Oct 1, 2015
As I have previously indicated in my Blog, the world of Cellular Orthopedics is growing at an exponential pace. Evidence Based Medicine supports weight reduction, physical therapy, anti-inflammatories, analgesics, and cortisone injections for symptomatic relief. Evidence Based Medicine no longer supports the use of Hyaluronic Acid injections (visco-supplementation). Historically, the next step is a joint replacement when the aforementioned conservative measures no longer have an effect. When I initiated my practice of Interventional Orthopedics as part of the Regenexx Network, their patient satisfaction surveys supported the use of Bone Marrow Aspirate Concentrate interventions for osteoarthritic joints. Since my entry into the sub-discipline of Regenerative Medicine, we have gathered data on every patient seeking consultation and care and, have expanded the Outcomes measurement intake to include objective data points in addition to those of a subjective nature. Along the way, we have gained a better understanding as to how a patient might better respond to Interventional orthopedic options. The evidence is growing.
Just as my practice has grown and the Regenexx Outcomes Data base has grown, so too have the Interventional Orthopedic treatment alternatives increased. Now there is Amniotic Fluid Concentrates available to replace Hyaluronic Acid as a six to 12 month anti-inflammatory. As of July of this year, two companies have introduced Adipose derived stem cell alternatives claiming a mechanical means of emulsifying fat and eliminating the need for the enzyme collagenase; the latter not approved by the FDA when it comes to the musculoskeletal system. As of this time, there is no scientific evidence to support the claims of success in arthritis with both Amniotic Fluid Concentrate and Adipose Derived Stem Cells. Those studies will take several years before there is clinical evidence to support said use in arthritis.
What we have learned and is supported by clinical evidence is how to better plan and prepare for a Bone Marrow Aspirate Concentrate intervention. First a clinician must rule out referral of pain from other sources; this is accomplished by a thorough history and physical examination. The status of a meniscus, labrum, and the articular cartilage must be taken into account. Mechanical malalignment –a bowed leg or knock knee-must be ascertained and excesses corrected. Ligamentous deficiencies will contribute to the end result and must be corrected before any Intervention of an orthopedic nature.
I have provided a lot for a reader to digest. If you want clarification or to learn if you are a candidate for INTERVENTIONAL ORTHOPEDIC to postpone or eliminate a joint replacement for osteoarthritis, call for an appointment:.
847 390 7666
Tags: Amniotic, arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment
Sep 24, 2015
An all too common practice today is when the surgeon looks at your X-ray, tells you that you have “Bone on Bone “ and that you need a Total Joint Replacement. There is little discussion of the risks and the potential of an unsatisfactory result. The patient looks for pain relief but doesn’t really appreciate why a joint replacement may be indicated or whether there may be other options for delaying or even avoiding a joint replacement; particularly in Grades two and three osteoarthritis.
During my orthopedic training (readers of this Blog are aware I was a joint replacement surgeon for 37 years before “graduating” into interventional orthopedics) I was made aware that the X-ray evidence of osteoarthritis included joint space narrowing, subchondral sclerosis and osteophyte formation. The lay public refers to these observations as “bone on bone” and spurs. The general connotation is that these findings are consistent with Degenerative Arthritis. The synonym is Hypertrophic Osteoarthritis. The other general category of arthritis is Inflammatory and the most frequent category is Rheumatoid Arthritis. The synonym for Inflammatory Arthritis is Atrophic Arthritis in which there is joint space narrowing with osteoporotic adjacent bone changes (joint space narrowing without spurs or thickening of subchondral bone). There is yet another presentation on X-ray of Degenerative Arthritis that is not inflammatory but shares the atrophic nature of bony change. These occur in patients experiencing systemic osteoporosis who undergo degenerative changes. The interesting observation of the latter category is these subjects don’t hurt until very late into the disease process.
In trying to understand what causes the pain in degenerative arthritis, I haven’t lost sight of the inflammatory mature of the bioimmune process inside the joint but I am recently reminded of the shock absorbing and structural support nature of the bone supporting the cartilage. Is the pain generator the bone or the inflammation within the joint? If there is still a joint space but hypertrophic (sclerotic) subchondral bone, will the subchondroplasty alter the progression of osteoarthritis and delay or postpone a joint replacement? If there is X-ray evidence of “Bone on Bone”, should a bone marrow aspirate concentrate intervention be coupled with the subchondroplasty? If there is atrophic arthritis of a degenerative nature, should treatment be limited to an intraarticular intervention alone? Incidentally, Atrophic Arthritis of a degenerative nature is determined after a C-reactive protein and Erythrocyte Sedimentation Rate serum test excludes inflammatory systemic disease.
What is causing your joint pain and what might be done to delay or perhaps avoid a joint replacement while returning you to a more active life? Call and make an appointment so I may assess you, review images and advance an evidence-based recommendation:
847 390 7666
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment, Ultrasound Guided Injection
Sep 17, 2015
In the last week, I have become aware of four companies developing new regenerative medicine product for Musculoskeletal Care of the Aging Athlete. What I find extremely interesting is the fact that three years ago, when I entered the practice of using bone marrow aspirate concentrate in an attempt to postpone or possibly avoid a joint replacement in an arthritic knee or hip, the orthopedic community was very critical telling patients that regenerative medicine was still ten years away. Fast forward three years and four new initiatives into the emerging field of regenerative medicine have come to my attention; underwritten by orthopedic surgeons or companies that have produced prosthetic joints for over 30 years. All of the product in development has not yet been approved by the FDA and many developing products are still being tested in Europe. What we at the Regenerative Pain Center offer is within FDA guidelines and approved by all regulatory agencies of the government. At the same time, I am very much aware of what is taking place nationally and internationally; when a newer regenerative medicine product is made available and FDA approved, we at the Regenerative Pain Center will be aware and closely evaluate as to whether it should be incorporated into our service line.
Let me be candid, our success rate is not 100 per cent. There have been three or four hip patients that have not provided the outcome the patient sought or that I hoped to provide; namely, avoidance of a hip replacement. On the other hand, the vast majority of hip bone marrow aspirate concentrate procedures are still allowing the patient a very full return to activities with about 70% percent patient satisfaction at a minimum of one year. When it comes to those who sought help for an arthritic knee, we have done even better with an 85% patient satisfaction outcome at a minimum of one year. Several of those patients had reached a plateau at six months but realized a marked improvement in the pain score with a Platelet Rich Plasma refresher. When a patient elects to under go a bone marrow aspirate concentrate hip or knee intervention at the Regenerative Pain Center, that patient may be assured that what we are doing is based on FDA guidelines and our clinical outcomes research. In addition, each patient should recognize that Regenexx continually statistically reviews our outcomes data. Last week, we recognized that those who underwent Cellular Orthopedic interventions for an arthritic knee did best when the cell count of mononuclear cells exceeded 400 million. Be aware that we count the cells in every Regenerative Medicine procedure. Our approach is no longer “this is the way we do it.” Our approach is based on experience and outcomes research, the same that I used in a long joint replacement career.
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, FDA, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, Regenerative, Regenerative Pain Center, Regenexx, stem cells, treatment
Sep 10, 2015
The PERSPECTIVE section of the Chicago Tribune / Wednesday, February 11, 2015 ran the headline and an article written by Gerald D Skoning. It was well thought out, I have kept the page on my desk since February thinking that this was a marvelous subject for me to Blog about and how to possibly extend the career of injured or aging athletes, be they amateur or professional.
I am surrounded by several good friends who want to continue skiing, cycling, wadding up a stream with fly rod in hand, or spend an hour each day in the health club. Unfortunately, most of my contemporaries in their sixties and seventies have hung up their athletic gear but maybe it isn’t too late for you. An athlete doesn’t have to win but you might still enjoy competing and participating. Our mission statement is our ethos. Mary, the research coordinator and physical therapist in our office wore her medal to work on Tuesday earned as a cycling participant in the Co-Ed relay division of the Chicago Triathlon two weekends ago. I have recently returned from a week of cycling and fly fishing in Southwest Wisconsin. I am not injury free nor have I avoided the effects of arthritis after a lifetime of athletic participation. When the time came where I was surrounded by “ I am just a used to be”; I opted for a cellular orthopedic intervention to my left knee and here I am. Grit and determination can prolong your recreational and athletic enjoyment; so can Orthobiologics. Our regenerative offerings contain an enhanced profile of ant-inflammatory cytokines, anabolic growth factors, and adult mesenchymal stem cells. Our data clearly documents improved function of the knee. With the introduction of Subchondroplasty, we hope to do even better. Whereas our initial hip outcomes did not compare to those of the knee, the several patients who returned for a second procedure are doing extremely well. Now I am happy to note that patients presenting with arthritic shoulders and ankles are very improved from our interventions,
You must decide if you want to be a “still” or “used to be”. When four of us rode up and down the hills of the Driftless Area two weeks ago for hours at a time, you couldn’t match that camaraderie. I did the same four weeks earlier with my wife and two sons; the time has not come and I won’t quit because the next orthobiologic intervention for the other knee is waiting.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Osteoarthritis, Pain Management, Regenexx, stem cells, Subchondroplasty, treatment
Sep 3, 2015
In the field of Orthobiologics, the introduction of new product and possibility is continuous. The challenge to the clinician is to adopt a clinical approach based on scientific proof and clinical data; not marketing hype and anecdote. Regenexx, where I have been invited to be part of an advisory board, is home to the nation’s most advanced and studied stem cell and blood derived platelet procedures. We have more clinical experience and research with bone marrow derived orthobiologics for arthritis, than any other clinical setting in the United States.
At the Regenexx Chicago office, we offer non-surgical options for people experiencing moderate to advanced pain and limitation due to degenerative arthritis no matter the cause. Our patients experience little to no down time from our procedures and avoid the painful and lengthy rehabilitation that is inherent in a joint replacement. Knowing there are non-surgical and minimally invasive orthobiologic options, don’t throw away your skis or let your bike get rusty. Just as the skis need to be tuned for the upcoming season, (Vail opens in 12 weeks), and the wonderful cycling days through the changing colors are four weeks away, so too does your body need to be updated and upgraded. If you have limitations from an arthritic joint, perhaps you should let me determine how Cellular Orthopedics may allow you to return to an unlimited athletic or recreational profile.
Our data include Efficacy and Safety of Bone Marrow Concentrate for Osteoarthritis of the Hip; Treatment Registry Results for 196 patients. At the knee, I have presented in July and will be presenting the outcomes in October of 187 Bone Marrow Aspirate Concentrate Knee interventions with comparison to Total Knee Replacements. The fact is that at Regenexx, our therapeutic recommendations are not based on new product and the associated marketing hype inherent in a corporate initiative but rather on our data base statistical analyses and scientific studies, both in the laboratory and in the clinical setting. We practice evidence-based medicine, not offerings based on unsubstantiated claims.
Of course, we are able to provide an abundance of anecdotal success stories in our athletes be it a torn acetabular labrum, a torn medial meniscus or a torn rotator cuff. To learn more, check out my Blog www.sheinkopmd.com/blog even better yet, call for a consultation: (312) 475-1893.
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, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
