Jan 11, 2016
The Regenerative Medicine Menu
- Hydrocortisone
- Hyaluronic Acid (HA)
- Platelet Rich Plasma (PRP)
- Amniotic Fluid Concentrate (AFC)
- Bone Marrow Aspirate Concentrate (BMAC)
- Regenexx-SD Procedure
- Simple Adipose Graft
- Stromal Vascular Fraction (SVF)
The human body posses a remarkable capacity to heal. Following tissue damage or disease, the body’s immune response coordinates a sequence of events to fight off harmful disease or infections and repair the damaged tissue. While scar tissue may form as a byproduct of rapid healing, scar tissue may be remodeled over time. This is the Normal Healing Response. The goal of regenerative therapies is to modulate these stages of healing be it soft tissue, cartilage or bone.
As a response to the delisting by the AAOS of Hyaluronic Acid from the osteoarthritis armamentarium, industry has attempted to fill the void with Amniotic Fluid Concentrate. For those unfamiliar, when a pregnant woman schedules a C-Section, she is approached about “donating” her amniotic fluid that may be recovered at the time of the procedure. During the course of the pregnancy, the potential donor is screened for communicable diseases. There is little if any immuno-rejection phenomenon and the AFC has growth factors, anti-inflammatory cytokines and Hyaluronic acid all in high concentration. While there are large numbers of stem cells deposited by the fetus and the placenta during the course of the pregnancy, by time the Amniotic Fluid is concentrated, processed, frozen for preservation and finally fast thawed for usage, little in the way of viable stem cells may be observed. Never the less, the AFC has great potential in the arthritic setting; and when micronized, is a marvelous adjunct in effecting wound healing for the diabetic and wound that won’t heal.
At our Regenerative Pain Center, we have observed over 40 different interpretations for the term PRP. The problem is that there is no standard of concentration, quality or quantity. To that end, an attempt is underway to reach accord on an actual standard definition. Then there comes the dilemma of whether the PRP is best when leukocyte free or not. Next comes the argument to support Platelet Poor Plasma (PPP). In our practice, we alter the formula according to the needs of the patient.
You will note at the get go, the repeat Bone Marrow Aspirate Concentrate bullets. There is bone marrow aspirate concentrate and then there is the Regenexx -SD approach. The latter is what has been so effective in our practice for three and a half years; so much so that it is what I truly believe in for moderate osteoarthritis and even advanced in certain settings.
While “simple” adipose grafts are heavily marketed, let me refer you to Pope Brock’s Charlatans, first published in 2008 to understand my view of how plastic surgeons are victimizing patients by including the management of arthritis in their cosmetic approaches. Last of all is the new introduction of the Stromal Vascular Fraction following the micro-fracture of fat graft. The latter became available in the US in mid summer, 2015. Clinical trials are in progress. If you want to delay or possibly avoid a joint replacement for arthritis, call for a consultation 847 390 7666
Tags: Amniotic, arthritis, athletes, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Oct 22, 2015
Autograft is a tissue or organ that is grafted into a new position in or on the body of the individual from whom it was removed; whereas allograft is the transplantation of tissue taken from one individual to another. Bone Marrow Aspirate Concentrate is an autograft while Amniotic Fluid Concentrate is an allograft. Autograft, at this time serves as the gold standard for almost all situations in which the use of orthobiologics is indicated. Bone Marrow Aspirate Concentrate (BMAC) offers nearly every essential component involved in reversing the damage caused by arthritis including Adult Mesenchymal Stem Cells, Growth Factors, Cytokines, and Vascular Progenitor Cells. Because of the inherent value of Bone Marrow, my first interventional thought is BMAC; in addition it is virtually free of risks and side effects.
The U.S. Food and Drug Administration (FDA) has approved certain growth factors and allied substances for specific indications. Platelet Rich Plasma falls into this category. In addition to BMAC, Autogenous PRP contains many growth factors as well. Stem Cells are at this time, the ideal biological treatment because they recreate the original microenvironment and supply paracrine factors (a type of hormone which binds to receptors in nearby cells influencing their function). Bone Marrow Aspirate contains a variety of cell types such as endothelial progenitor cells (EPCs), osteoprogenitor cells (OPCs), stem cell niche-supporting cells, and cytokines.
You bet this is confusing and not easy to understand. That’s why I try to clarify by writing the Blog. At the same time, it demands that a clinician stays well informed and not depend on the hype of marketing from the start-ups in the field of orthobiologics to influence a potential patient intervention. On Thursday, I travel to Broomfield, Colorado for the first meeting of the Interventional Orthopedics Foundation, the first not for profit dedicated to Regenerative Interventional Orthopedics: The Next Frontier. My presentation will be based on the 24 month outcomes of Bone Marrow Concentrate in knee arthritis. Another issue will be addressed, are there viable stem cells in Amniotic Fluid Concentrate? The Regenexx Advisory Board of which I am a member, will review the challenges presented by the patient with Grade 4 Osteoarthritis for whom until now, we have had little to offer other than referral for a joint replacement. Next week, I will be in a position to upgrade the reader about the present role, if any for mechanically liberated, adipose derived, stem cells as this subject as well will be studied by the advisory panel.
Tags: Amniotic, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, PRP, Regenerative, Regenexx, stem cells, technology, treatment
Jun 11, 2015
Cellular Orthopedics for the Musculoskeletal injury and Degenerative Arthritis
What is the problem?
Trauma and Osteoarthritis are part of the cycle of life. Muscle, ligament and tendon injuries frequently occur during sports related activities or accidents; degenerative arthritis may be post traumatic by many years or occur as part of the aging process
What treatments are available?
As of today, it includes Platelet Rich Plasma (PRP) following several protocols and Bone Marrow Aspirate Concentrate (BMAC) rich in stem cells, growth factors and anti-inflammatories called Cytokines. As of next week, all may change as the Orthobiologic update taking place in Las Vegas over the weekend will potentially introduce an entire new menu of therapeutic intervention alternatives for musculoskeletal injury and disease.
What is Platelet Rich Plasma?
Platelets are part of your circulating blood producing growth factors that assist in repair and regeneration of tissue. When a high concentration of platelets are created via the centrifuge, healing may progress more quickly and pain may be reduced
What is Bone Marrow Aspirate Concentrate?
Taken form the back of your pelvis, aspirated bone marrow may be concentrated and prepared allowing for pain relief, improved function, a more rewarding quality of life, and possibly influence the Bio-immune response of degenerative arthritis
What is Amniotic Fluid Concentrate?
The source is the pregnant woman coming to term and delivering via Cesarean section. The recovered amniotic fluid is processed, concentrated, and now available as an alternative to Visco-supplemenation with hyaluronic acid. It is a new option and data concerning the length of pain relief is still being determined.
Do these Regenerative Medicine alternatives work?
When properly applied the answer is yes. What we don’t know is for how long? The effect of Platelet Rich Plasma in injury is intended to speed up the repair process. In the case of Amniotic Fluid, the outcomes are still being studied without a known end point. I have been involved in studying the clinical outcomes of Bone Marrow Aspirate Concentrate intervention for osteoarthritis. The paper I will be presenting this weekend confirms satisfactory results up to two years. The data collection continues.
Is there a downside side to Regenerative Medicine and Cellular Orthopedics?
In my experience the answer is yes and no. Yes because there is no indemnification for the new world of regenerative medicine; care is an out of pocket self pay undertaking because the field is new and five year outcomes data still not available. On the other hand, at three years, I have seen no adverse events and the vast majority have responded well with improved function and quality of life. Out of over 600 knees and over 100 hips, to the best of my knowledge, seven have gone on to a total joint replacement.
Tags: Amniotic, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, C-SCP, Clinical Studies, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Apr 30, 2015
“Dwight Howard dominated the paint during Tuesday’s series-clinching victory, finishing with 18 points, 19 rebounds, four steals and four blocks.” (From Yahoo sport) Three months ago, the following appeared in the Press/News from ESPNDallas.com “Dwight Howard Out Indefinitely. There is no timetable for Houston Rockets center Dwight Howards return.” There are many other athletes who undergo Regenerative Medicine-Cellular Orthopedic interventions during the course of the year, they are not as public about it but there is successful return to sports, more often than not. If you imagine the forces generated across the knee in a 6’11’’, 265 lb. professional basketball player, you must conclude that his regenerative medicine intervention is a success for a continually painful knee.
Cellular Orthopedics is here to stay and is rapidly gaining a foothold as the non-operative treatment regimen for skeletal muscular trauma and the progressive restrictions imposed by degenerative arthritis. This past weekend, I was in Southwest Wisconsin fly fishing and cycling. Wading up a spring creek and climbing up and down the cliffs is as demanding as playing center on a professional basketball team. Cycling for three hours up 1500 foot climbs depends not only on conditioning but on functional knees. It was possible for my buddy and me in part because of the several cellular orthopedic procedures I have completed on him in the past three years. We have many more similar trips planned.
Bone Marrow Aspirate Concentrate-Stem Cell treatment is only one of the possibilities available for helping a patient postpone or avoid a joint replacement, diminish pain, increase motion and assist in returning an injured or arthritic individual to well being and a full recreational profile. From Concentrated Platelet Rich Plasma to Bone Marrow Aspirate Concentrate-Stem Cells, there are several alternatives for altering the natural history of post traumatic and degenerative arthritis. Many more offerings are in the works and I will continually update you as to when these latest interventions become available. In the meantime, please understand that while I don’t have to break a bone to best understand how to treat a fracture, my treatment recommendations for Cellular Orthopedic intervention concerning both post traumatic arthritis and degenerative arthritis in part are influenced by my own experiences so I will continue to report on such. To learn more about what is available in Regenerative Medicine and what clinical trials are in the works, make an appointment for a consultation.
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, C-SCP, Clinical Studies, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Pain Management, PRP, Regenexx, Regenexx-SD, stem cells, treatment
Feb 2, 2015
The world of Regenerative Orthopedics began in the United States with the publication of a scientific article reporting the results of platelet rich plasma in the treatment of knee arthritis. That took place about six years ago. No one really understood at the time of the publication why something so important in the clotting cascade of the human body would be beneficial in the treatment of an arthritic joint.
The next step in improving results of Platelet Rich Plasma injections for an arthritic joint was the understanding that whereas one injection would help, three injections over a three month period would improve outcomes. Scientists began further efforts at understanding why the platelet, so critical in the clotting cascade, would be beneficial in treating arthritis, and soon a better understanding of how platelets function came to be appreciated.
Platelets are the primary source of bioactive tissue growth factors. When concentrated they are potent. When activated, they release their growth factors and cytokines in clinically active quantities. Regenexx has developed a formula for superior concentrations and immediate activation. Whereas most Platelet Rich Plasma is created at bedside, we create ours in a laboratory with maximum concentration and prompt activation. Our research supports better stem cell growth following the Regenexx SCP procedure. Although the Regenexx Stem Cell Plasma formula is part of the Bone Marrow Aspirate Concentrate algorithm, we now are able to offer it when indicated as an independent intervention when Bone Marrow Concentrate is not possible. In addition, it is a wonderful “booster” when anticipated milestones with Bone Marrow Aspirate Concentrate are not met. Let me cite two patient examples.
Two years ago, an 83 year old man was selling his condo in Palm Springs because his arthritic knee would no longer tolerate a round of golf and his co-morbidity posed a very high risk for a joint replacement. He sought consultation and I recommended a Regenexx SCP intervention. Three weeks after the procedure, he took his condo off the market and returned to Palm Springs for the winter migration from Chicago. I spoke with him via phone in August and he had purchased his tickets for the return migration to the desert this winter.
36 weeks ago, I performed a Bone Marrow Aspirate Concentrate/Stem Cell intervention into the right hip of a 29 year old man with early onset degenerative arthritis. At six weeks, he was 25% symptomatically improved. At 12 weeks, he was 50% improved. At 18 weeks, he was still 50% improved so I administered a C-SCP booster. At 36 weeks he is 80% improved and thrilled. Cellular Orthopedics requires a continuum of monitoring and possibly more than one intervention.
Contact us to learn more.
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, PRP, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
