Aug 13, 2015
You have presented with a painful joint and imaging is compatible with an arthritic process and/or a bone marrow lesion (contusion/bruise). Bone supports the joint and when damaged either by injury or as part of the arthritic process, contributes to pain and the progression of arthritis. The bone marrow lesion is seen on the MRI while the change of bone, subchondral sclerosis, is seen on the routine X-ray.
Patients with Bone Marrow Lesions are known to have increased pain, less function, faster joint cartilage destruction and reduced benefits from present forms of intervention. By addressing not only the arthritis but the bone surrounding the joint, it is anticipated that the results of intervention for the arthritic or injured joint will be markedly improved.
Subchondroplasty is a minimally invasive procedure targeting and treating subchondral defects that is the altered bone adjacent to and responsible for supporting the joint. During the treatment phase of injecting Bone Marrow Aspirate Concentrate for the arthritic joint, the subchondroplasty adjunct is completed under the fluoroscope. In conjunction with delivering the BMAC into the joint itself, additional Bone Marrow Aspirate Concentrate is placed into the surrounding bone through small drill holes created with a special canula. Up until now, the subchondroplasty drill holes were filled with a synthetic substance manufactured from Calcium Phosphate. The theory was that the Calcium Phosphate granules when placed into the bone defect would eventually be resorbed and replaced by bone. Using Bone Marrow Aspirate Concentrate is a much more physiologic stimulus for effecting bone healing in a much shorter time and by a means that more closely approximates bone healing after injury.
Our goal is to assist the patient in delaying or possibly avoiding a joint replacement through Regenerative Medicine (Cellular Orthopedic) approaches. The Bone Marrow Aspirate Concentrate intervention has proven extremely successful in meeting those goals. The introduction of Subchondroplasty will allow us to offer the possibility of increasing the success rate and the longevity of effect in appropriate settings and in any joint; hip, knee, ankle or shoulder.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment, Ultrasound Guided Injection
Jun 29, 2015
As written a week ago, I attended a Regenerative Medicine International Conference in Las Vegas for the purpose of presenting a scientific paper that has generated a lot of interest and may influence how others practice Regenerative Medicine for arthritis. The meeting also served as a vehicle of continuing Cellular Orthopedic Education. The science of cellular biology is dynamic. It has been a major undertaking for me these past several years not only to have exchanged the scalpel for a trochar needle when managing arthritis but to reeducate in the basic science cellular biology.
Three years ago, the Adult Mesenchymal Stem Cell was thought of as a precursor cell directly responsible for replacing cartilage in the arthritic joint. The thought at the time was that the Stem Cell would take on the characteristics of whatever environment into which it happened to be placed and morph into that tissue or organ. In just three years, scientists have changed their thinking based on continuing research. The Mesenchymal Stem Cell (MSC) is no longer looked at as a progenitor but rather, a Medicinal Signaling Cell directing the body’s response to injury. When placed into a joint, it signals molecules and cells from the local environment and from distant locations to alter the bio-immune response of osteoarthritis, act as an anti-inflammatory, relieve pain, improve function and perhaps regenerate cartilage. We have also learned that while one Bone Marrow Aspirate Concentrate intervention causes improvement, several may be the answer over an 18 to 36 month period. In addition, there is increasing evidence that not only should the joint itself be addressed but the bone immediately adjacent to the joint as well. In the orthopedic community, Subchondroplasty has been applied over the past several years for the patient with a painful joint, relatively “normal” X-ray and an MRI compatible with bone marrow changes in the bone adjacent to the painful joint. That core decompression might be visualized as a dentist relieving the pain and pressure of a cavity by drilling. In the case of the dentist, the resultant void is filled with a synthetic material. In the case of the orthopedic surgeon, the cavity created by drilling is filled with calcium phosphate. At Regenexx Chicago, – my practice, I will introduce the subchondroplasty, a minimally invasive needling for the bone adjacent to the joint in addition to the joint itself filling the voids created in the bone as I fill the arthritic joint with Bone Marrow Aspirate Concentrate. The Europeans have documented success and I will be able to improve results and extend indications with Bone Marrow Aspirate Concentrate for the arthritic joint and now the surrounding bone.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Osteochondritis Dissecans, Pain Management, stem cells, treatment
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
Feb 5, 2013
The Leading Physicians of the World
THE INTERNATIONAL ASSOCIATION OF ORTHOPEDIC SURGEONS RECOGNIZES
Mitchell B. Sheinkop, M.D.
As a
LEADING PHYSICIAN OF THE WORLD
&
TOP ORTHOPEDIC SURGEON AND REGENERATIVE ORTHOPEDIC SPECIALIST
IN CHICAGO, ILLINOIS
How Might You Need Stem Cells in 2013
Advances in the care of the aging athlete
Leading the News
40 years ago this week, I started practice at Presbyterian-St Luke’s Hospital in Chicago and became Director of the Orthopedic Residency Training Program, Head of The Children’s Orthopedic Program, and Head of the Orthopedic Oncology Program at Rush University having been recruited from the University of Chicago Hospitals. In 1979, I became a member of the team of three that introduced the cementless hip prosthesis into clinical practice in America. After 38 years of surgery and after having authored or co-authored almost 100 scientific articles, I graduated into non-operative orthopedics. In 2012, the next milestone was my embracing Regenerative Medicine, stem cell intervention in order to assist a patient in possibly avoiding or postponing a joint replacement. So what of the future?
Because of the snowfall, I will be able to go snowshoe running in Lincoln Park this afternoon, as weather has resulted in most of my patients rescheduling their office encounters for today. I return to ski in Colorado later this month and I look forward to the opening of Wisconsin trout season on the first Saturday in March. Should the snow melt and the temperature hit 45 degrees, I will be out cycling along the lake. The secret is out and now you know my interest in the aging athlete. I want to keep on going; come on along, join me.
The posting this weekend in the Testimonial section of the Web Site www.sheinkopmd.com suggests what is possible with stem cells. While the remote future will be based on tissue and stem cell engineering, those trials are being developed; the immediate future is based on Concentrated Platelet Rich Plasma (C-SCP), Bone Marrow Aspirate Concentrate (BMAC) intraarticular interventions and subchondal plasty with BMAC. I described the latter for Bone Marrow lesions (BMLs) seen on MRI in my Blog last week. In order to provide a more comprehensive explanation of the ongoing development within the field of Cellular Orthopedics, I will be expanding and continually updating my web site. On Wednesday, there will be a site visit from Regenexx while I perform a Same Day (SD) Bone Marrow Aspirate Concentrated stem cell intervention in three patients including an arthritis of the hip candidate, an arthritis of the knee candidate and a carpal instability at the wrist candidate. In addition, there will be an ultrasound guided PRP injection of the ankle for a patient with a fracture at the ankle seven months ago presenting with a osteochondral fracture at the dome of the talus and a “High Ankle Sprain”.
The Blog next week will feature other stem cell orthopedic interventions that might be of interest in 2013. “Keep going my friend”.
Tags: arthritis, athletes, Knee, medicine, Microfracture surgery, Osteoarthritis, Regenerative Pain Center, Regenexx
Dec 26, 2012
Orthopedic Care of the Mature Athlete
Bone Marrow Aspirate Concentrate is increasingly shown to be a highly effective treatment in the Orthopedic care of the aging athlete. My experience since I started my Regenerative Medicine initiative when combined with the outcomes at Regenexx demonstrate that Stem Cell therapies will reduce pain and improve function among patients with Osteoarthritis and Avascular Necrosis. In stage 2 or 3 arthritis, the total joint replacement may be avoided; in stage 4 arthritis, the total joint may be postponed. It is becoming increasingly evident that the success of the Stem Cell therapies are based on a number of factors related to the patient (age, activity level, weight, use of tobacco and other medications and co-morbidities); the physician (training, technique and volume of procedures performed); the setting (implementation of standardized clinical care pathways, availability of dedicated staff, and volume of procedures performed); and the technology for stem cell procurement concentration, and quantization of the injectate.
A Stem Cell intervention should reduce the long term need for a total joint replacement or entirely eliminate that possibility. Historically, much emphasis has been placed on overcoming opposition to the concept of using ones own cells for elective treatment of arthritis. Much effort is now directed to evolution of better technologies. Regenexx has gone so far as to standardize methodologies in its affiliated network based on continuing research. As a result of that research, for those over 65, an alternative means of delivering stem cells and platelet rich plasma was introduced in 2012 and is proving remarkably successful in the short run.
The U.S health-care system is going through a period of unprecedented change and faces many challenges in the years ahead. Total joint replacements constitute the highest single procedural expense in the Medicare budget. A recent article in the Journal of Bone and Joint Surgery reviews strategies to improve patient outcomes after a total joint replacement and concludes that enhancements of implant longevity should be deemphasized. Because the end result of a failed joint replacement is a revision surgery with a less than satisfactory functional outcome, doesn’t it make sense for a patient to understand stem cell therapy of arthritis? In my Blog, I have emphasized the fact that as an orthopedic surgeon, I performed hip and knee replacements for 38 years. I look back at 2012 as my having found a way to offer my patient a joint replacement alternative. I begin 2013 with several clinical research initiatives, which I hope will extend the duration of a stem cell treatment for arthritis and improve the functional outcome.
Tags: athletes, Microfracture surgery, Osteoarthritis, stem cells, technology
