymal stem cells. The belief had been that those stem cells would morph into cartilage. Now we know there is a lot more happening in the joint following the introduction of bone marrow aspirate concentrate/stem cells.
We know that Osteoarthritis is the most common form of arthritis mainly characterized by the degradation of articular cartilage and associated with subchondral bone lesions. Whereas I had spent the vast majority of my orthopedic career on joint replacement for grade 4 osteoarthritis, over the past four years, I have focused my initiative on cell based interventions for stages two and three arthritis; although next month, I am introducing a novel cell-based therapy for grade 4 osteoarthritis of the hip and knee. Stromal Cells (MSCs) have gained much interest on their trophic and immunomodulatory functions that can help tissue repair/regeneration. The review article from France focuses on the anti-inflammatory effect of Mesenchymal Stem cells on Mitochondrial RNA modulation in OA. With continued cellular science advances, the notion that stem cell management of your arthritic knee and hip still is in the future is erroneous. Four years ago, there may have been some basis for your physician to minimize the possibilities of interventional orthopedic in lieu of a joint replacement because there wasn’t enough clinical proof of efficacy; and, the understanding was that the MSCs would morph into cartilage. As a result of our continued data collection coupled with better understanding of the anti-inflammatory effect of bone marrow aspirate concentrate, there is every reason for an arthritic patient to attempt to avoid a joint replacement.
This past weekend, we had every reason to give thanks and I am no different. I give thanks to my family, to my health, and to my profession for allowing me to help my patients enjoy a pain free active lifestyle. To learn about our non-operative approach to reversing the pain and limitations of arthritis, call to see if you are a candidate or to schedule an appointment. 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
Nov 23, 2015
The holiday season is here and along with it, the customary retrospectives and predictions. Here in Chicago, we could look back at the weather a week ago or look forward to the opening of the Western ski resorts and the new opening date of trout fishing in Wisconsin’s Driftless area on January 2nd. For those who want to cycle through the winter, the choice is spin class or the new world of winter friendly bikes. Whatever your interest, be it indoors or outdoors, you need not be limited by arthritis. The new world of Regenerative Medicine and Interventional Orthopedics offers pain relief, improved function, better motion and a maintenance or return to an active life style. Vail opened on November 20, and my wife and I will soon be there for a tune up. Over the Thanksgiving weekend, I will be shopping for the winterized bike and we are scheduling a fly fishing outing to Wisconsin sometime during the first two weeks in January. While it seems strange to think of trout fishing in the winter, the notion of a reason for a snowshoe hike is new and stimulating.
Last week, along with the follow-ups and new patients, two individuals exemplify what Bone Marrow Aspirate Concentrate/ Stem Cell interventions make possible. A 67 year old man with an osteoarthritic knee works in heating and air conditioning; wherein as part of his job description, he climbs ladders while occasionally squatting and kneeling. While he plans to retire at age 70, he doesn’t want to take on the risk of a knee replacement adverse outcome now nor does he want to take up to three months post operative for rehabilitation. After my evaluation and review of images, he elected to schedule an Orthopedic Cellular intervention with the plan to return to a minimum demand work profile for four to six weeks following the intervention; but only one week away from work. The patient is aware he may still come to a joint replacement; but if he does, it would be well after retirement.
The second patient was a 70 year old man, who had been scheduled for a shoulder replacement and a hip replacement. The appointment was really for his wife; but while he was in the office, after hearing my informed consent for his wife’s knee; he requested my input after examining him and reviewing the fact that he didn’t want to lose a winter of skiing. When all was said and done, he scheduled a Bone Marrow Aspirate Concentrate/ Stem Cell intervention to his shoulder and hip, cancelled his hip and shoulder replacements, and booked his winter travel to Beaver Creek.
The above are examples of what is possible with Interventional Orthopedics. Before closing with a customary wish for a Happy Thanksgiving, let me share how I have been regenerated by a knee intervention. In anticipation of a full house over the holidays, I spent three hours, Saturday afternoon on my hands and knees scrubbing the kitchen floor with a microfiber cloth and a 10% solution of vinegar.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, shoulder, stem cells, treatment
Nov 16, 2015
And Let us say Amen. You may not have noticed, but last Thursday, the weekly Blog I write was not posted; because I was off for a week with my two sons fishing the flats of Ascension Bay along the eastern cost of Mexico. While I practice Regenerative Medicine and Interventional Orthopedics, I am very much aware that accompanying the notion of physical well being is spiritual well being. Every year at this time I repeat the “pilgrimage” because just as the spiritual reminds us, your knee joint is connected to your thigh bone and your hip joint is connected to your back, so too is your body connected to your mind. Regeneration and Renewal are like love and marriage; you can’t have one without the other.
I am reminded of the patient I treated two years ago with a bone marrow aspirate concentrate intervention for his arthritic knees. At the time of his first office consultation, though he only lived six blocks from my office; because he couldn’t walk that far, he took a cab. Six weeks later, he returned for follow-up and complained about his ongoing pain and his disappointment in the outcome although in preparation for the procedure, I had informed him it might take up to 18 months to reach maximum medical improvement. When I inquired as to his mode of transportation to my office, he responded that he had walked. Physically, he was enjoying an excellent outcome but spiritually, he needed renewal as well.
As I look at the storefronts in my neighborhood and in downtown Chicago, I am reminded that the holidays are not far away. As I look at the weather forecast, I see that a high of 32 degrees is forecast for November 23 and my thoughts turn to skiing and your hips and knees. What Regenexx does is renew your hips and knees for the outdoors or indoors, holidays and more. If you want a renewal of spirit, try living without pain and increasing your functional capacity. We can make this happen with our Bone Marrow Aspirate Concentrate/ Stem Cell interventions. This morning, a patient contacted me via e-mail to tell me about his friend who before age 55, is on his third hip replacement at the same joint. While my patient has not been totally relieved of his hip pain by my BMAC intervention, he play golf and is fully active whereas his buddy, after a third hip replacement, lives a painful, inactive life dependent on a cane. When coping with the limitations of arthritis, give the opportunity for renewal of body leading to renewal of spirit some thought and then give me a call for an appointment: 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Nov 5, 2015
My last Blog brought you greetings and discussed some of the issues reviewed at the first meeting of the Interventional Orthopedic Foundation. This not for profit foundation was founded to help facilitate the transfer of scientific regenerative medicine developments into clinical practice. One challenge is how to improve the outcomes of what is now the gold standard of Interventional Orthopedics, Bone Marrow Aspirate Concentrate in managing arthritis of major joints. We seek to see longer effect and better results. While there are all kinds of claims being made for amniotic fluid concentrate and adipose (fat) derived stem cells, as of now, there is no data to support said claims.
I have played a large role in documenting the success of Bone Marrow Concentrate intervention for arthritis. Now I want to see if I can improve those results. At the Interventional Orthopedic Foundation meeting, various means of improving outcomes were discussed including, hyperbaric oxygen, ultrasound, lasers, ultraviolet light and finally, electro-stimulation. I was reminded of a study in which I was involved five years ago using an electronic pulse joined to a knee brace to try to regenerate cartilage. The study was based on animal models who when subjected to an electronic pulse grew cartilage. It occurred to me that the answer to improving the quantity and the quality of a Bone Marrow Aspirate Concentrate/ Stem cell intervention for an arthritic knee might be the pulsed brace. If every patient who undergoes a stem cell intervention for arthritis is prescribed a brace post treatment, since we know that the pulse is safe and potentially helpful, why not add the pulse to the post intervention protocol. To that end, I am happy to announce the introduction of this methodology to our post intervention protocol via a clinical trial starting in December
We will follow each patient for up to a year with our standard clinical objective and subjective means and periodic X-Rays with no added fiscal burden to the patient. The results of this study will then be presented to the 2016 meeting of the Interventional Orthopedic Foundation as I continue to integrate patient care with research. There is no question that patients who wore the brace and used the pulse for arthritis without stem cell intervention in the past were improved; imagine the potential leap forward by adding the pulse to the brace after a Bone marrow Aspirate Concentrate/ Stem Cell intervention.
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Pilot Study, Regenerative, Regenerative Pain Center, Regenexx, Regenexx-SD, stem cells, treatment
Oct 29, 2015
In spite of what a patient may be told by the physician and what salesmen tell the doctors, research by the Interventional Orthopedics Foundation laboratories found no viable stem cells in Amniotic Fluid Concentrate once shock thawed. While there may have been living stem cells in amniotic fluid when harvested, part of the commercial preparation and storage requires freezing. Once shipped for clinical use, the preparation is quickly thawed (shock thawing) as required for injection. While a slow thaw over 24 to 48 hours will preserve stem cells, shock thawing kills cells although the hyaluronic acid content and the Cytokine/Growth Factor content is maintained. The net conclusion is that Amniotic Fluid Concentrate may be beneficial as a symptom altering intervention but with no regenerative potential.
Analysis of the available enzymatic means of liberating stem cells from fat is a violation of FDA restrictions. The Interventional Orthopedics Foundation has been aware of the increasing claims that adipose derived stem cells are superior to Bone Marrow Aspirate Concentrate derived stem cells in various orthopedic conditions. As such, the Foundation studied the law and the proprietary claims. The conclusions reached are that there is no scientific data or publications to support the claims of superior outcomes of fat over bone marrow and the use of the enzyme, collagenase to liberate the stem cell from the adipose tissue is violation of FDA guidelines. By the same token, the introduction of a mechanical means to liberate biologically active molecules from fat may fall within FDA guidelines but the impact in arthritis has yet to be clinically documented.
No consensus has yet been reached regarding the substitution of Amniotic Fluid Concentrate for hyaluronic acid in relieving the symptoms of degenerative arthritis. The necessary clinical evidence to support a change in skeletal muscular practice guidelines is still being collected. As of January 1, 2016, I will be participating in that latter initiative in my interventional orthopedic practice. The Interventional Orthopedics Foundation also recognizes the absence of a scientific based means of helping a patient delay or even avoid a joint replacement for advanced arthritis. What we are able to do now and for which we have supporting data is to successfully intervene in Grades two and three osteoarthritis. Beginning in December, I will be initiating a clinical trial that is designed to meet the challenge in advanced arthritis but we will not have statistical evidence of a successful outcome for some time.
If you want more information regarding proven methods using Interventional Orthopedics for delaying or even avoiding a joint replacement in Grades 2 and 3 arthritis or what may be possible for advanced osteoarthritis to avoid a joint replacement, schedule your consultation at 847 390 7666. For those patients who have been told they have too serious a co-morbidity to allow for a joint replacement, let us try to help you as well using needle instead of a scalpel.
Tags: Amniotic, arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, FDA, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Pilot Study, Regenerative, Regenexx, stem cells, technology, treatment
