Apr 7, 2014
Total Knee Prosthetic sales rose almost 7% in the fourth quarter of 2013. When Wall Street analysts sought to find out why and asked physicians-73% of those surveyed reported that patient behavior had changed during the quarter; 35% attributed the changes in behavior to the Pull –Forward theory resulting from concerns about Obamacare. While it is very difficult to differentiate between aging demographics, seasonal variations, and an increase of those covered by insurance, or patient angst about health care changes; my question is what is the hurry? Before surgery, there are a large number of possibilities for Non-Arthroplasy treatment of Osteoarthritis of the Knee. I have reviewed those options and they are archived in my Blogs. Remember, once you have a total knee, the only salvage for dissatisfaction is a very life altering revision procedure. Last week, I focused on the reasons for early failure of a knee replacement (early is defined as two years). What has not been addressed is the life altering impact of revision knee prosthesis. While a surgeon might change the X-Ray at the time of the revision knee surgery; what are the chances of returning to the quality of life enjoyed with arthritis prior to the initial procedure two years earlier? “ Doctor, Can I have my arthritis back and the life I enjoyed prior to the knee replacement?” The latter is not an infrequent question that I have heard over my professional career.
Aging has normal physiologic effects and they affect sports for mature athletes. That aging also affects the activities of daily living of non-athletes. Basic Science principles now allow us to address age-related changes in bone, meniscus, articular cartilage, and the muscle tendon complex without surgery. What is the appropriate non-operative management of stages 2 and 3 arthritis owing to traumatic, degenerative and arthritic conditions? There is little question concerning a joint replacement for stage four debilitating arthritis when there is limited motion, instability and deformity. As well, there is an Appropriate Use Criteria to analyze the impact of arthroplasty and cartilage restoration/stem cell intervention. When there is no alternative, have a joint replacement; but failure results in a revision surgery at two years. There is an alternative for most; it is called Bone marrow Aspirate Concentrate/ Stem Cell intervention. The failure of such might lead to a primary joint replacement. To date, not one of my several hundred knee stem cell recipients have gone on to a knee replacement.
Tags: arthritis, bone marrow, Knee, Knee Pain Relief, Mature Athlete, Pain Management, Regenerative Pain Center, stem cells
Feb 6, 2014
There are several reasons behind the subject matter of this Blog. First, recent scientific studies have indicated that 2% of patients who have a joint replacement will have undergone a corrective revision within the first three years. Two percent isn’t a large number until it affects you. Approximately 20% of knee replacement recipients have significant pain and another 30 % fail to regain the desired motion confirming an earlier Canadian study in addition to those who fail outright at three years or less. Lastly, clinical studies at Regenexx have documented an average 15-point pain score improvement following a second stem cell intervention. Assume if you will that 100 points indicate a patient is pain free and prior to the Bone Marrow Aspirate Concentrate procedure, that patient had a score of 60. The average improvement after a stem cell procedure is to about 80 points. If you assume an additional 15 points will be gained by the second stem cell intervention, you will understand why I am writing this Blog.
We in the Regenerative Medicine world have been waiting a ruling by the DC Circuit Court regarding stem cell expansion and manipulation. The FDA allows Stem Cell intervention as long as those cells are not cultured or manipulated with external adjuncts. That is why we follow the Same Day Procedure in its present format. The Regenexx algorithm is FDA compliant. On February 5th, The DC Circuit sided with the FDA regarding stem cell culturing and manipulation with external agents. If you go stem cell “surfing” on the web, watch out for those sites marketing stem cell expansion and use of Adipose Derived Stem cells (SVF). I expect the FDA to go after several new SVF clinic networks within the year.
Meanwhile let’s return to the issue of a second stem cell intervention. If we can’t culture, we certainly may repeat. The Regenexx Data clearly support an average 15-point increase in a patient’s pain score when that second intervention is completed within a year of the index procedure. As many of my patients have experienced, to date, I have offered a booster PRP injection within three to six months when that patient wants more from the Same Day Stem cell undertaking. My approach has been helpful; although as of this time, I don’t know to what degree and for how long? For those contemplating a Bone Marrow Aspirate Concentrate minimally invasive treatment of an arthritic joint, be aware that there is now a way to predictably improve the ultimate outcome at 18 months with a second Stem Cell procedure.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, FDA, Mature Athlete, Microfracture surgery, Platelet Rich Plasma, Regenerative Pain Center, Regenexx, stem cells
Dec 30, 2013
What prompted the subject matter for this blog is the article appearing in the December 25, 2013 issue of the New York Times by Pam Belluck: Common Knee Surgery Does Very Little for Some, Study Suggests. What the writer is citing is a scientific article that appeared in The New England Journal of Medicine “suggesting that thousands of people may be undergoing unnecessary surgery”. The study reported from Finland recognized that about 80% of tears seen on the MRI of patients develop from wear and aging. In the study patients were randomized with some undergoing arthroscopy and the others having a sham operation. All received physical therapy. A year later, most patients in both groups felt the same.
Assume if you will that you are seen in my office for knee pain without a history of a major athletic trauma. My first question, “ Are you having mechanical symptoms; that is clunking, locking or giving way? Before I write the prescription for the MRI, a complete orthopedic history and a physical examination is performed. Our research at Regenexx has documented that the treatment recommendations for adult non-traumatic knee pain should be based on the history and the physical findings, not on the MRI alone. The physical findings of significance include the range of motion and the mechanical axis. Is the patient developing inability to fully straighten, symmetrically bend, bow leg or knock-knee? Next comes the request for the imaging.
Based on the results of history, physical examination and imaging, I propose a therapeutic approach almost always beginning with physical therapy. I might suggest an ultrasound guided cortisone injection to control discomfort for more effective PT. When the X-rays and MRI are reviewed, I more often than not will discover a torn meniscus of some type with degenerative arthritic changes elsewhere in the joint. The treatment will be directed to the entire arthritic process and not targeted to the frayed meniscus. That’s what I have been doing over the last ten years and that’s what the Finnish study confirmed is the correct approach. More likely than not, the next step will be a visco-supplementation program.
With an emphasis on advancing the care of the aging athlete, you will receive an informed consent regarding cellular orthopedics based on stem cells, should the aforementioned measures not succeed. While Regenerative Medicine is not presently indemnified by Medicare or the private insurer, compared to your anticipated out of pocket expenses in the new world of affordable insurance, your costs for symptomatic relief from arthritis while actually reversing the degenerative process will be comparable to that which you will have to pay for hospitalization or out of network care starting in 2014.
Having introduced the New Year, what are so exciting will be the next initiatives taking place in the processing of Bone Marrow Aspirate Concentrate. We now have the technology to increase the number of stem cells available by a 7X to 200X multiple via a revolutionary development of how we manage the bone marrow in the laboratory prior to injection into your arthritic joint. Have a happy and healthy 2014 and just call to learn more about advances in the aging athlete.
Tags: arthritis, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, Knee, medicine, Orthopedic Surgeon, Regenerative Pain Center, stem cells
Apr 9, 2013
Stem Cell intervention is increasingly offered by anyone and everyone with a license to practice. As of this time, there are no certifying bodies or residencies or Board sanctioned fellowships. In my blogs, I have attempted to educate the readers and keep them up to date. Most recently, I posted data pertaining to knee outcomes when compared to a knee replacement. For those of you who might have missed it, I used the standard 100-point Knee Society Assessment Score which all clinical researchers use to compare the results of a cohort of Total Knee Replacement recipients with the outcome of a similar cohort of patients whose arthritis at the knee was treated with Bone Marrow Aspirate Concentrate. Pre-operative, the KSS in the Total Knee Replacement group was 48 points, post-operative at one year, 80 points. You may compare that score with the preliminary sores of BMAC recipients. Pre-intervention, the mean Knee Society Score 68; Post-intervention, 85 and no concern about revision surgery. Only an orthopedic surgeon is trained to properly harvest stem cells from bone marrow and only the orthopedic joint replacement surgeon is experienced and equipped to provide the kind of data I am posting and will continue to publish.
Will the skiers, cyclists, athletes, fitness buffs be able to experience at year four that which they enjoyed at week four following a stem cell intervention at the arthritic hip, knee or ankle? The Outcomes work at Regenexx indicates a positive subjective response from over 70% of patients who underwent a SD Stem Cell procedure 28 months earlier. I am adding to the studies by collecting objective data. How might we improve the success rate and the durability of a BMAC intervention? It would seem the answer to that question is two fold and I have introduced two alternatives in my practice. Only time will tell the better alternative:
1) Should a BMAC recipient experience incomplete relief within four months or the return of symptoms within six months of the procedure, then a Platelet Rich Plasma booster makes sense.
2) Should a BMAC recipient not respond to the PRP booster then a repeat stem cell intervention makes sense.
In the upcoming weeks, I will continue to publish comparisons between the outcomes of BMAC intervention for arthritis and Total Joint Replacement. If you want to “stay active my friend”, give stem cells a chance.
Tags: arthritis, Osteoarthritis, Regenerative Pain Center, Regenexx, Regenexx-SD, stem cells
Feb 5, 2013
The Leading Physicians of the World
THE INTERNATIONAL ASSOCIATION OF ORTHOPEDIC SURGEONS RECOGNIZES
Mitchell B. Sheinkop, M.D.
As a
LEADING PHYSICIAN OF THE WORLD
&
TOP ORTHOPEDIC SURGEON AND REGENERATIVE ORTHOPEDIC SPECIALIST
IN CHICAGO, ILLINOIS
How Might You Need Stem Cells in 2013
Advances in the care of the aging athlete
Leading the News
40 years ago this week, I started practice at Presbyterian-St Luke’s Hospital in Chicago and became Director of the Orthopedic Residency Training Program, Head of The Children’s Orthopedic Program, and Head of the Orthopedic Oncology Program at Rush University having been recruited from the University of Chicago Hospitals. In 1979, I became a member of the team of three that introduced the cementless hip prosthesis into clinical practice in America. After 38 years of surgery and after having authored or co-authored almost 100 scientific articles, I graduated into non-operative orthopedics. In 2012, the next milestone was my embracing Regenerative Medicine, stem cell intervention in order to assist a patient in possibly avoiding or postponing a joint replacement. So what of the future?
Because of the snowfall, I will be able to go snowshoe running in Lincoln Park this afternoon, as weather has resulted in most of my patients rescheduling their office encounters for today. I return to ski in Colorado later this month and I look forward to the opening of Wisconsin trout season on the first Saturday in March. Should the snow melt and the temperature hit 45 degrees, I will be out cycling along the lake. The secret is out and now you know my interest in the aging athlete. I want to keep on going; come on along, join me.
The posting this weekend in the Testimonial section of the Web Site www.sheinkopmd.com suggests what is possible with stem cells. While the remote future will be based on tissue and stem cell engineering, those trials are being developed; the immediate future is based on Concentrated Platelet Rich Plasma (C-SCP), Bone Marrow Aspirate Concentrate (BMAC) intraarticular interventions and subchondal plasty with BMAC. I described the latter for Bone Marrow lesions (BMLs) seen on MRI in my Blog last week. In order to provide a more comprehensive explanation of the ongoing development within the field of Cellular Orthopedics, I will be expanding and continually updating my web site. On Wednesday, there will be a site visit from Regenexx while I perform a Same Day (SD) Bone Marrow Aspirate Concentrated stem cell intervention in three patients including an arthritis of the hip candidate, an arthritis of the knee candidate and a carpal instability at the wrist candidate. In addition, there will be an ultrasound guided PRP injection of the ankle for a patient with a fracture at the ankle seven months ago presenting with a osteochondral fracture at the dome of the talus and a “High Ankle Sprain”.
The Blog next week will feature other stem cell orthopedic interventions that might be of interest in 2013. “Keep going my friend”.
Tags: arthritis, athletes, Knee, medicine, Microfracture surgery, Osteoarthritis, Regenerative Pain Center, Regenexx
