Oct 18, 2018
We are speaking of stem cell therapy integrated with clinical research, and the resultant evidence-based stem cell intervention. Osteoarthritis is becoming more prevalent as I am seeing younger patients with arthritis as a consequence of sporting injuries such as ACL tears. The baby boomer population is experiencing accelerated onset of arthritis; their joints are prematurely aging in large numbers. At the same time, the master population is aging and living longer. As a result, I continually research biologic interventions to best address the ever-increasing number of those effected.
Why should a patient choose an orthopedic surgeon to manage their Osteoarthritic related symptoms and functional impairment? Our world is evidence based.
Study Observes Better Outcomes for OA Patients Treated by an Orthopaedic Specialist
In a retrospective study published online in BMC Musculoskeletal Disorders, shoulder osteoarthritis (OA) patients received faster and more invasive treatment when they received a new diagnosis from an orthopaedic specialist (OS) versus a nonorthopaedic physician (NOP). Patients with shoulder OA (n = 572) received care from either an OS (n = 474) or NOP (n = 98) on the date of their index shoulder visit. OS patients received their first treatment significantly quicker than the NOP cohort (16.3 days versus 32.3 days, respectively). The OS group also had higher rates of operative treatment within one year following their initial visit.
Study: Patients Report Similar Improvements for Nonobstructive Meniscal Tear with PT and Early Surgery
Physical therapy (PT) may not be inferior to early operative treatment of arthroscopic partial meniscectomy (APM) for improving knee functionality in patients with nonobstructive meniscal tears, according to a study published online inJAMA. The randomized clinical trial included 321 patients with nonobstructive meniscal tears aged 45 to 70 years who were treated at nine hospitals in the Netherlands between July 17, 2013, and Nov. 4, 2015. Patients were treated with APM (n = 159) or a predefined PT protocol (n = 162) that included 16 exercise therapy sessions over eight weeks. PT sessions focused on coordination and closed kinetic chain strength exercises. At 24-month follow-up, knee functionality in the PT group improved by 20.4 points compared to 26.2 points in the APM group. The difference did not exceed the noninferiority margin.
In order to maximize the benefits, Orthobiologics, that is stem cell therapy must be integrated with clinical research, and the resultant evidence-based stem cell intervention followed long term. In my practice, I am researching biologic interventions to address the ever-increasing number of those effected, not one and done. To learn more or schedule a consultation, Call (312)475-1893. You may visit my web site and read my blogs at www.sheinkopmd.com
Tags: ACL tear, arthritis, Cartilage, cellular orthopedic, joint pain, joint replacement, knee pain, MCL tear, meniscus tear, menisectomy, orthobiologics, orthopedic surgen, Osteoarthritis, Physical Therapy, PRP, regenerative medicine, stem cell
Sep 13, 2018
I rode my bike this past Saturday and Sunday through the Chicago Forest Preserve bike trails and I had some time to reflect. Just as in fly fishing, cycling is meditation time. I tried to answer questions that came to mind such as how could Abraham have fathered both Izsak and Ishmael in his late 90s? Was it the triumph of stem cells or something more? I reflected on this through the Monday service without resolution other than we are still dealing with the ramifications.am
On Tuesday morning, the usual and customary ad in the Chicago Tribune paid for by the Stem Cell Institutes of America appeared inviting readers to a seminar to learn more about their approach to pain from arthritis and assuring the reader that their techniques are FDA compliant. Their approach is based on Amniotic Fluid injection. What I do know is FDA compliance requires that the stem cells must be yours (autologous) and that amniotic fluid once processed, sterilized, frozen and fast thawed has no viable stem cells. I also am cognizant of the large body of scientific evidence supporting the notion that pain of arthritis is generated by the supporting bone as cartilage has no nerve supply. How does a single and costly injection of amniotic fluid result in long term benefit? I have to deal on a daily basis with the fallout of this marketing campaign.
Next the Wednesday, September 12, addition of the Chicago Sun Times carried an ad sponsored by The Pain Relief Institute headlining Stem Cell Recruitment. As I understand the approach, Amniofix, a placental derivative, micronized, is reconstituted and injected into the arthritic joint. Reader please note that the first bullet states “FDA Regulated”. Of interest is the fact that I refused and still refuse to use Amniofix in my practice as there are no evidence based clinical trials to support any clinical claims. Those trials are taking place now. Amniofix is a product rushed to market before there was scientific proof to support use. You may learn more about Amniofix by searching the product online. If you don’t count cells with a hemoanalyzer, how could you know what is being “recruited”?
My commitment is to stand up for my patient in this regenerative medicine chaos. I resolve to do better in the upcoming year with introspection and ongoing review of the discipline.
With best wishes for a happy and healthy 5779
You may visit the website at www.sheinkopmd.com
Schedule an appointment by calling (312) 475-1893
Tags: amniofix, amniotic fluid, autologous, cellular therapy, FDA, regenerative medicine, stem cell
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 8, 2018
Last week, I assessed three different patients for Cellular Orthopedic joint restoration; and each patient asked about the reason behind my fee schedules? One patient had told me of a friend who had attended a seminar by the Stem Cell Institutes of America and who was quoted a fee somewhat lower than my charges. As I have previously emphasized, the Stem cell Institutes of America use Amniotic Fluid that is concentrated and once processed and thawed, has no viable stem cells or regenerative potential. There may be proteins that survive but basically, a patient receives an injection of hyaluronic acid that cushions the joint for up to six months at best and for which there is no supportive outcomes data.
The second patient had been quoted a fee for cord blood. The latter is provided in frozen form and much of the value is lost during the thawing process. While significantly less costly than a bone marrow concentrate and growth factor concentrate intervention, there is no outcomes data to support usage. The FDA has warned against the use of “stem Cells” derived from anyone or anything other than your own (autologous). So if amniotic fluid and cord blood did deliver viable stem cells, their use would be contrary to FDA guidelines; but let’s move on since neither has living cells when thawed.
Then there are the adipose derived globules, notice I didn’t use the term stem cells. Fat globules are prepared after liposuction and the fat is mechanically broken down but the stem cells aren’t released. In order to release stem cells from the fat, the tissue has to be treated with collagenase. The FDA prohibits use of collagenase in fat unless it is for a cosmetic indication.
My knowledge base is the result of first having completed three clinical trials using Amniotic Fluid for arthritis and in each trial, the outcomes were not satisfactory after six months. I next traveled to Southern California to investigate cord blood. I was skeptical at best but tried the product in three knees, all with very unsatisfactory results. Two years ago, I completed a clinical trial on a mechanically derived adipose based product; the manuscript for that study was accepted by highly regarded orthopedic journal and will be published later this year.
When all is said and done, you may save money with the bottom feeders who advertise and market without data or outcomes to support their claims or you can avail yourself of my knowledge, expertise and statically proven outcomes. To schedule a consultation, call 847 390 7666. You may visit my web site at WWW.SheinkopMD.com
Tags: amniotic fluid, Cord blood, joint pain, joint restoration, regenerative medicine, stem cell
