Who wants a joint replacement for arthritis? For one, count me out as long as there are other options for dealing with my symptoms. I was head of a joint replacement program at a major medical center for the last 15 years of my orthopedic surgical life, and performed over twenty thousand hip and knee replacements over my 38-year surgical career. Yet, every orthopedic surgeon has an ethical and professional obligation to stay abreast of the accelerating knowledge expansion occurring in the musculoskeletal sciences. The covenant that exists between surgeon and patient requires acceptance of this obligation; that’s why I am sharing with you these advances in the care of the aging athlete.
Patient Education and Lifestyle Modifications
1) Participate in self-management educational programs such as those conducted by the Arthritis Foundation, and incorporate activity modifications (e.g. walking, swimming, and biking, instead of running) into your lifestyle.
2) Overweight individuals (as defined by a BMI>25) should lose 5% of body weight and maintain a lower weight.
3) Participate in low-impact aerobic fitness exercises. Yoga is great for your joint mobility.
4) Strengthen your thigh muscles with a physical therapist and maintain your strength with regular visits to a health club.
5) Use a patellar stabilizing knee brace available in any pharmacy. Shoe orthotics do not benefit your knees.
1) Acetaminophen (not to exceed 4 grams per day)
2) Non-steroidal anti-inflammatory drugs (NSAIDS)
1) Corticosteroids three times a year may offer short-term relief.
2) Hyaluronic acid may offer longer-term relief.
Recognizing that arthritis is a normal physiologic effect of aging and assuming you have applied all of the aforementioned non-operative treatment plans, what is the current state of cartilage regeneration before considering a joint replacement?
Allow me to introduce you to the new world of Cellular Orthopedics (Regenerative Medicine). By using your own stem cells normally present in your bone marrow, we are now able to control the symptoms of osteoarthritis, improve joint mobility, increase your functional capacity, possibly reverse the progression of the arthritic changes, delay or eliminate the need for the joint replacement and perhaps, and possibly regenerate your cartilage.
So how might your adult stem cells make it possible? Bone marrow concentrate contains mesenchymal stem cells that serve both an anti-inflammatory and bio-immune modulating function. They can facilitate the regeneration of tissue and cartilage damaged by arthritis. Following aspiration of bone marrow from your pelvis, the marrow is centrifuged and available for a same-day procedure with minimal manipulation of cells.
There is great scientific potential for stem cells. Over the past 18 months, I have used this approach in over 200 arthritic patients with no adverse affects. There has been over 75% patient satisfaction at the knee, hip, shoulder and ankle, including two wrist interventions as well. That was in the first year. The numbers improved in the second year as we gained experience and insight into those who would most likely benefit.
My blog sheinkopmd.com can provide you with weekly updates on new developments in cellular orthopedics. And the Regenexx web site regenexx.com will educate you further about the new world of cellular medicine and the introduction of clinical trials. Think stem cells before a joint replacement to maintain and restore a healthy joint.
Mitchell B. Sheinkop, MD
Emeritus Professor, Orthopedic Surgery
Rush Medical Center
Member of the Regenexx network
After helping found the Department of Orthopedic Surgery at Rush University in 1973, Mitchell served as Director of Orthopedic Residency Education for 15 years. Thereafter, he served as Director of the Joint Replacement Program until his retirement from orthopedic surgical practice in 2009. Having graduated from surgical practice, while still involved in clinical research, Mitchell looked for a means to postpone or perhaps eliminate the need for the joint replacement in a “younger” arthritic patient and started exploring the new world of Regenerative Medicine using stem cells. In 2012, he became a member of the Regenexx Network and uses their treatment innovations for stem cell intervention into the arthritic joint.