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
Dec 7, 2015
To determine if your quality of life may be improved by a Cellular Orthopedic intervention, a look at an X-ray or MRI is not the answer; a physical examination or several assessments may be needed in addition to reviewing an image.
In a Study: Hip pain and radiographic OA may not correlate reprinted in AAOS Headline News Now-December 4, 2015, Data from a study published online in the journal The BMJ suggest that hip pain and radiographic OA may not correlate in some patients. The research team assessed pelvic radiographs for hip OA among two cohorts: the Framingham Osteoarthritis Study and the Osteoarthritis Initiative. They found that in the Framingham study (n = 946), 15.6 percent of hips in patients with frequent hip pain displayed radiographic evidence of hip OA, while 20.7 percent of hips with radiographic hip OA were frequently painful. In the Osteoarthritis Initiative study (n = 4,366), 9.1 percent of hips in patients with frequent pain displayed radiographic hip OA, and 23.8 percent of hips with radiographic hip OA were frequently painful. The research team writes that hip pain was not present in many hips with radiographic OA, and many painful hips did not show radiographic hip OA. Thus, the evidence suggests that in many cases, hip OA might be missed if diagnosticians rely solely on hip radiographs.
In yet another article featured in the same publication
Study: Worsening lesion status may predict higher risk of knee OA.
According to a study published online in the journal Annals of the Rheumatic Diseases, worsening lesion status as determined via magnetic resonance imaging (MRI) may predict a significantly higher risk of developing knee osteoarthritis (OA) or painful symptoms for patients with at-risk knees. The researchers used MRI to assess cartilage damage, bone marrow lesions (BMLs), and menisci at 12 months (baseline) and 48 months for 849 participants in the Osteoarthritis Initiative who had been determined to be Kellgren-Lawrence Grade-0 in both knees. They found that from baseline to 48-month status, worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with concurrent incident radiographic OA and subsequent persistent symptoms. The researchers write that the findings suggest that such lesions may represent early stages of OA.
In this Blog, I am giving you some of the scientific basis for my reasoning that you allow me to complete a physical examination before I advance a therapeutic recommendation. You may also better understand why one intervention alone may not be the answer as arthritis silently progresses and may not necessarily allow for predictability. It takes an office visit or two or three and maybe yearly to help a patient enjoy the highest quality of life and a menu of services starting with a cortisone injection, next visco-supplementaion and ultimately, stem cell intervention. Some years down the line, that stem cell intervention may need to be repeated.
Tags: arthritis, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Pilot Study, Regenerative, Regenexx, stem cells, treatment
Nov 30, 2015
The title of the Blog this week is taken from a review article appearing this month in The Journal of Osteoarthritis and Cartilage focused on reviewing the state of the art and perspectives, authored in Montpellier, France. As I have indicating over the past several months, the original regenerative medicine concept had been that we would take your bone marrow via aspiration, concentrate it in our laboratory and inject the concentrate into an arthritic knee thereby introducing adult mesenchymal stem cells. The belief had been that those stem cells would morph into cartilage. Now we know there is a lot more happening in the joint following the introduction of bone marrow aspirate concentrate/stem cells.
We know that Osteoarthritis is the most common form of arthritis mainly characterized by the degradation of articular cartilage and associated with subchondral bone lesions. Whereas I had spent the vast majority of my orthopedic career on joint replacement for grade 4 osteoarthritis, over the past four years, I have focused my initiative on cell based interventions for stages two and three arthritis; although next month, I am introducing a novel cell-based therapy for grade 4 osteoarthritis of the hip and knee. Stromal Cells (MSCs) have gained much interest on their trophic and immunomodulatory functions that can help tissue repair/regeneration. The review article from France focuses on the anti-inflammatory effect of Mesenchymal Stem cells on Mitochondrial RNA modulation in OA. With continued cellular science advances, the notion that stem cell management of your arthritic knee and hip still is in the future is erroneous. Four years ago, there may have been some basis for your physician to minimize the possibilities of interventional orthopedic in lieu of a joint replacement because there wasn’t enough clinical proof of efficacy; and, the understanding was that the MSCs would morph into cartilage. As a result of our continued data collection coupled with better understanding of the anti-inflammatory effect of bone marrow aspirate concentrate, there is every reason for an arthritic patient to attempt to avoid a joint replacement.
This past weekend, we had every reason to give thanks and I am no different. I give thanks to my family, to my health, and to my profession for allowing me to help my patients enjoy a pain free active lifestyle. To learn about our non-operative approach to reversing the pain and limitations of arthritis, call to see if you are a candidate or to schedule an appointment. 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, Hip, Interventional Orthopedics, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, stem cells, treatment
Nov 23, 2015
The holiday season is here and along with it, the customary retrospectives and predictions. Here in Chicago, we could look back at the weather a week ago or look forward to the opening of the Western ski resorts and the new opening date of trout fishing in Wisconsin’s Driftless area on January 2nd. For those who want to cycle through the winter, the choice is spin class or the new world of winter friendly bikes. Whatever your interest, be it indoors or outdoors, you need not be limited by arthritis. The new world of Regenerative Medicine and Interventional Orthopedics offers pain relief, improved function, better motion and a maintenance or return to an active life style. Vail opened on November 20, and my wife and I will soon be there for a tune up. Over the Thanksgiving weekend, I will be shopping for the winterized bike and we are scheduling a fly fishing outing to Wisconsin sometime during the first two weeks in January. While it seems strange to think of trout fishing in the winter, the notion of a reason for a snowshoe hike is new and stimulating.
Last week, along with the follow-ups and new patients, two individuals exemplify what Bone Marrow Aspirate Concentrate/ Stem Cell interventions make possible. A 67 year old man with an osteoarthritic knee works in heating and air conditioning; wherein as part of his job description, he climbs ladders while occasionally squatting and kneeling. While he plans to retire at age 70, he doesn’t want to take on the risk of a knee replacement adverse outcome now nor does he want to take up to three months post operative for rehabilitation. After my evaluation and review of images, he elected to schedule an Orthopedic Cellular intervention with the plan to return to a minimum demand work profile for four to six weeks following the intervention; but only one week away from work. The patient is aware he may still come to a joint replacement; but if he does, it would be well after retirement.
The second patient was a 70 year old man, who had been scheduled for a shoulder replacement and a hip replacement. The appointment was really for his wife; but while he was in the office, after hearing my informed consent for his wife’s knee; he requested my input after examining him and reviewing the fact that he didn’t want to lose a winter of skiing. When all was said and done, he scheduled a Bone Marrow Aspirate Concentrate/ Stem Cell intervention to his shoulder and hip, cancelled his hip and shoulder replacements, and booked his winter travel to Beaver Creek.
The above are examples of what is possible with Interventional Orthopedics. Before closing with a customary wish for a Happy Thanksgiving, let me share how I have been regenerated by a knee intervention. In anticipation of a full house over the holidays, I spent three hours, Saturday afternoon on my hands and knees scrubbing the kitchen floor with a microfiber cloth and a 10% solution of vinegar.
Tags: arthritis, athletes, bone marrow, Bone Marrow Concentrate, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Orthopedic Care, Orthopedics, Osteoarthritis, Pain Management, Regenerative, Regenexx, Regenexx-SD, shoulder, stem cells, treatment
Nov 16, 2015
And Let us say Amen. You may not have noticed, but last Thursday, the weekly Blog I write was not posted; because I was off for a week with my two sons fishing the flats of Ascension Bay along the eastern cost of Mexico. While I practice Regenerative Medicine and Interventional Orthopedics, I am very much aware that accompanying the notion of physical well being is spiritual well being. Every year at this time I repeat the “pilgrimage” because just as the spiritual reminds us, your knee joint is connected to your thigh bone and your hip joint is connected to your back, so too is your body connected to your mind. Regeneration and Renewal are like love and marriage; you can’t have one without the other.
I am reminded of the patient I treated two years ago with a bone marrow aspirate concentrate intervention for his arthritic knees. At the time of his first office consultation, though he only lived six blocks from my office; because he couldn’t walk that far, he took a cab. Six weeks later, he returned for follow-up and complained about his ongoing pain and his disappointment in the outcome although in preparation for the procedure, I had informed him it might take up to 18 months to reach maximum medical improvement. When I inquired as to his mode of transportation to my office, he responded that he had walked. Physically, he was enjoying an excellent outcome but spiritually, he needed renewal as well.
As I look at the storefronts in my neighborhood and in downtown Chicago, I am reminded that the holidays are not far away. As I look at the weather forecast, I see that a high of 32 degrees is forecast for November 23 and my thoughts turn to skiing and your hips and knees. What Regenexx does is renew your hips and knees for the outdoors or indoors, holidays and more. If you want a renewal of spirit, try living without pain and increasing your functional capacity. We can make this happen with our Bone Marrow Aspirate Concentrate/ Stem Cell interventions. This morning, a patient contacted me via e-mail to tell me about his friend who before age 55, is on his third hip replacement at the same joint. While my patient has not been totally relieved of his hip pain by my BMAC intervention, he play golf and is fully active whereas his buddy, after a third hip replacement, lives a painful, inactive life dependent on a cane. When coping with the limitations of arthritis, give the opportunity for renewal of body leading to renewal of spirit some thought and then give me a call for an appointment: 847 390 7666
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, 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
