Feb 4, 2017
Options for treating patients with osteoarthritis of their joints are historically limited to pain medication, anti-inflammatory medications, steroids, physical therapy, chiropractic care, or any combination thereof. These treatments provide temporary symptom relieving care, but do not offer therapeutic benefit in altering the degenerative disease progression. While pain medication, steroids and anti-inflammatories may help temporarily with pain management, they do not have a long-lasting impact on healing of articular cartilage in the arthritic joint. Without a regenerative therapy, the osteoarthritis will continue to progress, and ultimately will result in a total joint replacement as the only option to manage pain. While the majority of joint replacements have proven successful, there is an inherent complication risk; sufficiently significant enough that a patient prior to surgery might want to look for a means of postponing, perhaps avoiding a joint replacement. A treatment that might slow or even reverse the degenerative process. Four and a half years into my Cellular Orthopedic initiative, I believe the evidence I have compiled supports the use of the patient’s own concentrated bone marrow derived cells (BMC) in combination with the patient’s own concentrated Platelets and Plasma as an alternative to a major joint replacement.
Accomplished in a surgi-center under local anesthesia, an intra-articular injection, with image confirmation of needle and orthobiologic placement, is performed with Concentrated Bone Marrow mixed with concentrated Platelets and Plasma. Recently, based on publications in the scientific literature, I have added a subchondroplasty, that is an injection of some Bone Marrow Concentrate and Platelet Rich Plasma Concentrate into the bone adjacent to the joint. After six months of having introduced the subchondroplasty when indicated to the intra-articular injection, the presumptive evidence encourages me to continue the combined procedure. I started with the knee and I have extended subchondroplasty to the hip and shoulder.
When I began the combined procedure, that is injecting Bone Marrow Concentrate into the joint as well as into the bone adjacent to the joint, I limited the indication to patients under age 60. In August of 2016, a clinical paper was published reviewing the results of said interventions into patients older than 60; Total Knee Arthroplasty versus cell therapy in bilateral knee osteoarthritis in patients older than 85 years. Space doesn’t allow me to reproduce the entire article but in those patients who had a TKR on one side and a combined intervention into the knee and into the bone supporting the knee with Bone Marrow Concentrate, the majority of patients expressed a preference for the stem cell therapy.
To learn more or schedule an appointment, call (312) 475-1893
You may visit my blog posted on my website www.sheinkopmd.com
You may view my webinar at www.ilcellulartherapy.com
Tags: arthritic pain, arthritis, Bone Marrow Concentrate, Interventional Orthopedics, Osteoarthritis, stem cells
Dec 16, 2016
You no longer will even need a physician, and I have been wasting my Blog space crusading about quality assurance; making certain your Regenerative Medicine specialist is Board Certified and willing to provide outcomes data. According to a recent email I received, all one needs is “Online Training” to practice Regenerative Medicine:
If you believe this is FDA compliant, no longer does stem cell treatment need to be done by a highly trained, highly experienced specialist; you won’t even have to use a physician.“Everything gets commoditized, including training to do stuff” (personal communication).
I believe the most effective approach is to direct a patient with joint pain to my credentials—37.5 years of joint replacement experience, Board-certified, Emeritus Professor, four and a half years of Cellular Orthopedic experience, the largest most comprehensive outcomes data base on which to base my recommendations for care, while introducing an analytical program based on a FDA-audited analytical laboratory for assessing the quality of regenerative preparations. As for the latter point, I am now working with a team using a FDA consultant to create approved text that I will post on my website, highlighting the standards I have adopted for all phases of therapy.
I hate to conclude that the current practice of interventional orthopedics and regenerative medicine ultimately comes down to how flashy the website may be or a free lunch from the camp followers.
To watch my Webinar, access www.ilCellulartherapy.com
To make an appointment, call 312 475 1893
Tags: bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, joint replacement, Orthopedics, Osteoarthritis, Regenerative, Regenerative Pain Center, stem cell certification, stem cells, training
Dec 1, 2016
Actually, that future started last week when we used a more aggressive PRP adjunct at the time of two Bone Marrow Concentrate/ Stem Cell interventions; one for an arthritic hip and the other, in an arthritic knee. More accurate and descriptive would be a Bone Marrow Concentrate/Adult Mesenchymal Stem Cell/ Hematopoietic Stem Cell/ Growth Factor Concentrate/Platelet Rich Plasma/Interleukin-1 Receptor Antagonist cellular orthopedic intervention to an arthritic joint but even I get confused, so I will stick to cellular orthopedics and Bone Marrow Concentrate.
It would seem from current Regenerative Medicine Science, that while concentrated and activated Platelet Rich Plasma alone has not been provided a predictable and reliable independent approach to arthritis, when aggressively used in conjunction with stem cell interventions, PRP significantly enhances the results in the short term. It will require another several years to determine if what we are seeing in the short term will continue to improve our outcomes in the long run. I am not waiting as concentrating and activating the platelets will cause no harm; and if there is the promise of long term benefits when used as an adjunct both at the time of the Bone Marrow collection, concentration and intervention as well as again in two to five days, there is no reason not to proceed.
What about the future? While we have been great advocates of counting cells at the time of the stem cell intervention, new tools are being introduced to allow us to better customize that which we inject after concentrating and processing of the bone marrow. We now will be able to get a more accurate count of that which is present in the concentrated and processed injectate prior to the intervention and add bone marrow or platelets if indicated.
Are Mesenchymal Stem cells really Stem Cells? Professor Arnold Caplan of Case Western Reserve is widely considered the father of mesenchymal stem cells. He now takes the view that MSCs aren’t stem cells and that he should have never given them that name. He also believes that the primary function of these cells is paracrine, so he calls them “medicinal signaling cells”. To save you the trouble, paracrine is defined as “a form of cell-cell communication in which a cell produces a signal to induce changes in nearby cells.” I am not negating the importance of mesenchymal stem cells, rather I want the reader to better understand the role of each component involved with regenerative medicine. It was Professor Caplan’s prodding that in part is responsible for my having entered the discipline of interventional orthopedics. Long ago, we became friends as team mates of the Roosevelt High School championship football team in Chicago; and our professional paths, while parallel, he in basic orthopedic research while I chose orthopedic surgery finally crossed again five years ago.
To learn more about the basic science behind Cellular Orthopedics or to find out about how you might postpone or avoid a Total Joint replacement for an arthritic joint, schedule a consultation (312) 475 1893
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, cellular orthopedics, Clinical Studies, Concentrated Stem Cell Plasma, Growth Factor Concentrate, Growth Factors, Hematopoietic Stem Cell, Hip Replacement, Interleukin-1 Receptor Antagonist, knee arthritis, Mesenchymal Stem Cell, Mitchell B. Sheinkop MD, Orthopedics, Osteoarthritis, paracrine, Platelet Rich Plasma, Professor Arnold Caplan, PRP, Regenerative Pain Center, stem cells
Nov 16, 2016
This week, I am repeating stem cell/growth factor interventions in two patients; one with arthritis of the
hip, and the other with osteoarthritis of both knees. Four years ago, at the initiation of my interventional
orthopedic practice, I spoke of adult mesenchymal stem cells alone but now we know that Bone Marrow
Concentrate has in addition to the adult mesenchymal stem cells, hematopoietic stem cells, growth
factors and platelets all playing a role in managing the symptoms and the altered functional impairment
attributable to osteoarthritis. The outgrowth is in new speak; namely, Bone Marrow Concentrate and not
just mesenchymal stem cells. When the two patients I alluded to were initially cared for, we had not yet
gained the understanding of the importance of platelets in the regenerative process. Platelets contain
the growth factors and those growth factors are responsible, in addition to Mesenchymal and
Hematopoietic Stem Cells, for regulating cartilage well-being. By having become aware of the
contribution following concentrated platelet rich plasma in conjunction with the bone marrow
concentrate intervention, I believe we are already seeing improved outcomes.
As well, subchondroplasty has been added to our menu of services and the latter is proving very
beneficial in the knee. To refresh your knowledge base, subchondroplasty is a procedure popularized in France where in bone marrow concentrate is injected into the bone marrow adjacent to a joint at the
same time that the stem cell, growth factors and platelet containing concentrate is intervention of the
joint itself is being completed. The value of intervening into the bone supporting the joint is the fact that
there is communication between the joint itself and the supportive subchondral environment. I have
addressed Adult Mesenchymal Stem Cells many times in previous Blogs as the orchestrater of the
healing process. Now we know that Hemopoietic Stem Cells from the marrow contribute as well. Growth
Factors such as Interlukin-1 Receptor Antagonist Protein (IRAP) are present in bone marrow and
circulating blood; It was IRAP alone that extended the professional basketball career of Kobe Bryant by
seven years for an arthritic knee. With an improved means of extracting and activating the growth
factors contained in platelets, the two patients I introduced in the opening sentences of this blog should
enjoy a very satisfactory return to function and recreation.
Interventional Orthopedics is a dynamic process and I continue to learn from the integration of clinical
research and my clinical practice. On Thursday, I will host two very interested scientists dedicated to
customizing biologic preparations and together we will explore how to further leverage scientific
advancements in creating autologous biologic preparations thereby optimizing the practice of
Regenerative Medicine.
Call 312 475 1893 to schedule your consultation
Tags: arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Growth Factors, Hematopoietic Stem Cells, Interlukin-1 Receptor Antagonist Protein, IRAP, joint replacement, Osteoarthritis, Platelet Rich Plasma, PRP, Regenerative Pain Center
Nov 10, 2016
I am receiving increased requests for my Outcomes Data following a Bone Marrow Concentrate intervention for osteoarthritis of the hip. There is a paucity of said outcomes data in the scientific literature in part because of the relatively recent introduction of Regenerative Medicine for Osteoarthritis. I believe equally important is the fact that I was one of the first orthopedic surgeons to embrace the practice and remain one of the few in the subspecialty who practices evidence based medicine through the integration of clinical research with a clinical practice. Perhaps the recent presidential campaign, where honesty took a beating across the US, is responsible for the heightened patient awareness of the charlatans victimizing the public when it comes to Regenerative Medicine.
There is no question that there is value in facts and that is why my cellular orthopedic initiative is evidence based. Earlier this week, owing to these patient inquiries about my particular data base results when it comes to stem cells and growth factor for the hip, I reviewed my data base. There are now just over 150 patients with osteoarthritis of the hip who have undergone a Bone Marrow Concentrate intervention of the hip. The introduction of those bone marrow derived Mesenchymal Stem Cells and Growth factors has the potential to relieve pain, improve function, increase motion, regenerate the cartilage, alter the natural history of the arthritic joint, and delay, perhaps help avoid a hip replacement.
In order to qualify for submission to an orthopedic journal or scientific meeting, orthopedic data must be statistically significant with greater than a two-year follow-up. Our numbers will reach those criteria by January 1, so I thought I would present the preliminary data in this Blog format.
Of the 150 arthritic hips with grade 2 and 3 osteoarthritis at the time of the intervention over the past four years, 92% of patents on average, reported a clinically important improvement in hip-related pain after 1 year while 1% reported worsening. To the best of my knowledge, one patient in the group progressed to grade 4 osteoarthritis and elected to undergo a Total Hip Replacement. As far as Hip-Related function after a minimum of 1 year, 90% of patients reported a clinically significant improvement while 1% reported worsening. Of importance is the fact that of the 9% who initially showed no detectable change in hip-related function, all 9 were significantly improved by a booster intervention.
During my four and one half year, Interventional Orthopedic practice, I have learned that when a patient doesn’t reach a sought-after goal while under observation, a repeat intervention be it Platelet Rich Plasma or a Bone Marrow Concentrate, is a very important part of achieving success. Herein is the basis for my integration of a clinical research initiative with timely follow-up as contrasted with a procedure, a bill and a goodbye. If you want to learn more about evidence based Cellular Orthopedics be it for an arthritic hip or knee, call and schedule a consultation.
312 475 1893
Tags: arthritis, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip Arthritis, Hip pain, Hip Replacement, hip surgery, Interventional Orthopedics, Orthopedic Care, Osteoarthritis
