Mar 6, 2017
Blog: Dr. Sheinkop , let’s pick up where we ended at the last interview. You were going to tell us about the hip labrum?
Sheinkop: Recently, there has been an increased frequency of diagnosis pertaining to an acetabular labral tear when a patient presents to a physician with groin pain. The cause may be attributed to trauma or it may be spontaneous in nature. While only an orthopedic surgeon really understands how to properly examine the hip joint, I am observing the next step in every and all patients with “hip” or “groin” pain is an MRI prescription. While a torn acetabular labrum is best diagnosed on the MRI after arthrogram, even that exercise may not result in a proper diagnosis. There are anatomic variants that are frequently mistakenly diagnosed as a tear and there are positive findings for a labral tear that when surgically addressed do not result in clinical improvement. In general, unless there are mechanical signs such as snapping, clunking or giving way, pain alone is not justification for arthroscopic hip surgery. In the presence of arthritis, arthroscopy is almost never indicated in the new world of evidence based medicine.
Blog: If I am not mistaken, the way you responded to the labral question is how you have responded in the past to a “positive” MRI of the knee and a diagnosis of a torn meniscus (cartilage).
Sheinkop: You are correct. The scientific evidence clearly identifies the fact that a pain generator must be identified before a surgical procedure. Even if the MRI is compatible with a torn labrum or meniscus, in the presence of arthritis, arthroscopic surgery will make things worse over six months. Surgery in said circumstances should be reserved for mechanical symptoms and not pain.
Blog: Then what is a patient with pain in the groin or knee to do?
Sheinkop: First and foremost, my job is to identify the cause of the pain and treat the patient, not the image. In the absence of clunking, snapping and giving way (joint instability), Interventional Orthopedics based on Platelet Rich Plasma and Bone Marrow Aspirate derived stem cells and growth factors provide the surgical alternative-remember the needle and not the knife.
Blog: I learned this week that you have been invited to St. Petersburg, Russia, this September to present non surgical alternatives for arthritis, at an international orthopedic meeting focused on joint replacement.
Sheinkop: Your information is correct. The role for Interventional and Cellular orthopedics, basically regenerative medicine, is in grades two and three osteoarthritis; while a patient is quite functional and not yet sufficiently impaired to justify the risks inherent in a joint replacement. On the other hand, there is a large patient population with advanced osteoarthritis of a major joint wherein the joint replacement option is to great a medical challenge and may risk survival. The evidence I have gathered over almost five years is not only of interest in the United States but has global potential impact.
To learn more call (312) 475-1893 to schedule a consultation
View my web site at www.sheinkopmd.com
Watch my webinar at www.ilcellulartherapy.com
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, hip surgery, joint replacement, knee surgery, Orthopedic Surgeon, Pain Management, Platelet Rich Plasma, stem cell treatment, torn labrum, torn meniscus
Nov 21, 2016
The current marketing of amniotic fluid as a regenerative approach to arthritis based on delivery of
viable stem cells falls is no different than the bending of the truth behavior we recently experienced
in the run up to the presidential election. Did the campaigns of the candidates reinforce some
notion that facts don’t necessarily matter? It seems that every office session, a patient shares with
me their having accepted a free lunch in exchange for the promise that for $7,000 to $9,000,
Amniotic Fluid containing living stem cells may be injected into an arthritic joint to regenerate that
joint.
During my entire 40-year plus orthopedic surgical and now regenerative medicine career, I never
accepted a free lunch from the army of pharmaceutical and orthopedic sales personnel who show
up daily as these gifts are contrary to corporate compliance requirements; and obligate me to listen
to sales pitches, Medical decisions must be based on evidence based medicine. At this time, there is
no scientific evidence of living stem cells in amniotic fluid once that fluid has been harvested,
sterilized, fast frozen for storage and fast thawed when used.
Before going any further, I will make it clear that, when indicated, I use amniotic fluid in my practice; but I also will make it clear, not as a source of stem cells or regeneration. Amniotic Fluid contains 15
times more hyaluronic acid than any available drug; hyaluronic acid is marketed under many trade
names starting with SynVisc. When I believe a patient with an arthritic joint might benefit from
hyaluronic acid, the best methodology is amniotic fluid. As well, the latter may contain viable
growth factors that play a role in controlling the limitations imposed by arthritis. At issue is the
question as to whether it is worth $7,000 to $9,000 for “generic” hyaluronic acid; when in fact, in a
proprietary form is covered by health insurance and Medicare?
There is another alternative if you are interested in Amniotic Fluid as a source of Hyaluronic Acid
and Growth Factors for which there is no charge to you if you meet the clinical trial inclusion
criteria. I am the principal investigator in a national amniotic fluid clinical trial underwritten by a
large pharmaceutical company that started working with amniotic fluid in 2006. Their focus now is
the use of amniotic fluid in the arthritic knee and determining dose and the duration of efficacy.
Facts do matter and the company is willing to underwrite the costs for gathering medical evidence.
To learn if you meet inclusion criteria, make an appointment at 312 475 1893
Tags: amniotic fluid, arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, hyaluronic acid, Knee, Orthopedic Surgeon, stem cells
Oct 20, 2016
Aging is known to contribute to a multitude of systemic changes including those of the musculoskeletal system leading to decreased health, mobility and function. Most changes in well-being are exacerbated by inactivity. It has been scientifically documented that physical activity and exercise may slow or even reverse these deleterious effects thereby improving health, mobility and function.
In particular, ligaments, tendons and joint capsules become stiffer with age as elastic fibers decrease and cross-links between collagen fibers increase. As connective tissue surrounding the joint changes, so too does the synovial fluid within the joint making movement more difficult. Not only do changes occur within the joint, they also occur in the muscles. The loss of muscle mass and strength also known as sarcopenia, increases with age. Then there is the fatty infiltration of muscle that comes with aging and lack of use.
Recognizing the value of Bone Marrow Concentrate derived Stem Cells, Cytokines and Growth Factors in dealing with his arthritic hip when the alternative was a joint replacement, seven months ago, a 58-year-old man underwent a cellular orthopedic intervention. Over the past many months, the patient committed himself to a minimum of 30 minutes a day, five days a week at moderate intensity aerobic exercise alternating with three days a week at vigorous intensity. In addition, he partook in resistance exercise a minimum of two days a week at a moderate high intensity focusing on 10 exercises at each session targeting most major muscle groups, with 10 to 15 repetitions for each exercise performed thus adding an additional 20 to 30 minutes to the commitment. Then there are the benefits of his additional flexibility and stretching. When this individual came to me at his first visit, his stated goals were to return to a high level of recreational enjoyment with a particular interest in ball room dancing. As of last week, he had reached those goals but he has no intention of failing to comply with his exercise prescription.
The obvious message of my Blog is to let you know I am unable to reach a desired goal without your commitment. I may introduce Stem Cells, Cytokines and Growth Factors into an arthritic joint but to reach your desired goal or delay or perhaps avoid a joint replacement, those many changes that occur with aging can be slowed and even reversed by a combination of cellular orthopedics and exercise.
If you want to learn about the evidence, schedule an appointment 312 475 1893
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Growth Factors, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, regenerative medicine, Regenexx, stem cells, treatment
Oct 15, 2016
Background: It is increasingly recognized that biochemical abnormalities of the joint precede radiographic abnormalities of post traumatic osteoarthritis (PTOA) by as much as decades. A growing body of evidence strongly suggests that the progression from anterior cruciate ligament (ACL) injury to PTOA is multifactorial, involving the interplay between biomechanical disturbances and biochemical homeostasis of articular cartilage.
Purpose: A randomized study using an acute ACL injury model were to (1) evaluate the natural progression of inflammatory and chondro-degenerative biomarkers, (2) evaluate the relationship between subjective reports of pain and inflammatory and chondro-degenerative biomarkers, and (3) determine if post injury knee drainage (arthrocentesis) and corticosteroid injection offer the ability to alter this biochemical cascade.
Study Design: Randomized controlled trial.
Methods: A total of 49 patients were randomized to 4 groups: group 1 (corticosteroid at 4 days after ACL injury, placebo injection of saline at 2 weeks), group 2 (placebo at 4 days after ACL injury, corticosteroid at 2 weeks), group 3 (corticosteroid at both time intervals), or a placebo group (saline injections at both time intervals). Patient-reported outcome measures and synovial biomarkers were collected at approximately 4 days, 11 days, and 5 weeks after injury. The change between the time points was assessed for all variables using statistical analysis, and the relationship between changes in outcome scores and biomarkers were assessed by calculating a commonly accepted mathematical analysis. Outcomes and biomarkers were also compared between the 4 groups using another statistical approach.
Results: No adverse events or infections were observed in any study patients. With the exception of matrix metalloproteinase 1 (MMP-1) and tumor necrosis factor–inducible gene 6 (TSG-6), chondro-degenerative markers worsened over the first 5 weeks while all patient-reported outcomes improved during this time, regardless of treatment group. Patient-reported outcomes did not differ between patients receiving corticosteroid injections and the placebo group. However, increases in C-telopeptide of type II collagen (CTX-II), associated with collagen type II breakdown, were significantly greater in the placebo group (1.32 ± 1.10 ng/mL) than in either of the groups that received the corticosteroid injection within the first several days after injury (group 1: 0.23 ± 0.27 ng/mL [P = .01]; group 3: 0.19 ± 0.34 ng/mL [P= .01]).
Conclusion: Post Traumatic Osteoarthritis begins at the time of injury and results early on in dramatic matrix changes in the knee. However, it is encouraging that early intervention with an anti-inflammatory agent was able to affect biomarkers of chondral degeneration. Should early intervention lead to meaningful changes in either the onset or severity of symptomatic PTOA, the current treatment paradigm for patients with ACL injury may have to be restructured to include early aspiration and intra-articular intervention.
This Blog is excerpted from a study appearing in the American Journal of Sports Medicine. My message, should you experience a significant joint injury, don’t wait until arthritic related symptoms appear, the Cellular Orthopedic intervention should take place within weeks; not years.
312-475-4523 to learn more or schedule an appointment
Tags: ACL Injury, ACL tear, arthritis, athletes, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, corticosteriod injection, Interventional Orthopedics, Knee, knee injury, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon
Oct 6, 2016
“Growth factor, any of a group of proteins that stimulate the growth of specific tissues. Growth factors play an important role I promoting cellular differentiation and cell division,” and they occur in bone marrow as well as your circulating blood.
“When investigators began studying the effects of biological substances on cells and tissues in culture, they discovered a group of peptide-hormone-like substances that were distinct from any previously known hormones. Because these substances were active in stimulating the growth of cells and tissues, they were called growth factors. Some growth factors are similar to hormones in that they can be secreted into the blood stream, which carries them to their target tissues. However, whereas the production of hormones is limited to glandular tissue, growth factors can be produced by many different types of tissue” and cells for that matter.
When a patient presents for a Bone Marrow Concentrate procedure for an arthritic joint in order to prevent, perhaps even avoid a joint replacement, the understanding to date is that it will be Mesenchymal Stem Cell that will serve as the key factor in reducing pain, increasing motion, improving function and influencing the progression of arthritis. The latter is only partially true but fails to address the role Growth Factors play in Cellular Orthopedics (Regenerative Medicine). When your orthopedic surgeon tells you that Stem Cells won’t work for your arthritis, schedule your joint replacement, that physician doesn’t understand that Stem cells are only part of what Bone Marrow concentrate provides us in assisting the patient with an arthritic joint, return to an active life style without surgery.
We now have several proprietary means of not only concentrating adult Mesenchymal Stem Cells but Growth Factors as well when addressing your arthritic joint with Bone Marrow Concentrate. While stem cells may be impacted by age, Growth Factors do not seem to be adversely impacted accounting for several recent successes with patients in their 90s. Since we have been concentrating stem cells with growth factors and combining the approach to the joint with subchondroplasty, we continue to document improving outcomes
Tags: arthritic pain, arthritis, arthritis treatment, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Growth Factors, Hip Replacement, joint replacement, Mesenchymal Stem Cell, Orthopedic Surgeon, Osteoarthritis, regenerative medicine, Regenerative Pain Center, stem cell treatment
