My goal is to inform each and every patient who presents with a painful joint, the cause of their pain; and based on our scientific and clinical evidence, that intervention which will have the greatest chance of short term and long-term success. While inflammation in the joint is a proximate cause of pain, that pain is not generated by cartilage deterioration as cartilage doesn’t have a nerve supply. While joint pain in part is generated by the synovial tissue lining the arthritic or traumatized joint, the subchondral bone supporting the joint may be even more important when it comes to the pain and limitations resulting from the arthritic affliction.
Bone pathologies resulting from acute or chronic injury presenting as bone marrow lesions associated with insufficiency fractures, persistent bone bruises, osteoarthritis and early stages of avascular necrosis are too often neglected by those holding themselves out to be regenerative medicine specialists. Options for the treatment of these subchondral conditions require a core decompression of the problematic bone and direct application of either bone marrow aspirate or a synthetic orthobiologic. The biologic treatment of bone marrow lesions with these techniques that encourage physiologic bone remodeling and repair when combined with Stem Cell and Protein/Growth Factor concentrates into an arthritic joint offers the best chance for joint preservation and a successful outcome for the patient undergoing a Stem Cell procedure.
Are there Stem Cells in Cord Blood, Wharton’s Jelly or Amniotic Fluid? These three alleged sources of Stem cells are processed when collected. The tissues are then cryopreserved with DMSO or some other cryopreservant. When thawing takes place, the few cells contained do not survive the thawing process. Additionally, DMSO is cytotoxic, a cell killer at room temperature.
As many of my patients are aware, I began my Cellular Orthopedic journey some years ago as an early member of the Regenexx Network. While my personal and practice ethos as the only orthopedic surgeon caused me to leave the network, I still follow the Blog and I find the one posted today most appropriate.
I was on a local radio show this week and a woman called in and claimed that she had been defrauded by a local chiropractic clinic. She paid big bucks for what she was told were “millions of young stem cells” injected intravenous. As I will show you this morning, as a medical expert in this area, I can show you that she is more likely than not the victim of consumer fraud. Let me explain.
The Problem of the Chiro Clinic Bait and Switch
I’ve blogged extensively about how chiropractic, acupuncture, naturopathic, and some physician clinics are defrauding patients by claiming to inject millions of live and young stem cells from amniotic fluid or cord blood (or other products). The problem is that none of these 361 registered tissue products has any significant number of live stem cells.
Tags: ACL Injury, bone edema, bone lesion, bone marrow, Cartilage, chondromalacia, chronic pain, Cord blood, cryopreserved, Hip, joint pain, joint replacement, Knee, meniscus tear, naturopathic, Osteoarthritis, osteochondral defect, regenerative medicine, shoulder, stem cell, subcondral bone
The holiday season is here and along with it, the customary retrospectives and predictions. Here in Chicago, we could look back at the weather a week ago or look forward to the opening of the Western ski resorts and the new opening date of trout fishing in Wisconsin’s Driftless area on January 2nd. For those who want to cycle through the winter, the choice is spin class or the new world of winter friendly bikes. Whatever your interest, be it indoors or outdoors, you need not be limited by arthritis. The new world of Regenerative Medicine and Interventional Orthopedics offers pain relief, improved function, better motion and a maintenance or return to an active life style. Vail opened on November 20, and my wife and I will soon be there for a tune up. Over the Thanksgiving weekend, I will be shopping for the winterized bike and we are scheduling a fly fishing outing to Wisconsin sometime during the first two weeks in January. While it seems strange to think of trout fishing in the winter, the notion of a reason for a snowshoe hike is new and stimulating.
Last week, along with the follow-ups and new patients, two individuals exemplify what Bone Marrow Aspirate Concentrate/ Stem Cell interventions make possible. A 67 year old man with an osteoarthritic knee works in heating and air conditioning; wherein as part of his job description, he climbs ladders while occasionally squatting and kneeling. While he plans to retire at age 70, he doesn’t want to take on the risk of a knee replacement adverse outcome now nor does he want to take up to three months post operative for rehabilitation. After my evaluation and review of images, he elected to schedule an Orthopedic Cellular intervention with the plan to return to a minimum demand work profile for four to six weeks following the intervention; but only one week away from work. The patient is aware he may still come to a joint replacement; but if he does, it would be well after retirement.
The second patient was a 70 year old man, who had been scheduled for a shoulder replacement and a hip replacement. The appointment was really for his wife; but while he was in the office, after hearing my informed consent for his wife’s knee; he requested my input after examining him and reviewing the fact that he didn’t want to lose a winter of skiing. When all was said and done, he scheduled a Bone Marrow Aspirate Concentrate/ Stem Cell intervention to his shoulder and hip, cancelled his hip and shoulder replacements, and booked his winter travel to Beaver Creek.
The above are examples of what is possible with Interventional Orthopedics. Before closing with a customary wish for a Happy Thanksgiving, let me share how I have been regenerated by a knee intervention. In anticipation of a full house over the holidays, I spent three hours, Saturday afternoon on my hands and knees scrubbing the kitchen floor with a microfiber cloth and a 10% solution of vinegar.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, shoulder, stem cells, treatment
In both the shoulder and the hip, there is a structure called the Labrum that since the introduction of the MRI and the arthroscope, has received exponential surgical attention. In the hip, the acetabular labrum is a ring of cartilage that surrounds the socket of the hip joint. Its function is to deepen the acetabulum and make it more difficult for the head of the femur to slip out of place. At the shoulder, the Glenoid Labrum is soft fibrous tissue that surrounds the socket to help stabilize the joint. Injuries to either structure may occur from acute trauma, repetitive impingement or as part of the degenerative osteoarthritic process. Symptoms of a tear in either location include pain, may be mechanical in nature (catching, locking, popping, or grinding), a decreased range of motion and loss of strength.
Herein is the diagnostic and therapeutic dilemma; does the orthopedist address the history and physical examination, the results of imaging, all of the above or some of the above? On the one hand, it has been clearly established both at the shoulder and at the hip, labral injury as demonstrated on the MRI or CT arthrogram may not be the source of the pain. If the problem is pain and there are arthritic changes in the joint, the results of arthroscopic surgery are poor. Even when there are mechanical symptoms such as catching, locking, grinding and popping, arthroscopic clean outs do not succeed in the presence of arthritis. When it comes to the shoulder, the arthroscopic attempt at repair of the labrum as part of the rotator cuff injury has only a 50% success rate. Even when done correctly, poor patient selection and complications can be devastating resulting in injury to cartilage, injury to bone, and chronic irritation of the joint lining.
Assume if you will that a 45 to 55 year old or even older patient presents with pain in the shoulder or hip. The MRI is interpreted as compatible with a labral tear. There is an option which may very well eliminate the pain and affect healing of the torn structure, Bone Marrow Aspirate Concentrate followed by physical therapy. The procedure is done with a needle and not a scalpel; the complication rate in my experience is extremely low and the success rate extremely high. Let me cite an example of a patient who presented at age 67 with bilateral chronic shoulder pain for which he had undergone multiple prior attempts at arthroscopic surgical remedy. Four months after having undergone bilateral Bone Marrow Aspirate Concentrate Stem Cell intervention, he is off his chronic opiate containing pain medication and playing golf while having returned to his unlimited fitness routine. This is only one success story, there are many more. If you want to learn more about the potential options for your painful shoulder or hip, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, shoulder, stem cells, treatment, Ultrasound Guided Injection
We are dealing in a field of science that aims to restore or establish normal functional capacity and eliminate, certainly reduce pain from arthritic inflammation by replacing or influencing human cells. Advances in cell biology have led to new options for cellular therapies and new strategies to stimulate endogenous repair and regeneration. Stem Cell populations have been identified in perinatal and adult tissues including amniotic fluid, placenta, bone marrow, and blood vessels. The US Department of Health and Human Services, in its report “2020: A New Vision-A Future for Regenerative Medicine” published in 2006, calls regenerative medicine “the next evolution of medical treatments” and predicts that regenerative medicine will be the “vanguard of 21st century healthcare.”
So what about costs and reimbursements? Government has made it clear that there is a relative lack of clinical science in this area and it will not pay at this time. We at Regenexx are making progress in gathering data and educating our patients and the medical profession as how to postpone or perhaps eliminate the need for a joint replacement when the symptoms and functional limitations of arthritis affect an individual. We believe that our data documents that Bone Marrow Aspirate Concentrate does reverse the course of osteoarthritis, relieve symptoms, restore function and allow the patient an improved recreational and athletic capacity. As an orthopedic surgeon dealing with a mixed patient population, I strive to deliver what matters most and that which will make the most profound difference in a patient’s life. First and foremost is the history and physical examination in the office. I won’t treat an image. For instance, a study presented at the recent Annual Meeting of the American Academy of Orthopedic Surgeons found a high incidence of Superior Labral Tears diagnosed by MRI in patients without shoulder symptoms or functional shoulder limitation. While the image was abnormal, the patient wasn’t limited in any functional way nor did they have a shoulder related complaint.
This morning, I am working on the scientific paper, I will be delivering at the June Meeting of the Ortho and Biologic Institute which is attended by the majority of scientists and clinicians involved in skeletal muscular Regenerative Medicine. It will scientifically and statistically document our successes; at Regenexx, we integrate clinical care with research and education. It is evidence based medicine helping to mold the future of Regenerative Medicine.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, FDA, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenerative, shoulder, stem cells, treatment
With all of our attention directed to arthritis, patients need to be reminded of the continued successes we are experiencing when using Bone Marrow Concentrate in fractures that fail to heal. When a fracture fails to heal in the expected average time, that is a Delayed Union. When it looses the ability to heal all together, that’s a Non-Union. The reasons that a fracture might fail to heal are beyond the scope of this Blog but non-union is not a rare complication. Areas of predilection toward difficulty in healing have to do with blood supply. The upper end of the femur (hip), navicular bone at the wrist, upper end of the humerus (shoulder), and clavicle as well as the tibia are areas of predilection. Historically, the only remedy has been a major operative procedure and even at that, there is a high failure rate with multiple complications including infection. It has been said that the only thing worse than an infected non-union is cancer. Let me share with you the story of two recent patients for whom I successfully intervened with Bone Marrow Concentrate when prior attempts at achieving fracture healing, one through surgery had failed.
VDVR is a 46-year-old woman who ten years ago sustained multiple fractures to her spine and lower extremities while serving in Iraq. She had undergone numerous surgical procedures, all successful except the inability to cause healing of fractures to her left calcaneus and talus. She had been left with Oxycontin addiction and crutch dependency. After several further orthopedic consultations she had a choice of amputation or more major surgical repair attempts with only 50% chance of success. Twelve weeks ago, I performed a Bone Marrow Concentrate/ Stem Cell intervention to her left calcaneus and talus. Last week she called and indicated she no longer required narcotics and could walk without crutches. The X-ray I received a day or two after the call was indicative of fracture healing.
JM is a 76-year old man with an established non-union of the left clavicle, of several years duration. He was experiencing arthritic changes in his left shoulder and asked me to try and achieve healing of the clavicle, even after several years while I was injecting Bone Marrow Concentrate into his arthritic left shoulder. About 16 weeks ago, I completed a stem cell intervention to his left shoulder and into the area of non-union of the outer one-third of the left clavicle. When I saw him in follow-up last week, the collarbone was completely healed. He had been afraid to undergo a surgical repair because of the high incidence of infection, failure and neurovascular injury associated with surgery of non-union at the clavicle.
These are but two illustrations of what is happening in the new world of Cellular Orthopedics. The initiative is gaining traction in the orthopedic world as I more and more success stories are realized
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Fracture, Interventional Orthopedics, Non-Union Fracture, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, shoulder, stem cells, treatment