Apr 2, 2014
Last week, an article appeared in the orthopedic peer reviewed literature reporting reasons for failure of Knee Replacement Prosthetic reconstruction within two years of the procedure. It is though such review and publications that we surgeons gain knowledge so as to offer the patient with arthritis, the most comprehensive informed consent. At the same time, it is only by reviewing our technology and surgical techniques that the surgeon is able to minimize unsatisfactory results and short lived outcomes. Understanding the cause of failure and type of revision knee arthroplasty procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in Knee Replacement surgery. The most common cause of revision surgery is infection followed by implant loosening. Next comes malpositioning of components and failure of soft tissue balance leading to pain and limited motion. Patellar instability was also identified as a reason for patient dissatisfaction leading to an early revision. The average length of hospital stay associated with a knee revision was 5.1 days; this does not take into account, the rehabilitation center stay or time lost from work. The average total charges were $57,600; again, this does not take into account the costs of rehabilitation, outpatient antibiotics and ongoing physical therapy.
As readers of this Blog are aware, I maintain a Data Base containing outcome measures for every patient I have treated since joining the Regenexx Network and the Cellular Orthopedic initiative 22 months ago using Bone Marrow Aspirated Concentrate derived Mesenchymal Stem Cells for the care and treatment of Grade two and three knee arthritis instead of a knee replacement procedure. Last July, I presented a comparison of patients one year following stem cell intervention for an arthritic knee with historical data for those who had undergone a knee replacement one-year prior. At one year after a procedure, the stem cell cohort had more functional outcomes than those patients who had undergone a knee replacement. The two populations studied had one thing in common, an arthritic, symptomatic, life-style altering arthritic knee. My interest was peeked by the scientific article published last week concerning why Total Knee Prostheses had failed at two years; so I decided to review the complications of stem cell interventions for an arthritic knee and report them here:
Nothing is listed because there are no adverse outcomes to report. To date, to the best of my knowledge, no stem cell recipient for an arthritic knee in my practice has undergone a knee replacement. That may not be the case after another year of follow-up; but there has not been an infection or reportable complication in 22 months. The only “revision” procedures I have had to perform were three patients with repeat stem cell interventions to achieve a higher outcome score and several patients who requested booster PRP between four and nine months. The rescue of a failed stem cell intervention is a primary knee replacement; but to date, none have been reported. For your arthritic knee, Total Knee Replacement or try Stem Cells first?
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Surgeon, Osteoarthritis, stem cells, Ultrasound Guided Injection
Feb 18, 2014
Musculoskeletal Care of the Mature Athlete
A 67-year-old man came to my office to learn more about Bone Marrow derived Stem Cells for his arthritic knees. While he had been discouraged by his sports medicine physician from seeking the Regenerative Cellular alternative, he was not ready to undergo a bilateral total knee replacement after having investigated the potential complications associated with the surgery. I started with a review of his medication profile and determined that BMAC/Stem Cells might not produce the quantity and quality potential I would want to see to justify the procedure. My concern had to do with the adverse effects of certain medicinals on stem cell numbers. I offered an alternative, Concentrated Stem cell Plasma.
The development of Regenerative Cellular interventions for the management of arthritis started several years ago with Platelet Rich Plasma. Platelets not only play a role in initiating the clotting cascade, they contain an abundance of anti-inflammatories and healing agents termed growth factors. At the outset, clinicians performed a venous puncture and filled a test tube with blood. The latter was now spun in a centrifuge and the plasma with platelets suspended was injected in the arthritic knee. Within a year, it became apparent that two or three staged PRP interventions would result in better outcomes. About a year ago, the group of physicians at Regenexx began concentrating the Platelet Rich Plasma 10X and the results of treatment have been very encouraging in that patients did better and for longer than with standard PRP. More recently, we have developed a better way to activate with a faster and longer acting release of growth factors.
Bone Marrow Aspirate Concentrated/Stem Cells remain the best possible alternative in our Cellular Orthopedic Regimen at this time. Concentrated Stem Cell Plasma (PRP 10X) is a reasonable alternative although with a shorter outcome potential and probably to a lesser extent. No bridges are burned. I have suggested the 10X PRP option to patients heavily dependent on pharmaceuticals for co-morbidities or when I anticipate a possible compromise in the quantity or quality of stem cells because of age or other factors. Primum Non Nocere, First No Harm. There is nothing lost and a lot gained by a staged approach to the Regenerative Medical management of arthritis.
Addendum: I now have several patients who were managed as above when their pharmaceutical profile excluded them from a stem cell procedure; that went on to loose weight and get fit, and minimize their medication dependency. By so doing they became reasonable candidates for stem cells; and, now are enjoying the longer term and more comprehensive benefits of Bone Marrow Concentrate Stem Cell intervention.
Tags: C-SCP, Concentrated Stem Cell Plasma, Growth Factors, joint replacement, Orthopedic Care, Orthopedics, Platelet Rich Plasma, PRP, Ultrasound Guided Injection
Mar 8, 2012
Musculoskeletal Care of the Mature Patient
The potential benefit of regenerative medicine is avoidance of orthopedic surgery. That’s the goal and I am the orthopedic surgeon leading the charge. I have spent several years now investigating, meeting, traveling, learning and preparing for that reality with the start-up anticipated in mid-April. While there is anecdote about subjective improvement following autologous, mesenchymal, Bone Marrow Concentrate derived stem cells for management of arthritis, there are no peer reviewed published long-term clinical outcomes to the best of my knowledge. There have been testimonials by orthopedic surgeons that following the adjunctive use of stem cells in conjunction with arthroscopic micro fracture of an arthritis knee, when the patient subsequently underwent knee replacement, hyaline cartilage was observed growing rather than fibro cartilage. This is not good enough for me, as I want a procedure that will postpone the need for a joint replacement or possibly eliminate that need. Is it a matter of when to intervene with regenerative medicine? When there is major deformity of an arthritic joint, significant alteration in function and a “bone on bone” X-ray, it probably is too late. Will regenerative medical intervention delay the joint replacement by a three to five year control of pain by the anti-inflammatory nature of bone marrow concentrate or will the joint cartilage actually re-grow? These are unanswered questions and what I seek to learn as I embark on my clinical project
Recently, the orthopedic surgical spine community became aware of a fourfold risk of cancer in patients who underwent spinal fusion using Bone Morphogenic Protein to increase the likelihood of successful fusion. As a result, attention quickly was redirected to stem cells as an adjunct in spinal surgery to replace human BMP. As of this writing, I have found no evidence of carcinogenesis in conjunction with autologous, mesenchymal Bone Marrow Aspirate Concentrated stem cells used in the skeleton and certainly not when used in a joint. The same might not be said when embryonic stem cells have been injected into the blood of patients to treat probably what shouldn’t be addressed with stem cells in the first place. Desperate people are not infrequently victims of charlatans as has been repeatedly pointed out on 60 Minutes. Contrast the risks of stem cell misdeeds with the benefits of scientific application. Today, the AMA News headline covered the potential for stem cells to eliminate the need for long-term anti-rejection pharmaceuticals in organ transplant recipients.
How to avoid orthopedic surgery by an orthopedic surgeon? Not just a mission statement by an ethos. Call to see if you are a candidate.
Mitchell B. Sheinkop, M.D.
312-475-1893
1565 N. LaSalle Street, Chicago, Illinois 60610
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, medicine, Osteoarthritis, Pilot Study, Platelet Rich Plasma, PRP, Regenerative Pain Center, stem cells, Ultrasound Guided Injection
Feb 21, 2012
I have recently seen an increasing number of patients with altered function of their hands because of pain or reduced range of motion due to common injuries, overuse, basal joint arthritis/osteoarthritis, or other degenerative problems.
Thumb arthritis (or basal joint arthritis) can appear early in life. Because of the constant swiveling and pivoting motions of the basal joint–the joint at the base of the thumb, or thumb CMC (carpometacarpal) joint–the thumb joint tends to wear out easily. Basal joint arthritis is also common in people who have osteoarthritis. As well, tendinitis in the wrist and hand is rampant because of over use of the computer mouse and improper ergonomics.
One way to treat the arthritic condition is with total joint reconstruction surgery. Perhaps over use syndromes may be reduced via voice recognition software but I personally still need to edit and then correct about 15% of my dictations. While surgery may improve the condition for some, this is not the case for all. New problems in the thumb joint may redevelop over time, causing such symptoms as numbness or tenderness. Then there is amazing increase in the occurrence of trigger finger and De Quervains Disease; both which lend themselves to ultrasound guided injection.
A reasonably successful approach to all of these wrist and hand problems is to start with an ultrasound guided intraarticular cortisone injection. Should the latter be of short-term relief, then platelet rich plasma may be successful for a longer period. Before considering the surgical alternative, be aware that Regenexx has published the outcome of 6 patients who were just under a year out (11.3 months) from treatment with their own stem cells 83.4% of thumb patients are reporting greater than 50% improvement after a simple injection of their own stem cells, 66.7% of thumb patients are reporting greater than 75% improvement and the average change is 70% improved. No significant complications in this group were reported.
If you have pain in your hand or wrist, start with a change in the ergonomics in your work place. Most office suppliers have the necessary mechanical devices available. The next step is an arthritic glove available in most large drug stores. If unsuccessful, the next step is an ultrasound guided injection of cortisone, platelet rich plasma and then stem cells in that order when all else fails.
Mitchell B. Sheinkop, M.D.
312-475-1893
1565 N. LaSalle Street, Chicago, Illinois 60622
Tags: Clinical Trial. Mitchell B. Sheinkop, hand, medicine, Osteoarthritis, Platelet Rich Plasma, PRP, Regenerative, stem cells, Ultrasound Guided Injection
