Aug 30, 2018
Evidence for the efficacy of Platelet Rich Plasma, a blood-derived formulation, and bone marrow derived biologics in osteoarthritis continues to grow in the orthopedic community. On the other hand, as I continually monitor the current landscape of indiscriminate and sometimes inappropriate marketing and use of biologics by the non-orthopedic opportunists, I doubt if the charlatans and camp followers have an overview of what is known about these agents. The increased presence of clinics Is driven by the popularity of PRP and its biologic cousins:
- consumer demand
- aggressive marketing
- a low regulatory bar for many of these regenerative medicine clinics
- the autologous nature that makes many approaches largely safe
- positive data from centers such as ours demonstrating functional and symptom modification
PRP works by activating cellular pathways; more than 3,000 genes are related to these and other pathways, suggesting that PRP probably acts by inducing a transitory inflammatory event, which then triggers tissue regeneration. Bone Marrow Concentrate, does more and addresses the subchondral bone when appropriately injected as well as initiate joint preservation and possible regeneration.
Taking aim
I use a hemoanalyzer to characterize a dose of PRP or Bone Marrow Concentrate allowing me to quantify the composition and biologic activity of these agents. Soon, I will begin pretreatment assessment of the synovial fluid of the arthritic joint so as to best determine who is the optimal candidate for a particular procedure
What do we know?
- Knee osteoarthritis: white blood cell-poor PRP has a positive effect on symptoms, not structure; while Bone marrow Concentrate affects symptoms and structure. I identify what I am putting into the patient. My goal is to have reliable predictors of outcome; that is, do the composition and biologic activity of the material implanted in the patient predict the clinical/imaging outcomes? My PRP contains a high concentration of anti-inflammatory cytokines and anabolic growth factors whereas my use of Bone Marrow Concentrate inside the bone adjacent to the joint in addition to the joint itself is improving the outcomes of the patients I treat.
- To learn more, call my office to schedule an appointment at (312) 475-1893
- You may view my Web site at WWW.Sheinkopmd.com
Tags: anit-inflammatory, biologics, bone marrow, cellular orthopedic, cellular therapy, cytokines, knee osteoarthritis, Orthopedic Surgeon, PRP, regenerative medicine, stem cell
Aug 21, 2018
It is my belief and practice that each patient has full understanding of his or her orthopedic condition, its implications, the various options for treatment, and the expected outcome of each treatment. As a basic principle of bioethics, respect for autonomy recognizes an individual person’s right to live that life consistent with personal needs, desires and morality.
Stepping away from the lectern, let me share with you my motivation for the theme running through this blog. I have two arthritic hips, two arthritic knees and one arthritic low back. On Sunday, two of us completed a 35-mile, arduous bike ride from Chicago’s Lincoln Park, stopping for coffee at the northern end of Glencoe and returning home making for a four-hour effort. 12 hours earlier, Sharon and I had danced the night away at the wedding of one of my part time staff members. As an aside, we long ago decided we would never become the older guests at an event that sat out the evening watching the younger crowd shaking their booty to KC and the Sunshine Band. While it is easier for me to write about others and their recreation, athletic and fitness pursuits; even tough more difficult, I wanted to share with my readers what is possible with cellular orthopedic interventions such as I have received. None of this would have been possible prior to my joint preservation and restoration procedures eight months ago.
Stepping back up to the lectern, all too often, a patient will share with me a statement from an initial orthopedic surgical visit in which he or she was subjected to the outdated practice of paternalism, in which that physician dictated the “best” treatment; for arthritis, probably a total joint replacement. Another bioethical principle is one of beneficence; the latter obligates the physician to help the patient do well. This requires the physician to have a knowledge of the expected outcomes of each treatment. Just as a certain restaurant chain’s tagline is “we have the meats”, one of the best reasons for seeking a cellular orthopedic intervention in my practice is we have the outcomes data for each cellular orthopedic intervention we offer.
Nonmaleficence simply means that physicians should not harm their patients. This is why we have an FDA; yet the plethora of claims for umbilical cord blood, Wharton’s jelly, amniotic fluid, the latter all without proper scientific clinical outcomes or living stem cells when thawed and injected violates the concept of primum non nocere, first do no harm.
If you want to learn more about Cellular Orthopedic interventions to help you postpone or avoid a major surgical procedure, call (312) 475-1893 to schedule a consultation. You may visit my website at www.sheinkopmd.com
Tags: cellular orthopedic, joint pain, PRP, regenerative medicine, sports injury, sports medicine, stem cell
Aug 16, 2018
From the front page of the September, 2018 issue of GOLF “This Tiger is for real. He’s faster, sharper-and an up-and-down machine.” Then, from the September/October issue of Tennis, “Juan Martin del Potro He’s back…. and ready to once again conquer”. His once promising career was reaching the end owing to wrist injuries. Quoting Del Potro in the article “one doctor would say something to me; another would say something different. It was difficult to believe one or the other”; however, he demanded excellence and eventually found it
I could go on citing and quoting from all sports and recreational resources but you get the idea. These are recovery and come back examples of what motivated individuals may accomplish. Now, if you tune in to upcoming US Open later this month, you will be able to follow Rafael Nadal, another super athlete who was able to return to compete at the top of his game owing to cellular orthopedics for several potentially career ending injuries over recent years. I could go on with the examples in each and every recreational pursuit or from those who wished to regain a pain free and very active life even if not at the aforementioned level of demand. Suffice it to say, the common denominator for those with skeletomuscular restrictions is a combination of physical training, mental motivation and timely medical care.
You can put some of this Tiger in your tank and reignite your enjoyment of activities at any level if arthritic or traumatic injury of your bone and joints is holding you back. The new world, (actually it is not so new anymore) of Cellular Orthopedics may allow for a return to a virtually unlimited lifestyle with a needle instead of a knife. I choose to define myself as a Cellular Orthopedist so a patient might not be trapped in the web of so called regenerative medicine specialists. An orthopedic surgeon has dedicated many years to understand the musculoskeletal system whereas a regenerative medicine clinic frequently is populated by those who attended a two-day training seminar. While my own recreational pursuits and fitness profile is far removed from those of the famous professionals noted earlier in this blog, following cellular orthopedic interventions into my own knees in December of 2017, and for my hips in January, 2018, I returned to skiing last winter, cycling and fly fishing this summer, and I am able to enjoy a full fitness commitment in doing my part to maintain the highest possible level of performance.
You may access my website at WWW.SheinkopMD.com or call (312) 475-1893 to schedule a consultation.
Tags: BMC, Bone Marrow Concentrate, cellular orthopedis, golfers elbow, injection, Platelet Rich Plasma, PRP, regenerative medicine, sports injury, stemcell, tendon repair, tendon tear, tennis elbow
Jul 19, 2018
The argument frequently advanced by orthopedic surgeons in response to a patient’s inquiry concerning stem cells for arthritis is that it is too early, there is not enough research, It is better to have a major surgical procedure. For those of you who have read my blog or have sought orthopedic consultation in my office, I have emphasized that my recommendations are evidence based. Each patient, for whom I have completed a cellular orthopedic intervention for arthritis, has been entered into a registry or clinical outcomes data base, IRB approved. Just as I pioneered the integration of clinical care with clinical research over 37 years as a joint replacement surgeon, so too do I now partake in the growth and development of the clinical pathways for regenerative medicine.
Last month, I exhibited a poster at a large regenerative medicine meeting wherein I shared my preliminary outcomes and thus educated other professionals using Intraarticular and Subchondral Bone Injection of Autologous Bone Marrow Concentrate and General Fluid Concentrate for Osteoarthritic Knees-A Prospective Clinical Study. Osteoarthritis is an organ disease that affects most structures of joints including cartilage, synovium and subchondral bone. Pathology in subchondral bone contributes to the initiation, progression and pain of Osteoarthritis. In previous European studies, the injection of autologous bone marrow concentrates into bone supporting the joint significantly relieved pain and improved function of the affected knee. The preliminary outcomes in the study that I presented via a poster exhibit, investigated the effectiveness of injections of Bone Marrow Concentrate with General Fluid Concentrate (Growth factors), into both the knee joint and the subchondral bone. The study recorded all the standard Endpoints I had previously used in joint replacement clinical outcomes trials.
Bone Marrow was collected from the pelvis and a filtration system allowed for concentration of Mesenchymal Stem Cells, Platelets, Precursor Cells and Growth factors such as A2M, IRAP, EGF, PDGF, TNF-B blocker, etc. After preparation, a mixture of Bone Marrow Concentrate and Growth factor Concentrate was injected into the bone (subchondral) and into the joint.
In the study, all patient injections went well and there were no complications. The Preliminary Results documented diminished pain and improved function. We concluded that injection of Bone Marrow Concentrate and Growth factor Concentrate into both the subchondral bone area and joint cavity significantly improved function of the affected knee joints and significantly reduced joint pain. While there are many stem cell providers to be found because of their marketing, choose the center of excellence in Cellular Orthopedics that is evidence based.
Call to schedule a scientific based consultation from an orthopedic surgeon 1 (312) 475-1893.
You may access my web site at www.SheinkopMD.com.
Tags: avascular necrosis, bone lession, bone marrow, Cartilage, cellular orthopedics, clinical study, Growth Factors, IRAP, joint pain, joint replacement, knee pain, knee replacement, meniscus tear, Osteoarthritis, platelets, PRP, regenerative medicine, sports medicine, stem cells, subchondral bone
Jul 12, 2018
Just as I cringe when a new patient announces that they have “bone on bone”, so too do I squirm when I am told by a patient “I have a torn” at times meniscus or cartilage; others, a torn rotator cuff; and then again, a torn labrum. Attention please, your X-ray or MRI image is not causing pain, the inflammation in or around your joint is the pain generator. 95% of the population over age 45 will have an abnormality interpreted by the radiologist on the report their MRI, be it of the shoulder, hip or knee. Cartilage and meniscal changes at the knee, labral tears at the hip or shoulder, and rotator cuff abnormalities are part of the attritional process; alternatively, these changes are commonly over diagnosed.
Last week, a 70-year-old woman called to schedule an appointment and indicated that she had a torn acetabular(hip) labrum diagnosed on a recent MRI. I responded, “your pain generator is arthritis unless you are a hockey goalie”. I was being a bit facetious but at the same time truthful. My 37-year experience as a reconstructive orthopedic surgeon specializing in hip and knee replacement really prepared me for this life after surgery; namely, a cellular orthopedic interventionalist.
It takes a history and hands on physical examination prior to review of images to determine what is causing a painful musculoskeletal condition. The common denominator is inflammation, not a computer image. In the case of arthritis, unless the cartilage (meniscus), labrum or rotator cuff alteration is generating mechanical problems such as weakness, locking, “clunking” or giving way, we frequently need not address the former with a maximally invasive surgical procedure; a needle will suffice and deliver the platelets, Mesenchymal Stem Cells, Growth Factors and precursor cells required to address pain, improve function, increase motion, stop progression of arthritis and restore, at times regenerate the joint.
Cellular Orthopedics encompasses a full joint Preservation, Restoration and Regenerative scope of options. The notion introduced by a print media ad, that it is “one and done”, won’t help you postpone, perhaps avoid a joint replacement. In my practice, we monitor progress and intervene when necessary at five months or five years if indicated.
To learn more, visit my web site at www.SheinkopMD.com or call and schedule a consultation at (312) 475-1893
Tags: arthritis, bone lesion, Bone Marrow Concentrate, cellular orthopedics, hip pian, joint pain, joint replace, knee pain, meniscus, Osteoarthritis, PRP, Rotator cuff, stem cells, stiffness, torn labrum
