Dec 29, 2014
Actually it is closer to stem cell misrepresentations and is being propagated by the uninformed clinician, clever marketing schemes, and out and out charlatans. Last week, the FDA made a very strong statement warning against the use of Adipose Derived Stem Cells in the treatment of arthritis. The Government Health Care oversight process stated that there would be large fines and perhaps imprisonment for those health care providers who do not comply with the law. The regulations clearly state that your stem cells may be used if not manipulated or expanded. In order to liberate stem cells from adipose tissue, the adipose tissue has to be treated with an enzyme collagenase, a clear violation of the law. Yet, there are the web sites too numerous to list marketing adipose derived stem cells for arthritis. I am aware of several clinics that circumvent the law by performing liposuction and injecting the fat into the joint without liberating the stem cells with collagenase. My response, beware and take care.
Then come those providers who use local anesthetics to expand the Bone Marrow Aspirate Concentrate when Regenexx has documented the death of stem cells if mixed with local anesthetics. Don’t stop reading, I have yet another alert. The latest addition to the field of Regenerative Medicine comes from Amniotic Fluid that is marketed as an allograft. The pregnant woman at term donates her amniotic fluid that is then processed and made available for wound healing or as an injectate for the arthritic joint in either a concentrated or powder form. While the early outcomes are promising for pain relief, no one has more than four months of outcomes monitoring for amniotic fluid preparations in arthritis. The processing laboratories claim an abundance of stem cells in the concentrate as well as large quantities of Cytokines and Growth Factors; but this is yet to be corroborated by independent researchers. The good news here is the latter research is taking place and more being planned; there should be preliminary data by mid 2015.
Assume if you will that you have an arthritic joint, and are not yet ready for a joint replacement or the extent of your arthritis still lends itself to non-operative management. How can you be sure that you are protected from the abuses I describe above? Regenexx initiated outcomes surveillance over five years ago and as an orthopedic surgeon, I joined and expanded those data points Regenexx studies two and a half years ago. No other Cellular Orthopedic or Regenerative Medicine initiative has the comprehensive Outcomes Data or basic research to support a clinical intervention recommendation, as do the members of the Regenexx Network. Beware here as well of non Regenexx Network web sites that post Regenexx Outcomes as if the patient is too uninformed to recognize the deception. If you want the truth, make an appointment: 847 390 7666
Tags: Amniotic, arthritis, athletes, Bone Marrow Concentrate, Clinical Studies, Interventional Orthopedics, joint replacement, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Regenerative, Regenexx, stem cells, treatment
Dec 16, 2014
Let’s enter the new world of Cellular Orthopedics into which I graduated three years ago. Several months, ago, a long time friend was visiting his family in Chicago and stopped by to say hello. He told me about his skiing last winter and his hiking over the summer and fall. He also related he was seeing an orthopedic surgeon in the state where he now lived and that he had “bone on bone” in his knee. I launched into my customary spiel about his current level of athleticism, my cellular orthopedic initiative and the limits and risks of a knee replacement. Last week, a mutual friend told me that the out of state visitor had related “Mitch was right, I shouldn’t have done it”. He had undergone the Total Knee Replacement in spite of there being no limit in his recreational capacity and was now readmitted with an infected total knee prosthesis that might have to be removed to clear up the infection. Not being one to suggest “I told you so” but that’s what I am trying to get across to the patients I advise.
The Stem Cell Solution, Using the body’s almost magical repair kit to fix bad knees and hips-no surgery required is the title of an article appearing in the December, 2014, edition of The Saturday Evening Post, written by Sharon Begley, the senior U.S. health and science correspondent at Reuters. Last spring, the author had contacted me for an interview after having followed my Blogs unbeknownst to me. Ms Begley introduced herself and told me about an article she was writing for The Post to be published in June. I had forgotten about the interview until a patient came in last week and told me that she had read the article in the December issue. What I didn’t recognize at the time of the interview was that not only is the bone marrow a source of Adult Mesenchymal Stem Cells but of Growth factors and Cytokines as well that may be of equal importance. The opening of the article features my patient. In 2011,”I was in a bad way.” ”He was diagnosed with osteoarthritis, a degenerative disease eating away at the cartilage in his knees writes Begley.”The patient: ”and now I’m climbing stairs, have gone on two skiing trips, planning another, and playing golf in the summer.” “I am way beyond pleased.”
Tags: arthritis, athletes, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Hip Replacement, Interventional Orthopedics, joint replacement, Knee Pain Relief, Mature Athlete, Orthopedic Surgeon, Osteoarthritis, Pain Management, Regenerative, Regenexx-SD, stem cells, treatment
Dec 8, 2014
The majority of patients I see with knee pain either tell me “my doctor told me I have bone on bone” or “I have a torn meniscus”. They usually have already seen a physician and come in with the MRI. In a day and age when almost everyone over age 55 has MRI changes consistent with meniscal disease or has some joint space narrowing on the X-ray, I am still amazed as to how quickly a patient is willing to sign the informed consent for either arthroscopic meniscal surgery or a total knee replacement. “Referring patients to other physicians is one of the most fundamental and frequently performed tasks in clinical practice” according to an opinion in VIEWPOINT, an opinion section in The Journal of The American Medical Association appearing in the November 12, 2014 edition. The article concludes that the single most important factor for making the referral should be based on scientific evidence; not the usual and customary.
So what is the evidence supporting cellular orthopedics and not invasive surgery for meniscal pathology? The very essence of the response is to be found in the scientific evidence; you need the meniscus now so as to avoid degenerative joint disease later. It is one thing to have a “clunking” meniscus causing giving way and knee buckling; that’s the positive MacMurray sign. That’s a mechanical problem and not a pain problem usually resulting from trauma. The issue I am referring to is the almost every day patient presenting with knee pain The scientific evidence clearly documents worsening of a condition wherein surgical meniscectomy, be it open or arthroscopic, will worsen the symptoms and hasten the need for the knee replacement. Even in the younger population presenting with knee pain and devoid of mechanical symptoms, evidence based scientific orthopedics emphasizes saving the meniscus. For a better understanding check out http://www.regenexx.com/
By chance, while I was writing this Blog, the Radiologic Society was meeting in Chicago and here is an excerpt of a scientific presentation. “A popular surgery to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.”
“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function,” said Frank W. Roemer, M.D., from Boston University School of Medicine in Boston and the University of Erlangen-Nuremberg in Erlangen, Germany. “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”
“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before,” Dr. Roemer said.
All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59 percent) of the knees with meniscal damage that didn’t have surgery. In addition, cartilage loss was much more common among knees that had undergone surgery: 80.8 percent of knees with surgery showed cartilage loss, compared with 39.5 percent of knees with meniscal damage and no surgery.
Cellular Orthopedics offers the alternative to surgery, preserving the critical meniscus with Bone Marrow Aspirate Concentrate and Mesenchymal Stem Cells
Tags: arthritis, athletes, Benefits and Risk, Bone Marrow Concentrate, Interventional Orthopedics, medicine, meniscus injury, Osteoarthritis, Pain Management, Regenexx, stem cells, treatment
Dec 1, 2014
Every month, I receive The American Academy of Orthopedic Surgeons News Magazine; in the Clinical News and Views Section, timely issues are reviewed. The November magazine devoted two pages to Surgical vs. Nonsurgical Treatment for Atraumatic Rotator Cuff Tears. The message is “The jury is still out on best course.” Basically, rotator cuff disease is increasing in an aging and active society but the orthopedic surgeon has a difficult time in clinical decision making. The benefits of conservative and surgical options are still controversial.
Our goal of treatment is to relieve pain, restore and maintain function, and provide lasting, durable relief. First of all, imaging studies continually document a high number of Rotator Cuff Tears in patients over 60; but most patients have no symptoms and thus need no treatment. Although the clinical management of Rotator Cuff Tears is highly successful in the short term, the repair often fails in those over 60.
The American Academy’s Clinical Practice Guidelines on “Optimizing the Management of Rotator Cuff Management” found a lack of definitive evidence. The number one recommendation is “exercise and anti-inflammatory medications may be useful in the management of rotator cuff symptoms in the absence of a full-thickness tear.” Highlighted and emphasized is the fact that surgical repair fails in 35% of cases.
An article that appeared in International Orthopaedics , (SICOT); 2014 reviewed Recent Data Showing the Positive Healing Effects from Augmenting a Rotator Cuff Repair (10 Year Follow up). The study documented that significant improvement in healing outcomes could be achieved by the use of Bone Marrow Aspirate Concentrate containing Mesenchymal Stem Cells. More important, studies by Regenexx demonstrated the healing of both symptomatic Atraumatic and Traumatic Rotator Cuff Tears with Bone Marrow Concentrate derived Stem Cells without surgery if the retraction of the torn tendon were minimal. The take home message, if you have shoulder problems, you need a physical examination, X-ray and MRI. For over half of the patient population with symptomatic rotator cuff tears, a BMAC/Stem Cell intervention may relieve symptoms and result in healing
Tags: athletes, bone marrow, Bone Marrow Concentrate, Interventional Orthopedics, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Regenerative, shoulder, stem cells
Nov 17, 2014
Nadal to get stem cell treatment
Updated: November 10, 2014, 2:18 PM ET
Associated Press
BARCELONA, Spain — Rafael Nadal‘s doctor says the 14-time Grand Slam winner will receive stem cell treatment on his ailing back.
Angel Ruiz-Cotorro told The Associated Press by phone on Monday that, “we are going to put cells in a joint in his spine” next week in Barcelona.
The Spanish tennis star was already sidelined for the rest of the season after having his appendix removed last week.
Ruiz-Cotorro, who has worked as a doctor for Nadal for the past 14 years, said Nadal’s back pain is “typical of tennis” players and that the treatment is meant to help repair his cartilage and is similar to stem cell treatment Nadal received on his knee last year.
He said Nadal is expected to return to training in early December.
Several NFL players and baseball players have received stem cell treatment. Nadal’s fellow Spaniard Pau Gasol, center of the Chicago Bulls, received stem cell treatment on his knee in 2013.
Stem Cell Treatment: Out from the Shadows, Onto the Cutting Edge
From Muscle and Medicine by Jenny Vrentas
Wed Jul. 30, 2014
The Jets’ Chris Johnson is one of hundreds of NFL players who’ve turned to stem cells to aid in recovery from injury. It may be the next big breakthrough in the treatment of sports ailments, but for now the use of such therapy is strictly limited in the U.S.—and questions about effectiveness outweigh the answers
New Jet Chris Johnson had stem cells from his bone marrow reinjected into his knee to augment January surgery for a torn meniscus. The hope is that it would boost healing and perhaps rebuild cartilage. (AP)
He’s 28. He has five 1,000-yard NFL rushing seasons to his name, one 2,000-yarder and a burning desire to prove he’s the same speedster he’s always been. So when Chris Johnson visited orthopedic surgeon James Andrews in January to fix his ailing left knee, he liked the sound of two intriguing words: Stem cells.
The veteran running back tore the meniscus in that knee in Week 3 of the 2013 season—his last with the Titans before being cut—but never missed a game. The injury to the knee’s natural shock absorber also caused other damage in the joint, and Andrews presented an option that might augment what surgery alone could do. The plan: Take stem cells, the body’s universal building blocks, and deliver them directly to the construction site.
“When I tore my meniscus and played the season out, through the wear and tear, I lost a lot of cartilage,” says Johnson, who was signed by the Jets to bring explosiveness to their offense. “When you put the stem cells in, it might be able to help rebuild that cartilage in your knee. Hopefully, it makes your knee better for even more years.”
For more Information on the Aging Adult and Regenerative Medicine:
312-475-1893 or 312-475-1893
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Concentrated Stem Cell Plasma, Interventional Orthopedics, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
Nov 13, 2014
What’s new for the musculoskeletal care of the aging athlete? First, let me define an athlete; or better put, the recreational interests of aging boomers, masters and seniors. This week, I undertook the knee care of a 67 year old woman from North Dakota whose major interest was a return to her twice a week bowling league. Then there is the 40 year old one time marathon runner from Madison whose knees are preventing him from continuing his athletic pursuit. When I left my house this morning, I had to brush some snow from my back window and I could have predicted the first phone call. “Dr. Sheinkop, I am afraid my arthritic hip will keep me from skiing this year, can you help me?”
The outcomes data that Regenexx posted on its web site these last several weeks as well as my own data base allow me to say “yes” to all of these aspiring athletes no matter the age or the sport/hobby/interest/fitness demand. Arthritis need not be followed by a joint replacement. Until the advent of Cellular Orthopedics, all treatment of the arthritic joint has been directed to relieving symptoms. The only means of actually intervening in the arthritic process was a joint replacement. While they work most of the time, there are risks involved in surgery, time off from work, facing the future of a revision, and little chance of genu flexing enough to bowl or ski down a black or blue run with a total hip or any run with a total knee. There is absolutely no chance of ever running again with a prosthetic joint unless you want a second surgery in less than five years. The orthopedic literature clearly documents that more than 60% of joint replacement recipients have given up all recreational and fitness pursuits within fewer than five years of undergoing said surgery.
Returning to the lead question in the first paragraph, it is Cellular Orthopedics; that is Bone Marrow Aspirate Concentrate containing the positive growth factors, Cytokines, Mesenchymal Stem Cells; and as yet undescribed, multiple agents that alter the bio-immune environment of the arthritic joint. The potential is to not only relieve your pain from the anti-inflammatory effect, restore motion by the reversal of scarring but actually postpone or eliminate the need for a joint replacement by altering or actually reversing the arthritic process.
Now if you will excuse me, after having spent the last week out of the office, I am heading off to the fitness center and begin the preparation for the skiing season
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Mature Athlete, medicine, Orthopedics, Osteoarthritis, Regenerative, Regenexx, stem cells
