Jan 7, 2016
The last Blog posted in 2015 indicated that I wouldn’t look back; but after its posting, I received this correction form Dr Chris Centeno, arguably, the best informed Regenerative Medicine expert in the North America.
“Mitch,
The discussion of amniotic injections isn’t correct. We found that amniotic tissue hurt stem cells. While we did find a weak growth factor/cytokine effect, it was less than PRP. So extrapolating that data, it would be stem cells>PRP>amniotic. Please correct.
Chris”
I very much appreciate his input as well as invite his ongoing constructive criticism, additions and recommended corrections. Let me add, the PRP he is referring to is not the usual and customary office based 15 minute procedure; but rather a proprietary process developed in the Regenexx laboratories and available from those physician members of the Regenexx network.
Changing my focus, in a review article appearing in the January 2016, volume of the Journal of the American Academy of Orthopedic Surgeons, an article appeared Risk Prediction Tools for Hip and Knee Arthroplasty. It is easier for me to quote rather than extrapolate: “After arthroplasty, complications such as infection, venous thromboembolism, acute myocardial infarction, pneumonia and many others are associated with poorer patient outcomes and represent a substantial cost burden to the American healthcare system”. The article continues: “Total joint arthroplasty is thus an appropriate target for quality improvement and cost containment via pay-for-performance initiatives.” For someone such as myself, an orthopedic surgeon who devoted a 37 year career after nine years of post graduate education and training performing Total Joint Replacements, I feel that my professional evolution into cellular orthopedics is again validated. In reviewing our data base, following a cellular orthopedic intervention for arthritis, we have not recorded one infection, venous thromboembolism, acute myocardial infarction, case of pneumonia, or any other complication. While 100% of my patients do not experience a successful or satisfactory outcome following the first cellular orthopedic intervention for arthritis, those numbers increase from 75% to 85% with a booster or repeat procedure. Once again, the end result of an unsuccessful Total Joint Replacement is a revision surgery; after a revision, it was not unusual to hear a patient volunteer “give me back my arthritis”. After a less than optimal outcome of a cellular orthopedic intervention, the fallback position is a repeat procedure followed by a patient’s “thank you doctor.”
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, C-SCP, Concentrated Stem Cell Plasma, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Dec 14, 2015
The December 2015, Journal of the American Academy of Orthopedic Surgery, featured a Review Article titled Establishing Realistic Patient Expectations Following Total Knee Arthroplasty. The abstract begins with the following sentence “nearly 20% of patients are dissatisfied following well-performed total knee arthroplasty with good functional outcomes.” It continues, “surgeons must understand the drivers of dissatisfaction to minimize the number of unhappy patients following surgery.” There are several studies that have shown unfulfilled expectations are a principal source of patient dissatisfaction following a joint replacement including a failure to relieve pain, improve walking ability, return a patient to sports, and improve psychological well-being. In my previous career as a joint replacement surgeon, it became all too apparent that patients were overly optimistic with regard to expected outcomes following surgery. Published data on clinical and functional outcomes following joint replacement show that persistent symptoms such as pain, stiffness, and failure to return to preoperative levels of function, are common and normal. I thought I should repeat realistic expectations after a Bone Marrow Aspirate/Stem Cell intervention for an arthritic joint based on my data over three and a half years of said procedures for arthritis allowing you to decide which is the next best procedure for you.
First and foremost, the fall back position of an unsatisfactory Bone Marrow Aspirate/Stem Cell intervention at any joint is a repeat procedure for which we have supporting data that a second intervention actually does better than a first. Compare the latter to the rescue of a failed or unsatisfactory joint replacement, a complex major surgical procedure called a revision. The outcome of a repeat Bone Marrow Aspirate/Stem Cell intervention is a better result. Compare that to the outcome of a revision hip or knee replacement; namely, a better X-ray, Even though we have experiencing higher than average temperatures in the Midwest for now, my thoughts turn to skiing. My patients, who have undergone a stem cell procedure with arthritic hips and knees are either on the slopes or headed that way. While after a hip replacement, I will admit that some patients return to the slopes, almost none do so after a total knee prosthesis. After a revision hip or knee, forget it and plan for a cane.
While the world of joint replacement surgery is really not changing, what has been still is; I am able to get you on the slopes or at least relieve your pain with a needle and not a knife without burning any bridges. Joint replacements have a place for advanced arthritis; although Cellular Orthopedics may even now help grade four osteoarthritis. To learn more about realistic expectations and avoid disappointment following a total joint replacement, call for an appointment 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment, Ultrasound Guided Injection
Aug 6, 2015
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
Jul 23, 2015
When a patient presents with advanced arthritis of the knee as confirmed by physical assessment and radiographic findings classified as Kellgren/Laurence 3 or 4, the standard approach has been a Total Knee Recommendation (TKR). Inherent in the outcome of any large group of patients who have undergone a Total Knee Replacement is a 40% dissatisfaction rate because of continued pain and failure to restore a functional range of motion. In addition, there is the risk of infection, blood clot (check the source) and repeat (revision) surgery starting at three years. The Regenerative Medicine alternative carries with none of the adverse potential consequences and unsatisfactory potential outcomes when compared to the surgical option. By using a needle and syringe rather than a scalpel, implant and complex surgical intervention, Cellular Orthopedics offers the patient a minimally invasive outpatient solution with virtually no risk. No bridges are burned and instead of a complex and costly revision associated with failure of a knee replacement ,the Regenerative Medicine recipient has the option at some time in the future of repeating the minimally invasive procedure or crossing over to a primary Total Knee Replacement. Our research data while tracking patient outcomes with other regenerative medicine options documents superior outcomes when compared to the result of a knee replacement. What we offer is the stem cell option for patients with advanced osteoarthritis for whom here-to-fore there have been few choices.
At our Center, we offer a range of minimally invasive options starting with cross-linked hyaluronic acid. Should the result of such prove unsatisfactory or not long lasting, the next step may fall under the world of Amniotic Fluid Concentrate. There is then the Platelet-Rich-Plasma series of options followed by the Bone Marrow Aspirate Concentrate intervention process. What is new and very exciting is the concept of Subchondroplasty (SCP). This latter intervention has proven a marvelous adjunct in Europe and now is available to us in the United States. The role of SCP is to improve outcomes of intervention for arthritis and to extend the indications for Regenerative Medicine. We are now introducing the latter in our treatment algorithm. Wherein we will differ in incorporating Subchondroplasty into our Minimally Invasive approaches is that we will use orthobiologics rather than synthetics to help rebuild the bone supporting the joint while addressing the arthritis with Bone Marrow Concentrate. To learn more, schedule a consultation.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
May 14, 2015
That’s the name of the lead article in the Wednesday, May 13 edition of the Health and Family Section in the Chicago Tribune. “The brain loves it when we move and will reward us handsomely if we do, researchers say.” That’s what Julie Deardorff has to say in the article. “Work out for the brain”, not just the body. “Physical activity is crucial to mind and body alike.”
I think you understand the point so let’s look at which arthritic complaint is your problem and how stem cells may help. It is too early in the scientific process to suggest clinically, that Regenerative Medicine can reverse changes in the brain though the scientific evidence supports exercise as having such impact. By the same token, it is not too early to state that Cellular Orthopedics can reverse and benefit your knee and hip. This morning, I am finalizing the talk I will be delivering next month, at The Orthopedic and Biologic Institute International Regenerative Medicine scientific meeting to be held in Las Vegas. My data clearly supports the statement that Bone Marrow Aspirate Concentrate will diminish pain and increase activity in those with arthritis of the major weight bearing joints. We have 187 patients in the data base on whom I have gathered evidence over a 24 month period. All were patients who presented for orthopedic cellular intervention of an arthritic knee. While space does not allow for a complete presentation of the outcomes, the studies clearly document, less pain, better motion, increased functional capacity, and a better state of emotional and physical well-being when compared to pretreatment baselines. The return to high impact recreational activity was statistically significant in the study group of 187 patients.
Bone marrow aspirate concentrate does contain mesenchymal stem cells but there is more to the success story. More recently almost on a monthly basis, molecules and proteins are being identified in the bone marrow in addition to the stem cells that all act together to diminish pain, increase motion, eliminate inflammation , and perhaps even regenerate cartilage. There is even a possibility of reversing or diminishing the bio-immune response of osteoarthritis. At this time, I am unable to document how long these benefits will be realized; my studies will continue as I integrate patient care with research. The latter allows me to determine what number of nucleated cells at the time of the bone marrow aspiration predicts the best chance of a successful outcome. I now have statistically significant evidence that age and BMI do not adversely influence the outcome of a Cellular Orthopedic procedure. By the same token, I can predict success based on the physical examination and history prior to an intervention and advise a patient as to the chance of success based on the combination of the pretreatment consultation and imaging. If you want to learn your chances of postponing or avoiding a joint replacement for arthritis using now scientifically documented results, call for a consultation:
847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, Orthopedic Care, Orthopedics, Pain Management, Regenerative, Regenexx, stem cells, treatment
Jan 29, 2015
From a Patient in Canada
On January 20, 2015
“Thank you, Doctor,
How are you today? Hope well.
My Mom is very grateful for your kind help, mentions your name frequently and wants to schedule the 3rd Rx-SD visit to your office in 2-3 months.
Please provide us with the special 50% discounted price for the procedure similar to the last time in July and the time convenient for you if possible.
Thank you for your help.
My Mom is currently almost free of pain, walks around the house with a walker. The 2nd Rx-SD procedure on July 9,11, 2014 went really well and with the anesthesia was painless. My Mom trusts you, wants to see you every 8-12 months and to start walking without a walker this summer.”
This was the Holiday greeting last month
“Thank you, Doctor,
We wish you a merry Xmas and all the best in 2015.
Thanks to your kindness and knowledge, we found you when we were in real pain and needed you the most and you saved us. My Mom is very gratefull to You, calls you God and mentions your name daily, she’s feeling better only because of your help. My Mom and I both wishing you good health and all the happiness, many years ahead and a Happy New Year 2015.
Thank you for your help
Kind Regards,”
On Oct 7, 2014, at 8:32 AM
“Thank you, Doctor,
3 months passed after the 2nd SD procedure (9 July).
My Mom feels a better improvement now vs right after the 1st procedure.
We have no words to express how grateful we are.
She still uses a walker but occasionally tries a bit on her own with a cane. The pain is almost gone, just occasionally when its rainy or she stands for too long. She didn’t find a great improvement after the PRP refill (2 May), followed by the 1st SD procedure (4 Dec).
What do you think, Doctor, should she just do the 3rd SD procedure in 6-11 months or is it better to do the PRP refill now prior to this. I was surprised to learn the latest Rx SD 2013-14 data show the result doesn’t depend on age (74), OA severity (3), BMI (35).
With BMI=35 what’s the average total hrs per day should she stand/walk?
Thank you for your help.
Kind Regards, “
On Aug 9, 2014, at 12:16 PM
“Thank you, Doctor,
The 2nd SD procedure on 9 July went well and with the knees anesthesia was very painless. After 1 month my Mom feels good, no pain, just a little bit of pain when its humid and raining, still can’t walk without a walker.
My Mom is really grateful for your help and hopes to start walking one day.
Thank you for your help.
Kind Regards,”
Tags: arthritis, Benefits and Risk, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenexx, Regenexx-SD, stem cells, treatment
