Osteoarthritis of the knee is one of the leading causes of functional limitation and progressive deterioration in the quality of life. Nonsurgical treatment of the osteoarthritic knee has been the usual and customary weight reduction directive, recommendation for physical therapy, prescription for non-steroidal anti-inflammatories, followed by injections with corticosteroids and hyaluronic acid. The goal is to reduce pain and improve function but the classical non operative approach is not universally successful or long lasting. Alternatives are continually sought to provide pain relief and improve functional outcomes.
Recently, there has been a major initiative to introduce Amniotic Fluid in the treatment of the osteoarthritic knee. Allograft (from a third party) amniotic tissues have a long history of clinical use having been first reported in 1938. It is thought to be a homologue to synovial fluid, acting as a cushion to protect and lubricate in the closed environment of the knee. A recent study measured the safety and efficacy of processed allograft amniotic fluid in treating osteoarthritic knees using common, validated outcomes measurement tools. In the registry review, early outcomes suggest that the use of processed amniotic fluid allograft may offer a safe and effective treatment for OA of the knee for 90 days. The suggestion is that this treatment may be more durable than single corticosteroid injections and perhaps hyaluronic acid treatments. The study providing the background for this blog is still in progress. Of interest is the fact that no claim is made in the article supported by the pharmaceutical company that amniotic fluid is chondrogenic or contains stem cells. The latter is an extremely important consideration; beware of those who promote amniotic fluid on their web sites as providing viable stem cell content. As of this time, while amniotic fluid may contain cytokines (anti-inflammatories) and growth factors, it is only to be considered in the same category and comparable, perhaps longer lasting than a corticosteroid injection or a hyaluronic acid intervention.
The standard of Regenerative Medicine and Cellular Orthopedics remains Bone Marrow Aspirate Concentrate as the best source of anti-inflammatory cytokines, growth factors and only FDA approved source of viable adult mesenchymal stem cells. In spite of the FDA approval mandate, as recent as this morning, I received an invitation to attend a course that would teach me how to use adipose derived stem cells in my practice. Let me emphasize two points, Amniotic Fluid does not have viable stem cells until proven otherwise and adipose derived stem cells are illegal for use in the musculoskeletal system. That being said, even if adipose derived stem cells were FDA approved and thus available; bone marrow aspirate concentrate provides the Cytokines and the growth factors not found in fat while bone marrow aspirate concentrate provides stem cells not found in processed amniotic fluid.
Tags: Amniotic, arthritis, athletes, bone marrow, Bone Marrow Concentrate, Clinical Studies, Concentrated Stem Cell Plasma, FDA, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, stem cells, Synvisc, treatment
It starts with an evaluation, a Bone Marrow Aspirate Concentrate intervention, a custom brace, and sports specific physical rehabilitation protocol that changes with the seasons, a nutritional consultation, a dietary supplement prescription, and a Concentrated Platelet Rich Plasma/Lysate Booster when appropriate. That’s my recommendation for hiking, biking, climbing, skiing, staying fit and fly-fishing. These far reaching futuristic statements are based on my clinical research, anecdotal observations on patients who join me in the aforementioned activities and my own lifestyle. Should your impairment return once you are a Sheinkop alumnus, or should you see an increase in arthritic related symptoms, do it again in a year or five.
You are what you eat is in part a truism. So too, you can be what you want to be. Sure we age and sure we all have to live with age related adjustments; the answer is not to quit. Take my prescription for maintaining or returning to the active life. To learn more, call for an appointment. As an example, we have changed our visco-supplementation formula because of a new development to one injection rather than three. We have improved our Platelet Rich Plasma formula to be much more effective than last year and we are constantly updating our Bone Marrow Concentrate formula.
So what’s in the Cellular Orthopedic news? “Novel Technology to increase Concentrations of Stem and Progenitor Cells in Marrow Aspiration.” Headline this weekend and I looked into it further. After all, I have a responsibility to my patients to stay in the forefront of new developments. As I delved further, I found that this “advanced” technology was tested on three patients before being brought to market. My analysis of this “breakthrough”, come back when you are for real. Then came the Alpha 2 Macroglobulin filter positioned to compete with Platelet Rich Plasma methodologies. The cart was put before the horse on this one, as we don’t even know if Alpha 2 Macroglobulin will work on a human. Then there is the Hip-Spine connection; but I will save that for next time.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, Knee Pain Relief, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, Synvisc, treatment
From time to time, I consult with patients who just don’t meet the inclusion criteria regarding Bone Marrow Aspirate Concentrate intervention for arthritis. At the same time, some of those patients are so pharmacologically dependent owing to medical conditions demanding maintenance that I am unable to offer them autogenous hope from their own Platelet Rich Plasma or that which may be created from a patient’s own platelets. While in the minority, as an orthopedic surgeon offering Cellular Orthopedic interventions for arthritis in those unable to undergo a joint replacement wherein the internist deems the procedure unsafe or who seek to avoid or at least postpone a joint replacement; weight loss, physical therapy, cortisone injection and visco-supplementation are short term fixes and not necessarily without potential risks. The real damage to stem cells from cortisone injections became the subject matter of several recent scientific publications. First no harm is what I was first taught in my orthopedic training.
Over the past several months, I have sought treatment alternatives for patients as described above; not candidates for current interventions with standard autogenous procedures. Enter the new alternative, allograft. Derived from Amniotic Fluid, the intervention is FDA approved, safe, and in some cases, even covered by third party indemnification. There are many companies offering this treatment alternative and I am investigating the multiple options. Please be aware, amniotic fluid alternatives are not a substitute for Bone Marrow Aspirate Concentrate derived stem cells ; but there may be a place for this anti-inflammatory alternative when established Cellular Orthopedic options can’t be used in an arthritic because of medical co-morbidities such as heart disease, chemotherapy, kidney disease, liver disease, obesity, Diabetes, etc, etc, etc. Amniotic Fluid usage in Orthopedic is not new; there are publications dating back to 1938 in the orthopedic scientific literature. It wasn’t though until the last five years evidently that allograft investigation led to the development of currently available products.
If you fall into the category of patients who do not meet the inclusion criteria for Bone Marrow Aspirate Concentrate or in whom your Platelet Rich Plasma would not be a suitable alternative, you may be a candidate for Amniotic Fluid Concentrate intervention. Under certain circumstances, the allograft may be covered by your insurance. To learn more, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Osteoarthritis, Pain Management, Regenerative, stem cells, Synvisc, treatment
I had pain with each step I took. I tried cortisone, Synvisc, Voltarin, with little to no relief. I researched all available surgeries and felt uneasy about their shortcomings and risks. I have been active and healthy all my adult life participating in racquetball, running, cycling, golf, and snowshoeing. To think it came to a point where I found it difficult even to sleep at night – with just the touch of a sheet, my right knee would throb in pain. After receiving my Regennex SD injections on both my “bone on bone” knees, on December 19, 2012 I had “Magical”, immediate, relief.
Three days after my injections I was at the health club doing upper body workouts , swimming, and pool walking. I walked daily increasing from one-half to two miles today. I recently turned 64 yrs. young, and feel it’s “Prime Time” for me. Although I’m still cautious and careful about my knees, I don’t think I will ever play racquetball again. Everything else…………..stay tuned.
I want to thank you, I found the the RIGHT GUY, at the RIGHT TIME, with the RIGHT PROCEDURE….THANKS REGENNEX!!!!
Tags: Knee Pain Relief, Regenexx-SD, Synvisc, Voltarin