Oct 22, 2015
Autograft is a tissue or organ that is grafted into a new position in or on the body of the individual from whom it was removed; whereas allograft is the transplantation of tissue taken from one individual to another. Bone Marrow Aspirate Concentrate is an autograft while Amniotic Fluid Concentrate is an allograft. Autograft, at this time serves as the gold standard for almost all situations in which the use of orthobiologics is indicated. Bone Marrow Aspirate Concentrate (BMAC) offers nearly every essential component involved in reversing the damage caused by arthritis including Adult Mesenchymal Stem Cells, Growth Factors, Cytokines, and Vascular Progenitor Cells. Because of the inherent value of Bone Marrow, my first interventional thought is BMAC; in addition it is virtually free of risks and side effects.
The U.S. Food and Drug Administration (FDA) has approved certain growth factors and allied substances for specific indications. Platelet Rich Plasma falls into this category. In addition to BMAC, Autogenous PRP contains many growth factors as well. Stem Cells are at this time, the ideal biological treatment because they recreate the original microenvironment and supply paracrine factors (a type of hormone which binds to receptors in nearby cells influencing their function). Bone Marrow Aspirate contains a variety of cell types such as endothelial progenitor cells (EPCs), osteoprogenitor cells (OPCs), stem cell niche-supporting cells, and cytokines.
You bet this is confusing and not easy to understand. That’s why I try to clarify by writing the Blog. At the same time, it demands that a clinician stays well informed and not depend on the hype of marketing from the start-ups in the field of orthobiologics to influence a potential patient intervention. On Thursday, I travel to Broomfield, Colorado for the first meeting of the Interventional Orthopedics Foundation, the first not for profit dedicated to Regenerative Interventional Orthopedics: The Next Frontier. My presentation will be based on the 24 month outcomes of Bone Marrow Concentrate in knee arthritis. Another issue will be addressed, are there viable stem cells in Amniotic Fluid Concentrate? The Regenexx Advisory Board of which I am a member, will review the challenges presented by the patient with Grade 4 Osteoarthritis for whom until now, we have had little to offer other than referral for a joint replacement. Next week, I will be in a position to upgrade the reader about the present role, if any for mechanically liberated, adipose derived, stem cells as this subject as well will be studied by the advisory panel.
Tags: Amniotic, arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, PRP, Regenerative, Regenexx, stem cells, technology, treatment
Oct 16, 2015
Tissue Regeneration has become the new standard for Grades 2 and 3 arthritis. Three years ago, I anticipated the future recognizing that the risks of joint replacement surgery were not fully taken into account when a surgeon recommended a new hip, knee or shoulder. Certainly, in advanced arthritis (Grade 4) there is little alternative for pain relief and restoration of function; but for Grades 2 and 3, do the risks outweigh the benefits? What is not taken seriously enough are the risks inherent in a surgical procedure. A recent scientific article reminds us of those risks.
“Knee, hip replacements might be bad for the heart short-term.”
“Contrary to some recent research, Boston-based researchers found osteoarthritis patients who had total knee or hip arthroplasty procedures were at increased risk of myocardial infarction in the early post-operative period. Their findings, published Aug. 31 in Arthritis & Rheumatology, a journal of the American College of Rheumatology, indicate long-term risk of heart attack did not persist, while the risk for venous thromboembolism remained years after the procedure.”
Up until 2001, the patient undergoing a joint replacement was discharged on post operative day four or five. Any complications taking place were reported as a postoperative morbidity, rarely, as a mortality. Today, a patient will leave the hospital between 23 and 36 hours following a joint replacement. Should, if, or when a complication ensues, it may never be recorded as a readmission to another hospital if not registered. Medicare has started penalizing hospitals for high readmission rates within 30 days of a discharge but this is only a recent development and doesn’t as of yet, include readmissions to a second location.
Last time, I indicated I would start updating the reader with new developments in the field of Regenerative Medicine. The goal of regenerative therapies is to modulate the stages of healing including inflammation, cell migration and proliferation. We do this though use of tissue grafts such as Bone Marrow Aspirate Concentrate.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, stem cells, treatment
Oct 8, 2015
Why our Regenerative Medicine/Interventional Orthopedic clinical practice is where you should consult before undergoing a Cellular Medicine intervention:
I am an orthopedic surgeon, Professor Emeritus at Rush, who for 37 years, performed Joint Replacement Surgery for arthritis before “graduating” into Cellular Orthopedics. Basically, I exchanged my knife for a needle. As a Fellow of the American Academy of Orthopedic Surgeons, I am required to partake in the Mandatory Disclosure Policy requiring me to update disclosures and potential conflicts of interest at least semiannually (April and October). All AAOS members involved as continued medical education faculty and authors, orthopedic volunteers in organizational governance, clinical practice guidelines, appropriate use criteria, and performance measures development, and editors-in-chief and members of editorial boards are required to complete disclosure in the AAOS Orthopedic Disclosure Program. My membership and active participation in the American Academy of Orthopedic Surgeons, my Fellowship in the American College of Surgeons, and my membership in the American Medical Association is your quality assurance that I subscribe to evidence based clinical practice guidelines. As such, it is my responsibility to offer Regenerative Medicine interventions to only those who meet Inclusion Criteria and educate patients who I can’t help about joint replacement alternatives. Furthermore, I also am bound by professional ethics not to add unproven treatments to my range of services.
Inclusion criteria are based on a medical history and physical examination, first and foremost and secondarily, after a look at an X-ray or MRI. Conversely, we employ a relatively strict list of exclusion criteria for those patients who just won’t benefit from Cellular Orthopedic interventions. Admittedly, while our practice is based on the scientific evidence, from time to time there are new treatment options. Unlike many who offer stem cell treatments, when a new regenerative option is brought to my attention, if I feel that it falls within FDA approved guidelines, I will investigate, apply for an IRB centered scrutiny and provide exhaustive informed consent to a patient. Your quality assurance of my standards of practice should also be reinforced by my participation as a member of the Regenexx Network and my involvement in the recently formed Regenexx Board of Advisors. In addition, I have made a commitment to my patients that I would become familiar with any new clinical trial initiatives and participate if I feel there is a role for such in my practice.
Over the next several weeks, I will share with you my review of new Regenerative Offerings, especially for those who might otherwise not meet our Regenexx inclusion criteria.
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Interventional Orthopedics, joint replacement, Orthopedic Care, Orthopedic Surgeon, Osteoarthritis, Pain Management, Pilot Study, Regenerative, Regenexx, stem cells, treatment
Oct 1, 2015
As I have previously indicated in my Blog, the world of Cellular Orthopedics is growing at an exponential pace. Evidence Based Medicine supports weight reduction, physical therapy, anti-inflammatories, analgesics, and cortisone injections for symptomatic relief. Evidence Based Medicine no longer supports the use of Hyaluronic Acid injections (visco-supplementation). Historically, the next step is a joint replacement when the aforementioned conservative measures no longer have an effect. When I initiated my practice of Interventional Orthopedics as part of the Regenexx Network, their patient satisfaction surveys supported the use of Bone Marrow Aspirate Concentrate interventions for osteoarthritic joints. Since my entry into the sub-discipline of Regenerative Medicine, we have gathered data on every patient seeking consultation and care and, have expanded the Outcomes measurement intake to include objective data points in addition to those of a subjective nature. Along the way, we have gained a better understanding as to how a patient might better respond to Interventional orthopedic options. The evidence is growing.
Just as my practice has grown and the Regenexx Outcomes Data base has grown, so too have the Interventional Orthopedic treatment alternatives increased. Now there is Amniotic Fluid Concentrates available to replace Hyaluronic Acid as a six to 12 month anti-inflammatory. As of July of this year, two companies have introduced Adipose derived stem cell alternatives claiming a mechanical means of emulsifying fat and eliminating the need for the enzyme collagenase; the latter not approved by the FDA when it comes to the musculoskeletal system. As of this time, there is no scientific evidence to support the claims of success in arthritis with both Amniotic Fluid Concentrate and Adipose Derived Stem Cells. Those studies will take several years before there is clinical evidence to support said use in arthritis.
What we have learned and is supported by clinical evidence is how to better plan and prepare for a Bone Marrow Aspirate Concentrate intervention. First a clinician must rule out referral of pain from other sources; this is accomplished by a thorough history and physical examination. The status of a meniscus, labrum, and the articular cartilage must be taken into account. Mechanical malalignment –a bowed leg or knock knee-must be ascertained and excesses corrected. Ligamentous deficiencies will contribute to the end result and must be corrected before any Intervention of an orthopedic nature.
I have provided a lot for a reader to digest. If you want clarification or to learn if you are a candidate for INTERVENTIONAL ORTHOPEDIC to postpone or eliminate a joint replacement for osteoarthritis, call for an appointment:.
847 390 7666
Tags: Amniotic, arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Clinical Studies, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, Subchondroplasty, treatment
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
