Jan 3, 2013
Last week, I happened on a patient for whom I had performed both a hip and a knee replacement some years back. The patient looked at my graying hair, the wrinkles on my face, sized me up and asked “are you retired?” It is an ever-increasing happening in my daily routine. Even though I am healthy and quite active, the usual and customary for an orthopedic surgeon after many years of practice is to burn out so the question is not without a precedent. My response, “ I have moved on and I now offer a minimally invasive technique through Cellular Orthopedics that might or could avoid a major orthopedic surgical procedure” What followed: “What is that?” I went on to explain as best I could.
Application of Mesenchymal Stem Cells in Regenerative Medicine
Cellular Orthopedics or Regenerative Medicine mainly includes two different strategies of cell-based therapy. In the first approach, cells are applied to substitute damaged cells within a tissue to reconstitute its integrity and function. During this procedure called “cell therapy” a cell suspension is simply injected into the damaged tissue. The second approach called “tissue engineering” is more complex. Here, cells are combined with a three-dimensional matrix to compose a tissue-like construct to substitute lost parts of the tissue, or even whole organs
Participation of Mesenchymal Stem Cells in Tissue Regeneration
Mesenchymal stem cells have the ability to migrate being attracted by cellular signals (chemo tactically) to tissues showing inflammation and injury in the body Besides their unique ability to differentiate into different cell types, mesenchymal stem cells secrete a variety of cytokines, showing anti-inflammatory activity and create an anabolic microenvironment. Furthermore, direct cell-cell contact (immunomodulation) also takes place. Thus, they participate in regeneration of injured tissues in different ways. On one hand, they directly differentiate into tissue-specific cells and thus substitute damaged or lost cells. On the other hand, they indirectly influence tissue regeneration by secretion of soluble factors. Thirdly, they are able to modulate the inflammatory response. Thus, they can promote new blood supply (vascularization,) cell proliferation, differentiation and modulate an inflammatory process As I have previously described in my Blog, Osteoarthritis is not limited to the joint cartilage but is an inflammatory cascade resulting in limited motion, swelling, loss of articular cartilage, pain, and altered functional capacity
I call attention to this new world of Cellular Orthopedics not because I can promise results but because non-surgical options are now available and may add dramatic advantages over a joint replacement. It is a process for deploying good treatment with ever improving smart strategies
Tags: arthritis, Regenerative, Regenerative Pain Center, stem cells
Jul 10, 2012
Up until now, I admit that for the most part, everything I have reported about Regenerative Medicine was based on what I had learned at medical meetings or read in the scientific literature. After all, when a patient sees an orthopedic surgeon, treatment options and informed consent are based on scientific data gathered in academic medical centers and dispersed though continued medical education initiatives. By now the reader familiar with my Blog knows I played a major role for more than three decades in gathering the data which was used around the world to help an orthopedic surgeon advance a treatment modality for a patient with an arthritic hip or knee. My outcomes observations and scientific teachings and writing still play a major role in the informed orthopedic consent process and orthopedic decision making. Then I retired from surgery; and thereafter, for a time, I became lost in the woods, entered the world of regenerative medicine, and became dependent on others as how to manage a patient with arthritis.
The drought has ended, I am initiated. Goodbye Rustoleum. My first cohort of patients who have undergone regenerative medical procedures using either Concentrated Stem Cell Plasma or Bone Marrow Aspirated Stem Cell Concentrate are returning for outcome surveillance. I am now able to share with you some very,very preliminary observations; but they are mine and not those of others. There are not too many orthopedic surgeons who can report about regenerative medicine and arthritis from actual clinical usage; most will tell you “not yet”.
Of the 22 patients treated over the past five weeks, two report some residual discomfort. Those two report marked diminution of the pretreatment arthritic pain. The others call or respond not because of pain, but rather the absence of their chronic pain. No one was prepared for such immediate improvement. Certainly these are exceedingly early observations but I think the initial anxieties of all 22 have been assuaged. No infection, no blood clots, no scars, no worry about surgical revision, no hospitalization, no bridges burned , NO PAIN!!!!!!!!!!!!!!
This cohort will be studied and followed as closely as possible to see how each patient responds over the next five years and I will periodically update you with their results. I will report how long the pain is controlled, how their motion improves, how many return to their sought after recreational endeavors and if there is a need for a total joint replacement. Over the next year, I can determine if there is any joint remodeling on X-ray or MRI.
Three are already back to cycling.
Short term anti inflammatory or longer term influence on joint remodeling, time will tell?
Mitchell B. Sheinkop, M.D.
312-475-1893 or 312-475-1893
1565 N. LaSalle Street . Chicago . Illinois . 60610
Tags: Bone Marrow Concentrate, Interventional Orthopedics, Regenerative Pain Center, stem cells
Jun 28, 2012
This past weekend, I had chance social encounters with two patients, not mine, unhappy with the outcome of their joint replacements. Their painful prostheses behaved no different than the patient with chronic osteoarthritis: swelling, limited motion, limp. Might stem cell management with an appropriate postoperative rehabilitation regimen have given the joint a better chance at remodeling and avoided a painful total joint?
We continually seek better mechanical and biologic approaches to osteoarthritis prevention and treatment. It is now known that following high-energy joint injury, articular remodeling can be promoted through distraction and motion of cartilage surfaces. Papers presented at the International Cartilage Repair Society -Montreal-May 12-15 confirmed that altered motion and loading might really make a difference in treating end stage osteoarthritis. Equally important though, what about the pain generators in OA?
- Loss of articular cartilage (bone on bone)
- Synovitis (chronic inflammation)
- Flexion contractures (loss of motion/capsular compliance)
It is paramount that the physician managing your arthritis try to understand all pain generators in a joint and optimize the joint environment prior to surgery, during the surgery or using stem cells in lieu of surgery. First, the joint volume and capsular compliance need be addressed. Second, the inflammatory burden need be minimized. Last, mal-alignment need be neutralized. I will stress over and over that the data to support my treatment algorithm must be increased via outcome surveillance. That data can only be gathered through clinical practice. Based on what we have learned in managing arthritis with stem cells over five years, there is data to support the reversal in loss of articlular cartilage, eliminate inflammation and increase range of motion.
Prior to undergoing a bone marrow aspirate concentrate procedure, the patient is directed to physical therapy. In the case of a knee, an offloading brace is prescribed. After the procedure, protected weight-bearing, range of motion exercising and gradual strengthening is introduced. The stem cells altering the bio-immune environment inside the joint might be the alternative at eliminating pain generators and postponing or even avoiding the joint replacement
Mitchell B. Sheinkop, M.D.
312-475-1893 or 312-475-1893
1565 N. La Salle Street . Chicago . Illinois . 60610
Tags: Hip Replacement, Interventional Orthopedics, Microfracture surgery, Orthopedic Surgeon, Orthopedics, Regenerative Pain Center, stem cells
Jun 12, 2012
Orthopedic Care of the Mature Athlete
Will stem cells work in relieving the pain from an arthritic joint; that is the question? A patient read my blog and called to discuss his experience with the orthopedic surgical community. Since his is not the first time I came across opposition to Regenerative Medicine, I thought I would focus on that resistance this week.
An orthopedic surgeon is just that, a surgeon. Usually trained with a major emphasis on surgical technique and evidenced based medicine, it is difficult to foster change within the orthopedic community. I should know as I practiced orthopedic surgery for 38 years developing that surgical technique in the joint replacement sub specialty and doing the clinical research that led to the evidence forming the basis of modern hip and knee replacement surgery. During that era, I also noted the failures of joint replacement and other adverse outcomes so I started seeking an alternative to joint replacement, basically a biological arthroplasty.You better believe the orthopedic community has not rapidly adopted this latter concept in theory. Yet, orthopedic surgeons have been attempting cartilage restoration for over seven years and actually informing the surgical candidate about stem cell treatment of arthritis every time they performed an arthroscopic micro fracture. The Arthroscopic Package for the injured or arthritic joint includes micro fracture. The explanation behind the technique of micro fracture is that one is allowing a patent’s own adult mesenchymal stem cells to migrate from within the bone marrow to the joint by creating multiple small holes in the diseased cartilage communicating with the marrow. The only problem with the hypothesis, no matter how enticing, is that by time a patient reaches the age of 40 to 50, there is no active marrow remaining near the knee and very little remaining at the hip or the shoulder. Why not then, harvest bone marrow from the pelvis where it is plentiful at any age, filter out the stem cells and concentrate them followed by reinjection after the micro fracture? It makes all the sense in the world, is worthy of clinical trial and outcomes surveillance, and does not make the Arthroscopic Package much more complex.
In my attempt to overcome the negative reaction of the orthopedic clinical community to my Regenerative Medicine initiative increasingly made known to my patients, I sought the guidance of the leader of a think tank and a mentor, Chef.
Dr Sheinkop: “How do I overcome resistance to my procedure of the future when the orthopedic surgeon has been using it for over five years?”
Chef: ” Forget all that genetic engineer whoosa-fudge…….if you want to combine a pig and an elephant, just get them to make sweet love”
Dr Sheinkop: “The orthopedic surgical community will never accept a non operative approach to the management of arthritis if it threatens a decrease in the number of procedures.”
Chef: “Sure they would but you’re gonna have to get’em in the mood”
In August, I have been invited to speak before an orthopedic audience for the first time to share my earliest observations regarding response to stem cell management of arthritis. Two weeks ago, I did my first case; last Wednesday, I did three. It won’t be a series on which to report but I certainly will have something new to share. The Reality show to be continued.
Tags: Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, Knee, medicine, Orthopedic Surgeon, Orthopedics, Pain Management, Regenerative Pain Center, stem cells
May 31, 2012
It has been said, you never forget the first time and Wednesday was that day. To the best of my knowledge, it was the first time in the Midwest that bone marrow aspirated and concentrated was used in an attempt to manage the pain and impairment secondary to an arthritic hip. The patient, in his early 50s, had previously undergone hip surgery on the left side and was seeking to avoid replacement of the other hip. I am the surgeon who performed his left hip replacement. He had followed my blog over the past several years where I began focusing on regenerative medicine for the management of arthritis. For 37 years, I had replaced hips and knees. When the pain and physical impairment had reached a point as to alter his athletic profile, his work related activities and his activities of daily living; he sought out my assistance again. This time though, in an attempt to maintain and perhaps restore his joint as contrasted to the last time, when I had replaced his hip joint.
After multiple office visits, examinations, documentations and repeated informed consent, the patient arrived at the surgicenter on Wednesday morning. I had dedicated over two years in preparation. He was anxious as was I; the first time, the initiation, the kickoff. Following registration and administrative perfunctory, he was taken into the surgicenter room and placed on a fluoroscopy table, resting on his belly. After scrubbing the low back and pelvis followed by sterile draping, under local anesthesia, using both sides of the back of the pelvis, I harvested 60 CCs of marrow following the algorithm of Regenexx. This was then taken to our lab for concentration and removal of everything but the autologous adult, mesenchymal stem cells; the latter were then transferred under sterile conditions into a 4 cc syringe. 45 minutes following the aspiration of the bone marrow, with the patient now on his back, fluoroscopic guidance was used for positioning those cells within the right hip joint between the femoral head and acetabulum. There are many other small steps to the process including the use of heparin; and following the administration of the bone marrow concentrate, administration of stem cell plasma (PRP). It all went as planned. The patient was taken to the recovery room and sent home with a set of crutches about three hours after he had arrived.
No significant pain during or after, but stay tuned. The patient will be seen next in six weeks with a return to work this Monday and a gradual resumption of physical activity. I will allow him to return to senior ice hockey at three months. The adage is one case does not make a series but we are off to a great start. Will it eliminate pain, restore motion, allow for return to full athletics, postpone or avoid a joint replacement? As in a realty show, stay tuned.
Tags: Bone Marrow Concentrate, Regenerative Pain Center, stem cells, treatment
