Sep 24, 2015
An all too common practice today is when the surgeon looks at your X-ray, tells you that you have “Bone on Bone “ and that you need a Total Joint Replacement. There is little discussion of the risks and the potential of an unsatisfactory result. The patient looks for pain relief but doesn’t really appreciate why a joint replacement may be indicated or whether there may be other options for delaying or even avoiding a joint replacement; particularly in Grades two and three osteoarthritis.
During my orthopedic training (readers of this Blog are aware I was a joint replacement surgeon for 37 years before “graduating” into interventional orthopedics) I was made aware that the X-ray evidence of osteoarthritis included joint space narrowing, subchondral sclerosis and osteophyte formation. The lay public refers to these observations as “bone on bone” and spurs. The general connotation is that these findings are consistent with Degenerative Arthritis. The synonym is Hypertrophic Osteoarthritis. The other general category of arthritis is Inflammatory and the most frequent category is Rheumatoid Arthritis. The synonym for Inflammatory Arthritis is Atrophic Arthritis in which there is joint space narrowing with osteoporotic adjacent bone changes (joint space narrowing without spurs or thickening of subchondral bone). There is yet another presentation on X-ray of Degenerative Arthritis that is not inflammatory but shares the atrophic nature of bony change. These occur in patients experiencing systemic osteoporosis who undergo degenerative changes. The interesting observation of the latter category is these subjects don’t hurt until very late into the disease process.
In trying to understand what causes the pain in degenerative arthritis, I haven’t lost sight of the inflammatory mature of the bioimmune process inside the joint but I am recently reminded of the shock absorbing and structural support nature of the bone supporting the cartilage. Is the pain generator the bone or the inflammation within the joint? If there is still a joint space but hypertrophic (sclerotic) subchondral bone, will the subchondroplasty alter the progression of osteoarthritis and delay or postpone a joint replacement? If there is X-ray evidence of “Bone on Bone”, should a bone marrow aspirate concentrate intervention be coupled with the subchondroplasty? If there is atrophic arthritis of a degenerative nature, should treatment be limited to an intraarticular intervention alone? Incidentally, Atrophic Arthritis of a degenerative nature is determined after a C-reactive protein and Erythrocyte Sedimentation Rate serum test excludes inflammatory systemic disease.
What is causing your joint pain and what might be done to delay or perhaps avoid a joint replacement while returning you to a more active life? Call and make an appointment so I may assess you, review images and advance an evidence-based recommendation:
847 390 7666
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment, Ultrasound Guided Injection
Sep 17, 2015
In the last week, I have become aware of four companies developing new regenerative medicine product for Musculoskeletal Care of the Aging Athlete. What I find extremely interesting is the fact that three years ago, when I entered the practice of using bone marrow aspirate concentrate in an attempt to postpone or possibly avoid a joint replacement in an arthritic knee or hip, the orthopedic community was very critical telling patients that regenerative medicine was still ten years away. Fast forward three years and four new initiatives into the emerging field of regenerative medicine have come to my attention; underwritten by orthopedic surgeons or companies that have produced prosthetic joints for over 30 years. All of the product in development has not yet been approved by the FDA and many developing products are still being tested in Europe. What we at the Regenerative Pain Center offer is within FDA guidelines and approved by all regulatory agencies of the government. At the same time, I am very much aware of what is taking place nationally and internationally; when a newer regenerative medicine product is made available and FDA approved, we at the Regenerative Pain Center will be aware and closely evaluate as to whether it should be incorporated into our service line.
Let me be candid, our success rate is not 100 per cent. There have been three or four hip patients that have not provided the outcome the patient sought or that I hoped to provide; namely, avoidance of a hip replacement. On the other hand, the vast majority of hip bone marrow aspirate concentrate procedures are still allowing the patient a very full return to activities with about 70% percent patient satisfaction at a minimum of one year. When it comes to those who sought help for an arthritic knee, we have done even better with an 85% patient satisfaction outcome at a minimum of one year. Several of those patients had reached a plateau at six months but realized a marked improvement in the pain score with a Platelet Rich Plasma refresher. When a patient elects to under go a bone marrow aspirate concentrate hip or knee intervention at the Regenerative Pain Center, that patient may be assured that what we are doing is based on FDA guidelines and our clinical outcomes research. In addition, each patient should recognize that Regenexx continually statistically reviews our outcomes data. Last week, we recognized that those who underwent Cellular Orthopedic interventions for an arthritic knee did best when the cell count of mononuclear cells exceeded 400 million. Be aware that we count the cells in every Regenerative Medicine procedure. Our approach is no longer “this is the way we do it.” Our approach is based on experience and outcomes research, the same that I used in a long joint replacement career.
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, FDA, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Platelet Rich Plasma, Regenerative, Regenerative Pain Center, Regenexx, stem cells, treatment
Sep 10, 2015
The PERSPECTIVE section of the Chicago Tribune / Wednesday, February 11, 2015 ran the headline and an article written by Gerald D Skoning. It was well thought out, I have kept the page on my desk since February thinking that this was a marvelous subject for me to Blog about and how to possibly extend the career of injured or aging athletes, be they amateur or professional.
I am surrounded by several good friends who want to continue skiing, cycling, wadding up a stream with fly rod in hand, or spend an hour each day in the health club. Unfortunately, most of my contemporaries in their sixties and seventies have hung up their athletic gear but maybe it isn’t too late for you. An athlete doesn’t have to win but you might still enjoy competing and participating. Our mission statement is our ethos. Mary, the research coordinator and physical therapist in our office wore her medal to work on Tuesday earned as a cycling participant in the Co-Ed relay division of the Chicago Triathlon two weekends ago. I have recently returned from a week of cycling and fly fishing in Southwest Wisconsin. I am not injury free nor have I avoided the effects of arthritis after a lifetime of athletic participation. When the time came where I was surrounded by “ I am just a used to be”; I opted for a cellular orthopedic intervention to my left knee and here I am. Grit and determination can prolong your recreational and athletic enjoyment; so can Orthobiologics. Our regenerative offerings contain an enhanced profile of ant-inflammatory cytokines, anabolic growth factors, and adult mesenchymal stem cells. Our data clearly documents improved function of the knee. With the introduction of Subchondroplasty, we hope to do even better. Whereas our initial hip outcomes did not compare to those of the knee, the several patients who returned for a second procedure are doing extremely well. Now I am happy to note that patients presenting with arthritic shoulders and ankles are very improved from our interventions,
You must decide if you want to be a “still” or “used to be”. When four of us rode up and down the hills of the Driftless Area two weeks ago for hours at a time, you couldn’t match that camaraderie. I did the same four weeks earlier with my wife and two sons; the time has not come and I won’t quit because the next orthobiologic intervention for the other knee is waiting.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Osteoarthritis, Pain Management, Regenexx, stem cells, Subchondroplasty, treatment
Sep 3, 2015
In the field of Orthobiologics, the introduction of new product and possibility is continuous. The challenge to the clinician is to adopt a clinical approach based on scientific proof and clinical data; not marketing hype and anecdote. Regenexx, where I have been invited to be part of an advisory board, is home to the nation’s most advanced and studied stem cell and blood derived platelet procedures. We have more clinical experience and research with bone marrow derived orthobiologics for arthritis, than any other clinical setting in the United States.
At the Regenexx Chicago office, we offer non-surgical options for people experiencing moderate to advanced pain and limitation due to degenerative arthritis no matter the cause. Our patients experience little to no down time from our procedures and avoid the painful and lengthy rehabilitation that is inherent in a joint replacement. Knowing there are non-surgical and minimally invasive orthobiologic options, don’t throw away your skis or let your bike get rusty. Just as the skis need to be tuned for the upcoming season, (Vail opens in 12 weeks), and the wonderful cycling days through the changing colors are four weeks away, so too does your body need to be updated and upgraded. If you have limitations from an arthritic joint, perhaps you should let me determine how Cellular Orthopedics may allow you to return to an unlimited athletic or recreational profile.
Our data include Efficacy and Safety of Bone Marrow Concentrate for Osteoarthritis of the Hip; Treatment Registry Results for 196 patients. At the knee, I have presented in July and will be presenting the outcomes in October of 187 Bone Marrow Aspirate Concentrate Knee interventions with comparison to Total Knee Replacements. The fact is that at Regenexx, our therapeutic recommendations are not based on new product and the associated marketing hype inherent in a corporate initiative but rather on our data base statistical analyses and scientific studies, both in the laboratory and in the clinical setting. We practice evidence-based medicine, not offerings based on unsubstantiated claims.
Of course, we are able to provide an abundance of anecdotal success stories in our athletes be it a torn acetabular labrum, a torn medial meniscus or a torn rotator cuff. To learn more, check out my Blog www.sheinkopmd.com/blog even better yet, call for a consultation: (312) 475-1893.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
Aug 27, 2015
In a more recent understanding of the arthritic joint, science now tells us that it is not only loss of cartilage that leads to pain, loss of motion, altered function and a progressive downhill course; but rather an involvement of the entire joint as well as the bone supporting the joint. The mechanism is probably bio-immune in nature and the reason for our success in treating the arthritic joint with orthobiologics is based on addressing molecular changes within the joint. The Europeans however have taught us that almost as important as intervention inside the joint is addressing the bone supporting the joint. In a recent scientific meeting, Spanish and French Orthopedic Surgeons demonstrated improved overall results within the arthritic joint by treating the changes outside of the joint as seen in an MRI. These changes are frequently described as bone contusions or bone marrow lesions. When followed, it becomes apparent that the altered bone fails to support or protect the cartilage within the joint. By drilling into the subchondral bone, one stimulates a healing process and by adding orthobiologics, one hastens the healing of those bony lesions.
Subchondroplasty is accomplished with a specially designed drill bit and the orthobiologic is introduced through a specially designed trochar needle that slides over the drill bit serving additionally as a guide wire. The entire process is accomplished through a small skin puncture with accuracy enhanced through fluoroscopy, real time X-ray. Because the drill bit causes little structural damage, there are few alterations in the rehabilitation process when compared to the joint intervention alone. While Orthopedic Surgeons have been addressing these bony lesions by a macro system for several years with documented success, our work, as was seen on the Fox News airing last Thursday night, is based on minimally invasive means thereby eliminating the need for prolonged restriction of weight bearing and crutch dependency. Additionally, by introducing Bone Marrow Aspirate Concentrate in addition to the present Calcium Phosphate adjunct, the patient should anticipate healing in weeks, not months. The first target was the knee but we have expanded subchondroplasty to the ankle and soon to the hip and shoulder.
Tags: arthritis, athletes, Benefits and Risk, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, stem cells, treatment, Ultrasound Guided Injection
Aug 20, 2015
In the past several years, the major joint replacement manufacturers have dedicated increasing resources to the field of OrthoBiologics with the belief that joint replacements for arthritis, as we know them today, will no longer control market share. In anticipation of this introduction of scientific advances for the care and treatment of arthritis, I “graduated” from joint replacement to Regenerative Medicine (Cellular Orthopedics ) three years ago. I exchanged an incision and scalpel for a trochar and syringe in offering pain relief, improved function, alteration of the natural history of arthritis progression, and perhaps regeneration of cartilage for the usual and customary prosthetic joint.
The poster child for the field of Regenerative Medicine has been Kolbe Bryant of the Los Angeles Lakers who when faced with career ending arthritic issues of his knee traveled to Germany for what at that time was unavailable in the United States. He has extended his career with a biologic intervention whereas a joint replacement would have necessitated retirement. Today in the United Sates, Bone Marrow Aspirate Concentrate containing Mesenchymal Stem Cells, Cytokines and Growth Factors is the basis for intervention whereas at the startup, three years ago, it was Platelet Rich Plasma. The next generation of OrthoBiologics is now in development and I am happy to announce that I will be playing a major role in the future of Regenerative Medicine as I am now helping design and introduce several clinical trials. On Friday night, August 21, Fox News Chicago will air the story of one of my patients and why, after an unsatisfactory outcome of a total knee replacement on the right, she chose the Orthobiologic option on the left. In that story, you will learn how and why I added Subchondroplasty as an adjunct to improve the outcome.
At Regenexx, we are continuing to stay ahead of the maddening crowds with research and development. I have been asked to join the Regenexx advisory panel and contribute based on my experience first as a Joint Replacement surgeon and for the past three years as an Interventional Orthopedist integrating patient care with research and education. If you want to benefit from the present, make an appointment; if you want to know about the future, stay tuned.
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Hip Replacement, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, stem cells, treatment
