Successful Stem Cell Therapy for Hip Pain

Nonsurgical treatment options are becoming more prevelant and attractive.  Both surgery and anesthesia have risks.  Surgery is often followed by extensive, time-consuming painful physical rehabilitation.

CH is an 50y/o athletic patient with  2yr histoyr of left hip who was an candidate for total hip joint replacemtn.  MRI of the left hip was significant for loss of cartilage, bone spurs and bruising of the bone.   CH rejected surgery and elected to use his own mesenchymal stem cells at the Centeno-Schultz Clinic.

Treatments included Regenexx-C, Regenexx SD and myofasical deactivation. 

Six months post stem cell injection CH writes:  ” I believe I am about 80% healed.  Pain is greatly reduced and some days I hardly notice it at all.  One of my favorite activities prior to the arthritis was hiking and backpacking.  I have been on two hikes of 4 and 7 miles on mountain trails post treatment and did fine.  I plan to go on a backpacking trip soon as well.”

Advances in the treatment of common orthopedic conditions have allowed CH and other patients to forgo total joint replacment and return to their passions.

Bone Marrow Stem Cells: Regular or Premium?

Adult stem cells are available from  three principal sources:  bone marrow, adipose and blood.

Bone marrow is obtained by placing a needle into a large, readily accessible bone and aspirating (withdrawing) marrow.  Hence the term bone marrow aspirate.

The use of x-ray during bone marrow aspirate ensures correct placement of the needle, minimizes time required, maximizes patient comfort and avoids complications such as puncture of blood vessels and organs.  X-ray guidance during bone marrow aspirate is the standard of care at the Centeno-Schultz Clinic.  We have had no complications and the procedure is performed in 20 minutes or less.

After the bone marrow is obtained the stem cell rich cells ( the nucleated cells)  need to be separated and concentrated.  Hence the term bone marrow aspirate concentrate:  BMAC.

Most clinics use a bed side centrifuge whereas Regenexx has a state of the art lab.

Does it make a difference?

Yes.

When compared to bedside centrifuges, the Regenexx lab  produced a concentrate that had a 3 times the number nucleated cells. This is illustrated in the graph below.  The greater the number of nucleated cells the better since studies have demonstrated that placement and number of cells injected can translate to better clinical outcome.

The Regenexx Procedure makes Headlines

The Regenexx procedure has once again made the headlines.

The Regenexx procedure allows patients to use their own bone marrow derived stem cells for common orthopedic conditions.

It’s a valid medical procedure right now,” said Dr. Christopher J. Centeno, medical director of the Centeno-Schultz Integrative Pain Management Clinic.

For many patients it can mean avoiding surgery and months of rehabilitation with a procedure that just requires a few needles of treatment.

Stem cell function continues to be a topic of intense research.  Stem cells play a key role in cellular repair.

“The body is in constant need of repairing itself,” Centeno noted. What’s more amazing than the differentiation, he said, is the ability of the stem cells to direct other cells and their traffic needed to complete the healing, or what he calls the “Bob the Builder” factor.

Safety of Implanted Mesenchymal Stem Cells

Fantastic publication today.

A four year study which examined 227 patient demonstrated no evidence of tumor growth in patients who had mesenchymal stem cells injected for orthopedic applications. Prior to injection, the mesenchymal stem cells has been expanded for a limited time. This differentiates them from those cells used in BMAC (bone marrow aspirate concentrates).  The findings are consistent with other reports which found  no evidence of tumor growth.  What is unique about the current study is the time frame ( 4 years) and number of patients.  Congrats to Dr. Centeno and other team members

Training Camp for Stem Cells

When teams from sea level play our Broncos they come early so as to acclimate.  Denver is the mile high city.

Travlers headed to Machu Picchu stop at Cusco to acclimate.

So to with stem cells.  Degenerative joints, knees and lumbar discs are tough environments.  They have poor blood flow, low oxygen content and limited nutrients. 

Stem cells need to be prepared for such a task:  pre-conditioning is essential for maximal results.

Rosova et. al. demonstrated that when mesenchymal stem cells are pre-conditioned in low oxygen environments their tissue regenerative potential is improved.

Regenexx  employs this technique to ensure the best clinical results in patients who are undergoing autologous mesenchymal stem cell therapy for orthopedic conditions.

Vulcan Shoulder Support

Vulcan Shoulder supports are commonly used for dislocated shoulder, frozen shoulder, broken collar bone, and  rotator cuff injuries.  In concept the neoprene support provides therapeutic heat, support and shoulder pain relief. The compression and warmth can also provide pain relief following shoulder surgery.

How does it work?

The support fastens securely around the shoulder with the Velcro straps to provide support and re-assurance following injury.  If the injury is mild and you are of good health and not taking any know toxins to your own stem cells, it is possible for some of these injuries to improve.  Unfortunately as we age, the vitality of our stem cells and their ability to mount a successful response to injury declines.  The result is continued pain due to incomplete healing.  Immobilizing the joint also goes against the finding supported by Sen who demonstrated mechanical stress led mesenchynmal stem cells to change into cartilage and bone as opposed to fat.

 

At the Centeno-Schultz Clinic we are committed to identifying and correcting the underlying program.  Prolotherapy often used  successfully to treat rotator cuff injuries, AC joint and shoulder dislocations if damaged has occurred to the supporting ligaments.

A non-surgical alternative for  partially torn rotator cuff tendons, dislocation of shoulders and acromio-clavicular injuries is the use of your own stem cells. At Regenexx a patient’s own bone-marrow-derived stem cells are isolated, expanded and then injected exactly into the area of damage under intermittent x-ray guidance. 

Intermittent X-ray to ensure accurate placement of MSC

 Utilizing your own stem cells (autologous) prevents the transmission of disease.

Please review testimonial of a patient who had bilateral rotator cuff tears who previously underwent surgery on one side and elected stem cell therapy for the other side.

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New Knee Cartilage

The knee is covered with cartilage.

Normal and Damaged Knee Cartilage

Cartilage is living material that produces glycosaminoglycans (GAG’s),  which allow for lubrication as well as holding onto water within the cartilage.

Bye, Bye Cartilage Cells

Maintenance of cartilage is a dynamic process.  Each time we cycle, ski the bumps or run, a number of cartilage cells perish.  The cells are then replaced by circulating mesenchymal stem cells which differentiate into new cartilage cells.  When the amount of damage exceeds repair, the cartilage starts to dry up and degenerate.  When the balance is reversed so that repair exceeds the damage, the cartilage remains healthy and full of GAG’s.  It is the balance that is key.  Unfortunately, all the issues regarding regeneration and degeneration of cartilage have yet to be fully understood.  What is known is that with age, the number of circulating repair cells (mesenchymal stem cells) decreases.

At Regenexx we attempt to restore a normal balance by injecting  autologous bone-marrow-derived mesenchymal stem cells into the area of damaged cartilage.  This is performed under x-ray guidance and a small needle.  Regenexx is unique in that we utilize a patient’s own stem cells, and therefore avoid the risk of disease transmission or rejection.  Unlike bone marrow aspirate concentrate therapies, we expand the number of mesenchymal stem cells so as to afford the patient the best outcome.

The MRI below outlines one of our recent knee successes.  This is a patient who had undergone microfracture surgery on her knee due to significant loss of cartilage, without success.  The top images are prior to the procedure,  bottom images are 16 months after therapy.  The red arrows identify breaks in the cartilage (white area in the gray cartilage).  The yellow arrows point to the areas of previous cartilage damage which have now been repaired.  Note the white areas which indicated cartilage damage have significantly resolved.  Clinically, the patient is now pain free and was last seen somewhere in Vail.

Knee Cartilage Before and After Regenexx Procedure

Another Strike Against Big Pharma

Zonegran, a commonly used medication for arm and leg pain secondary to nerve root irration was placed on the FDA medication watch list due to its significant life threatening side effects.  Updated clinical data has demonstrated that Zonegran can cause significant changes in acid-base balance (metabolic acidosis).  The list of medications with significant side effects continues to get longer.  In an earlier blog, I referenced the flouroquinolones, a class of antibiotics, which demonstrated the increase the risk of tendon rupture.  Sode et. al.,  demonstrated that the antibiotic tripled the risk of Achilles rupture.

Illustration of Nerve Root Irritation

Rather than masking the arm and leg pain associated with nerve irritation, at the Centeno-Schultz Clinic we are committed to identifying the cause of the pain and correcting it.  When a lumbar disc protrudes or herniates, often times there is compression of the nerve root with resultant lancinating electrical pain down the extremity. 

Nerve Root Irritation Due to Disc Herniation

 Treatment options include x-ray guided injections of local anesthetic and steroid in an attempt to decrease the pain and inflammation along the disc and nerve root. 

Epidural Injection Under X-Ray

 Another option is the injection of concentrated growth factors derived from a patient’s own platelets in an attempt to increase the blood supply to the damaged disc.  This therapy would aid in repairing the disc as opposed to simply decreasing the inflammation.

Before and 3 Months After Stem Cell Therapy

A novel new technique allows injection of expanded bone-marrow-derived mesenchymal stem cellsinto the disc to repair the damaged lumbar disc.  Please review MRI below of a patient who underwent injection of stem cells into his L5/S1 disc.   On the left, the arrow points the disc protrusion before treatment.  Three months after the Regenexx therapy there was a  reduction of his disc bulge as seen on image on the right, along with complete elimination of his leg pain.

Are All Mesenchymal Stem Cells The Same?

Stem cell therapy continues to expand and gain the attention of patients and politicians.  For many patients, the complexity of the science makes simple decision making difficult.  There are many different types of stem cells.  Mesenchymal stem cells differentiate into cartilage, ligament and bone.  So if you have any orthopedic problem, the stem cell of choice is mesenchymal.

Mesenchymal Stem Cell

But are all mesenchymal stem cells of equal potency?  Koga et. al., recently answered this question.   Mesenchymal stem cells from muscle, synovial fluid, bone marrow, and adipose (fat) tissue were examined for the potential to differentiate into cartilage.  The mesenchymal stem cells obtained from bone marrow and synovium had far greater potential to differentiate into cartilage than did the cells obtained from fat and muscles.  What does this mean to you?  If you have an orthopedic problem, your best bet is to utilize bone-marrow-derived mesenchymal stem cells.

Regenexx exclusively utilizes bone-marrow-derived mesenchymal stem cells.  The stem cells come from the patient, and therefore there is no risk of disease transmission or rejection.  Regenexx is a novel needle-in, needle out technique which allows patients to use their own stem cells to repair damaged ligaments, cartilage and bone.

Mesenchymal Stem Cells

There are various types of adult stem cells. The type of adult stem cells which are associated with tissue repair are called mesenchymal stem cell (MSC). These specific stem cells are capable of repairing damaged tendons, ligaments, intervertebral disc and fractured bones. There are two major sources of mesenchymal stem cells:  bone marrow derived and adipose (fat) derived.  Bone marrow stem cells are obtained via a needle which is inserted into iliac crest.  Adipose stem cells are typically collected during a liposuction.

Why is this important?  Bone marrow derived mesnechymal stem cells has been demonstrated to be superior in their ability to repair cartilage, tendon and ligament when compared to adipose derived cells.  Bunnell demonstrated  that  adipose stem cells are biologically similar, although not identical, to mesenchymal stem cells derived from the bone marrow. Vidal demonstrated that equine bone marrow derived mesenchymal stem cells have far greater regenerative properties for damaged cartilage than adipose derived cells.  Kisiday also demonstrated  that bone marrow derived mesenchymal stem cells have superior ability to repair and change into cartilage.

If you have an orthopedic condition and elect to use stem cell therapy, bone marrow derived stem cells offer the best success.  Regenexx exclusively utilizes autologous bone marrow derived mesenchymal stem cells  for damaged  ligaments, tendon, and cartilage.