Nov 9, 2017
The other day, I noted a www.Ilcellulartherapy.com (my web site) request from a patient seeking to schedule an appointment at my office. That phone call had been placed ten days earlier and my assistants failed to respond in a timely manner. When eventually returned, the potential patient indicated that she had decided to seek consultation elsewhere. I can understand her frustration and yet would her orthopedic needs have been better served by placing a second request? I share this with you and admit we are human; as hard as we try in achieving 100% patient satisfaction, at times the system doesn’t operate as intended. The ultimate question is where to seek Cellular Orthopedic consultation and treatment even if initially, the response is not as either side would like?
For almost five years of a Cellular Orthopedic, Regenerative Medicine practice, I have integrated patient care with clinical research. This is my contribution to the evolving discipline of Stem Cell therapy for arthritis; and is based on what I introduced into orthopedic surgery during my 37-year academic joint replacement career. It is only by monitoring outcomes that we continue to learn and improve results.
Listed below are my clinical research endeavors over the past five years and the basis for my clinical recommendations:
1) Stem Cell Counts and the Outcome of Bone Marrow Concentrate intra-articular and intra-osseous (subchondroplasty) interventions at the knee for grades 2 and 3 OA. (supported in part by Celling). Ongoing
2) Outcomes of Bone Marrow Concentrate (stem cell, platelet and growth factor) Intervention at the Knee for Grades 2 and 3 OA in 50 patients at 2 to 4 years. (supported in part by Regenexx)
3) Outcomes of Intra-articular Bone Marrow Concentrate versus those of combined Intraarticular and Intraosseous interventions for grades 2 and 3 OA at the knee at one year. (self-funded). Ongoing
4) How does the PRP and Mononucleated cell count affect the outcome of a BMC intervention for grades 2 and 3 Knee OA? (a joint project with Greyledge) Ongoing
5) Safety and Efficacy of Percutaneous Injection of Micro-Fractured Adipose Tissue for grade 4 Osteoarthritic Knees, minimum follow-up of 18 months in 30 patients (supported in part by Lipogems)
6) A Lyophilized Amniotic Fluid Clinical Trial for Grades 2 and 3 Knee OA (supported by MiMedx) Ongoing
7) An Amniotic Fluid Cryopreserved Clinical Trial for Grades 2 and 3 Knee OA in 30 patients. (supported by MiMedx)
8) An Amniotic Fluid Cryopreserved Clinical Trial for Grades 2 and 3 Knee OA in 45 patients. (sponsored by Liventa)
We Have The Evidences for Cellular Orthopedics; ask the camp followers to show you theirs.
To schedule an office visit call 312 475 1893 and please be patient.
Tags: cellular orthopedics, Clinical Trial. Mitchell B. Sheinkop, regenerative medicine, stem cell treatment, stem cells, Subchondroplasty
Oct 20, 2017
Well, it is really an internal debate as to whether I should have a concentrated platelet rich plasma procedure or a bone marrow concentrate procedure as I get ready for the upcoming ski season. While it is true that I exercise five to six days a week rotating between outdoor cycling, strength training and rowing, the demands of skiing on the knees are such that I need to rethink my approach. I share this personal flow of conscience to provide guidance and council for readers of this blog. As for so many of us senior recreational participants, each activity has unique demands so we must anticipate each activity from a separate approach. While generalized fitness improves the quality of life and even well-being, maybe even prolonging life, if you want to ski with arthritic knees, now is the time to plan ahead.
Let me share with you my plan based on an observation of the outcomes in over 1500 patients in whom I have intervened with Cellular Orthopedic alternatives over the past five years. In the next several weeks, I will undergo a concentrated PRP intervention ultrasound guided into both of my knees. I will be using the upgraded methodologies for preparation of injectate and customize the PRP with our soon to be activated cell counter. This will provide me with a 20x dosage over that which has been available up until the present; and yes, I too have to pay for the methodology. I will then wait until mid-December, and if I am not satisfied, I will undergo a Bone Marrow Cell Concentrate procedure for both of my knees.
Below are two reasons received in the last 48 hours as to why I believe Cellular Orthopedic is exciting:
“My uber-condensed version, though, is that on almost all days in the last 8 months, I’ve had virtually no knee pain with daily activity. That’s a massive improvement from even the 12-month follow-up visit. I first started to suspect things were improving at about 10 months post-op. At 12 months, I was hopeful but still skeptical. At 14 months things, rapidly improved and have mainly remained there ever since. So, on the whole, I’m vastly improved. I suppose any number of factors could have contributed to that improvement, but Regenexx certainly seems to have helped tremendously.”
“Attended the company golf outing this past weekend. Last year I was concerned so I took an Advil before we started and ended up taking another halfway through the 18 holes. The last four holes I didn’t even leave the cart (to sore/tight to get in and out).
This year I fully intended to bring the Advil again but forgot it. Turned out I did not need it. Finished the 18 holes like nothing. Felt fine after and the next day.
Believe we can consider this a win!!!!”
Do you want to enjoy relief from arthritic symptoms and limitations?
Call 312 475 1893 to schedule a visit or visit my website to watch my webinar www.Ilcellulartherapy.com
Tags: arthritis, Clinical Trial. Mitchell B. Sheinkop, Knee Pain Relief, Orthopedics, treatment
Oct 6, 2017
Assume that you schedule an office assessment for knee pain, altered function and a slight limp. I complete the examination and review the radiograph only to find it “normal”. The examination excludes referral from the low back and hip so the next step is an MRI. 48 hours later I am able to diagnose a Bone Marrow Lesion (BML) as the cause of the problem. The Bone Marrow Lesion is an abnormal area of defect inside the bone. Also called Bone Marrow Edema (BME), they are defects typically found below or adjacent to a joint. They appear a hazy white area on the MRI against the background of darker, unaffected bone and bone marrow. Pathologists have shown that the BML represents a healing response as a result of a bone injury that doesn’t heal properly. In other cases, the MRI finding may be consistent with a stress reaction that forms from overuse or poor joint mechanics.
Obesity and poor diet are thought to increase the likelihood of developing BML. They are more commonly found in middle-aged patients rather than younger patients. Patients with poor joint alignment (bow legs or knock knees) are more likely to develop BML. Adults who quickly increase activity may develop Bone Marrow Lesions or Edema.
As in most initial diagnoses, a course of conservative treatment should be instituted so as to allow the body to heal itself. If the lesion doesn’t heal with medications, braces, non-weight bearing, injections and physical therapy, then an intraosseous injection into the lesion is indicated. Left untreated, the problem may result in the loss of joint support and the development of osteoarthritis.
I treat the symptomatic, non-responsive BML with an intraossous, intralesional procedure called a subchondroplasty whereby Bone Marrow Concentrate rich in stem cells and growth factors is injected into the non-healing insufficiency fracture. Fluoroscopy is used (intraoperative X-ray) to guide the placement of a special drillable cannula into the bone defect. At times, should the BML be of sufficient size as to cause me to be concerned about a possible fracture, I will use a Calcium Phosphate preparation in addition to the Bone Marrow Concentrate. The engineered Calcium Phosphate readily fills the subchondral defect and mimics the properties of cancellous bone eventually being resorbed and replaced with new bone.
Most Orthopedic Surgeons believe that Chronic Bone Marrow Lesions will not heal without intervention. Additionally, the pain generator in osteoarthritis diagnosed by narrowing of a joint space may in fact be secondary to a BML. Bone Marrow Edema and lesions were among the topics I reviewed during my Instructional Programs in St Petersburg, Russia, two weeks ago. To learn about chronic joint pain with a “normal “or even abnormal X-ray, call for a consultation and evaluation.
312 475 1893
Or visit my website and watch the webinar Ilcellulartherapy.com
Jul 20, 2017
We now are approaching five-year outcomes regarding the use of Bone Marrow Concentrate for Osteoarthritis of the hip, knee, shoulder and ankle. Bone Marrow contains Adult Mesenchymal Stem (MSC) cells and Growth Factors. In the beginning, the entire informed consent process focused on the MSC in bone marrow as the agent responsible for diminishing pain, improving motion, stopping, at times reversing the progression of osteoarthritis, and potentially regenerating the joint itself. Now we know that equally important to the MSC are the growth factors produced and stored in the bone marrow. Some of the key proteins (Growth factors) include Interleukin-1 Receptor Antagonist Protein (IRAP), Alpha-2-Macroglobulin (A2M), fibrinogen, PDGF, VEGF, and TGF-B to name a few.
The reason we directed our clinical initiatives to Bone Marrow Concentrate is that while Amniotic Fluid contains Hyaluronic Acid, once harvested, sterilized and fast thawed for clinical application, there are no living stem cells left, so Amniotic Fluid Concentrate has no regenerative potential. When it comes to Adipose Derived Stem Cells, in order to liberate the stem cell from the adipocyte, an enzyme, collagenase must be employed. The latter is not approved by the FDA. Additionally, there is no evidence of Growth Factor content in adipose derived tissue.
While I have blogged about the superiority of Bone Marrow Concentrate over all other non-surgical approaches for arthritis, the introduction of the intraosseous adjunct, subchondroplasty, is resulting in even superior outcomes when compared to those who were treated prior to this contemporary version of Cellular Orthopedics. It has been nine months basically since I started injecting Bone Marrow Concentrate into the marrow adjacent to the joint in addition to the intraarticular approach. We already are seeing a better outcome in those who availed themselves of the Intraosseous adjunct. Up until eight weeks ago, my ability to offer contemporary and improved treatment options was limited by preexisting contractual obligations; but now unrestricted, I have expanded my scope of offerings including elevation of subchondroplasty from a clinical trial status to usual and customary adjunct standard of practice option. As well, I now offer an increased opportunity for participation in other clinical trials for the arthritic joint when a patient meets obligatory inclusion criteria determined by the trial sponsor.
If you want to postpone, perhaps avoid a major surgical replacement for an arthritic joint, call for a consultation 847 390 7666
You may visit my web site at IlCellulartherapy.com where you may watch my webinar.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Microfracture surgery, Orthopedics, Osteoarthritis, Pain Management, stem cells, treatment
Mar 6, 2017
Blog: Dr. Sheinkop , let’s pick up where we ended at the last interview. You were going to tell us about the hip labrum?
Sheinkop: Recently, there has been an increased frequency of diagnosis pertaining to an acetabular labral tear when a patient presents to a physician with groin pain. The cause may be attributed to trauma or it may be spontaneous in nature. While only an orthopedic surgeon really understands how to properly examine the hip joint, I am observing the next step in every and all patients with “hip” or “groin” pain is an MRI prescription. While a torn acetabular labrum is best diagnosed on the MRI after arthrogram, even that exercise may not result in a proper diagnosis. There are anatomic variants that are frequently mistakenly diagnosed as a tear and there are positive findings for a labral tear that when surgically addressed do not result in clinical improvement. In general, unless there are mechanical signs such as snapping, clunking or giving way, pain alone is not justification for arthroscopic hip surgery. In the presence of arthritis, arthroscopy is almost never indicated in the new world of evidence based medicine.
Blog: If I am not mistaken, the way you responded to the labral question is how you have responded in the past to a “positive” MRI of the knee and a diagnosis of a torn meniscus (cartilage).
Sheinkop: You are correct. The scientific evidence clearly identifies the fact that a pain generator must be identified before a surgical procedure. Even if the MRI is compatible with a torn labrum or meniscus, in the presence of arthritis, arthroscopic surgery will make things worse over six months. Surgery in said circumstances should be reserved for mechanical symptoms and not pain.
Blog: Then what is a patient with pain in the groin or knee to do?
Sheinkop: First and foremost, my job is to identify the cause of the pain and treat the patient, not the image. In the absence of clunking, snapping and giving way (joint instability), Interventional Orthopedics based on Platelet Rich Plasma and Bone Marrow Aspirate derived stem cells and growth factors provide the surgical alternative-remember the needle and not the knife.
Blog: I learned this week that you have been invited to St. Petersburg, Russia, this September to present non surgical alternatives for arthritis, at an international orthopedic meeting focused on joint replacement.
Sheinkop: Your information is correct. The role for Interventional and Cellular orthopedics, basically regenerative medicine, is in grades two and three osteoarthritis; while a patient is quite functional and not yet sufficiently impaired to justify the risks inherent in a joint replacement. On the other hand, there is a large patient population with advanced osteoarthritis of a major joint wherein the joint replacement option is to great a medical challenge and may risk survival. The evidence I have gathered over almost five years is not only of interest in the United States but has global potential impact.
To learn more call (312) 475-1893 to schedule a consultation
View my web site at www.sheinkopmd.com
Watch my webinar at www.ilcellulartherapy.com
Tags: arthritis, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, hip surgery, joint replacement, knee surgery, Orthopedic Surgeon, Pain Management, Platelet Rich Plasma, stem cell treatment, torn labrum, torn meniscus
Jan 6, 2017
In reviewing the plethora of proliferating Regenerative Medicine web sites, I found one with multiple points of service in metropolitan Chicago offering platelet rich plasma, fat graft, adipose derived stem cells and bone marrow derived stem cells in an office setting for the treatment of ALS, Alzheimer’s, Erectile Dysfunction, Alopecia, Autism, Cerebral Palsy, Aesthetic improvement and so on and more. There was no end to the promises advanced. At no time was there any evidence of success posted and absolutely no data.
For the first 37 years of my orthopedic practice, I collected outcomes data for every patient in whom I performed a hip or knee replacement. Prior to a surgical procedure, I provided the patient with meaningful outcomes data concerning success and length before a revision surgery might be required. That scientific documentation was scientifically published and used globally for informed consent by orthopedic surgeons around the world. Anticipating the future, actually the present if you live in Alabama, not only do I quantitate that which is injected into an arthritic joint, I am able to qualitate the injectate. I refer to Alabama because that State requires a physician to know exactly what is being injected into a patient when a she or he administers such or the physician is not complaint with that state’s law. With the incorporation of Abbott’s Ruby hemoanalyzer into my Cellular Orthopedic practice, I meet ethical, moral, legal and scientific guidelines and anticipate what I believe will shortly become an FDA compliance requirement. My practice is limited to that which has data to support my recommendations for a symptomatic, arthritic joint; while at the same time documenting the quality and quantity of the combination of Bone Marrow Concentrate, Growth Factors and Platelet Rich Plasma I am injecting.
There is the beginning of an initiative to comply with an anticipated more stringent oversite by the FDA concerning the developing subspecialty of Interventional Orthopedics and I am thrilled to be part of that small group. The FDA is a governmental agency responsible for the well-being, health and safety of the public. While likesome charlatans might get by in the short term, I am thrilled to be part of this initial group of responsible Board Certified Orthopedic Surgeons, Physiatrists and Pain Management specialists providing scientifically supported, FDA compliant, Cellular Orthopedic and Regenerative Medicine options in Sports Medicine and for management of an arthritic joint.
You may schedule an appointment by calling 312 475 1893
My Website is reached at www.Sheinkopmd.com
You may watch my webinar at www.ilcellulartherapy.com
Tags: Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Concentrated Stem Cell Plasma, Knee Pain Relief, Platelet Rich Plasma, PRP, stem cells
