An orthopedic surgeon recently compared patients suffering from hip arthritis, where he performed traditional hip replacement surgery on one group and used the latest stem cell treatment on another group. He found that the patients receiving stem cell treatments experienced more range of motion a year after receiving treatment than patients receiving hip replacement surgery. He also found that 73% of the patients that received the stem cell treatment were able to return to sporting activities. In terms of overall functional scores, patients receiving stem treatments were very similar to the surgery group, with the surgery group receiving a slightly better score for pain management. However, when you compare the invasiveness of surgery to stem cell therapy, the advantages of stem cell treatments are striking.
Traditional surgery: What are the risks?
Traditional hip surgery can range from removing the ball of the femur and replacing it with a metal ball to a total hip replacement. With a complete hip replacement, the entire head of the femur is removed and a metal prosthesis is hammered into place on the hip bone as well as the socket on the pelvis. Risks with these types of surgical procedures include:
- Risk of infection
- Increased risk of stroke and heart attack
- Allergic reaction to the metal used in the implant
- Wear particles from the implant causing high levels of metal ions in the blood stream
- Risk of blood clots in the legs (DVT) and/or lungs (PE)
- Painful post-surgical recovery
- Prolonged rehabilitation
- Recurrent hip dislocations if the replacement is not placed properly
- Failure of the hip prosthesis
After a hip replacement, the materials involved wear down over time, meaning that a hip revision surgery might be required at some point to replace failing implants. This surgery can be longer and even more involved that the original procedure.
Biologic regenerative treatments, such as Stem Cell Therapy, are much less invasive procedures with a quicker return to normal daily activity when compared to surgery. To maximize healing, Stem Cell treatments are used with other leading treatments in the field including Prolotherapy, Platelet Rich Plasma (PRP) and Platelet Lysate therapy. In certain cases, a patient’s unique medical condition or circumstance may preclude utilizing the benefits of all treatments used together. In this case, a customized plan is developed using one or more of the treatments to obtain the best patient outcomes possible. While sometimes there is no good alternative to surgical repair, most often biologic repair offers a better option.
Stem Cell Therapy: The Process
Stem Cell therapy makes use of the supply of stem cells available in the body to help repair injured and degenerated tissues. The easiest place to harvest these stem cells is from the back of the hip area, under ultrasound or x-ray guidance. This harvesting procedure is well tolerated by patients and not considered difficult as many patients claim it is not painful.
After bone marrow blood is drawn, it is centrifuged to concentrate and purify the stem cells, with each stem cell specimen custom designed to meet the needs of the specific injury. Utilizing either fluoroscopy or ultrasound, the stem cells are placed on the injured site precisely to improve the likelihood that stem cells will adhere to the damaged area and promote healing. After the stem cells are placed, concentrated platelets and other adjuvants are injected to stimulate the stem cells to multiply, and then transform into the repair cells needed to regenerate new tissue. The platelets are injected again 2-5 days later to keep the stem cells activated and promote additional healing.
Injected 2-5 days before the stem cells, Prolotherapy contains a solution of concentrated dextrose and local anesthetic (steroids are not used). This solution stimulates the body’s natural ability to repair damaged tissue, encouraging new growth and creating a positive environment into which the stem cells are placed.
Platelet Rich Plasma
Platelets initiate tissue repair by releasing growth factors. These growth factors start the healing process by attracting cells that repair us including critical stem cells. Platelet Rich Plasma therapy intensifies this process by delivering a higher concentration of platelets. The therapy involves a small sample of the patient’s blood placed in a centrifuge to separate the platelets from the other blood components. The concentrated PRP is then injected into and around the point of injury, significantly strengthening the body’s natural healing. Our process for PRP is much different and sets us apart. Because our samples are all hand processed, we are able to produce PRP that is free of contaminating red and white cells, which can inhibit repair. This same special process also allows us to customize the concentration and volume for each individual and each injury type. This greatly improves outcomes.
Platelets in the blood release powerful tissue growth factors that aid in the healing process. Normally this occurs slowly over time, but through the creation of a Platelet Lysate solution, a high concentration of growth factors can be released immediately into the body. The result is a targeted, faster healing process. Additionally, there are areas of the body where using traditional PRP may cause too much inflammation. Platelet Lysates are a better option where inflammation may become an issue.
While additional study is needed, the results of biologic regenerative treatments are too promising to ignore. This can be a real solution to alleviate the pain and loss of function from hip arthritis without the drastic approach of surgically cutting open a patient to replace the entire hip.
 Mitchell, B. Sheinkop, MD, The Orthobiologic Institute, “BMAC Intervention Versus Joint Arthroplasty for Arthritis,” results presented to LA Orthobiologic Conference on June 7th, 2013; http://www.regenexx.com/wp-content/uploads/2013/06/11-MITCHELL-B-SHEINKOP1.pdf
 It should be noted in the Sheinkop study that this was a comparison of patients treated in 2007 with surgery and patients treated in 2011-13 with stem cells. It was not a randomized controlled trial, as that type of study has not yet been conducted for stem cell treatments. It should also be noted that Dr. Sheinkop is a member of the Chicago Regenexx Network, Regenexx is the same treatment offered by Stem Cell Arts.
Painful Low Back Issue Responds To Advanced Treatment
One of the many causes of low back pain is related to injuries of the sacroiliac (SI) joint and ligaments. Most common in young and middle aged women, this condition can make sitting and standing quite painful. SI joint dysfunction is difficult to detect, but with precision diagnostics and effective, non-surgical therapy, a board certified specialist can help you obtain significant long-term, potentially permanent relief.
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A complex condition
The SI joints connect the pelvic bones to the lowest part of the spine. Small and very strong, SI joints provide structural support and stability, functioning as shock absorbers for the pelvis and the lower back.
Not a lot is known about why SI joints become painful, but current medical consensus is that a change in the normal motion of the joint may be the source. Too much or too little movement may cause pain in the ligaments and joints, as well as spasms in the supporting back and pelvic muscles. It may be the result of direct trauma such as a car accident or as simple as a missed step when descending stairs. The stress of childbirth can also weaken the SI joint and other supporting pelvic structures causing pain and instability. Sitting, standing and bending at the waist aggravates the pain. When SI joint dysfunction is severe, there can be referred pain into the hip, groin and leg.
SI joint dysfunction is difficult to diagnose because currently there are no radiologic tests available that consistently detect abnormal motion of the joint. Experienced pain specialists, familiar with the mechanics of the SI joint, can conduct a precise musculoskeletal examination of the spine and pelvis. This type of exam can often detect SI joint dysfunction. Tests such as x-rays, MRI, CT scan and bone scan may be used to rule out other causes of back pain, but they generally are not helpful with diagnosing SI joint injuries.
Long-lasting relief without surgery
Simple, non-surgical techniques have proven to be very effective in resolving SI joint pain. Injections of anti-inflammatory medication and local anesthetic in the SI joint and ligaments can greatly reduce pain and discomfort for extended periods of time. Radiofrequency neurotomy creates a longer lasting result through denervation – obstructing the nerve supply to the SI joint. Advanced regenerative treatments, such as prolotherapy and platelet rich plasma therapy, may also show excellent clinical benefit. These treatments specifically promote natural healing of the joint and ligaments. By improving strength and stability, regenerative therapies may offer longterm and potentially permanent pain relief.
Safely performed in a sterile, office- based setting, these therapies offer the potential for significant pain relief without surgery, general anesthesia, hospitalization or prolonged recovery periods.
Healing Back, Hip and Groin Pain from Pelvic Instability
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Many women live with the chronic, often crippling pain of pelvic instability, a condition believed to be widespread but not easily diagnosed. This prevalent source of pain in the lower back, hips and groin is difficult to detect because traditional examination and imaging tests do not reveal impairment. As a result, these women are frequently misdiagnosed and untreated. But now, advanced regenerative injection therapies have proven to be effective. They can promote lasting pain relief by healing the injured tissues that lead to instability and pain. The key is to find a pain specialist experienced in both diagnosing and treating this condition.
Women are more susceptible to this condition than men, because their pelvic structures are built wider and more flexible for childbirth. The pelvic bones bear the weight of the upper body and distribute it to the hips and legs. This basin-shaped structure consists of the hip, sacrum and pubic bones all held together by ligaments. When the ligaments are injured or overstretched, the pelvis loses its stability and begins to move excessively with physical activities, causing hip, back and groin pain. Even simple movements can become painful, making it difficult to sit, walk, stand, pick up a toddler, drive a car, or merely roll over in bed.
Trauma, a fall on the buttocks or lifting a heavy object, can weaken pelvic ligaments. However, the most common cause is childbirth. Many women first experience pelvic pain after delivering a baby. Symptoms may become apparent soon after birth, or gradually appear years later as ligaments are further impaired by normal physical activities.
Difficult to distinguish
Left untreated, pelvic instability can gradually worsen, leading to severe pain and limitations in activity tolerance. Unfortunately, this condition often goes undiagnosed for several reasons. The symptoms mimic other conditions. The true source of pain is not easily recognized. Today’s imaging technology is unable to detect the abnormal motion of the pelvis or ligament laxity. MRI and CAT scan studies only show torn ligaments, not weak ligaments. Attaining an accurate diagnosis requires a specialized musculoskeletal exam that is performed by a physician experienced in treating the condition.
Often untreated, yet highly treatable
Although difficult to diagnose, this condition can be effectively treated and potentially cured with innovative, non-surgical techniques such as prolotherapy and the revolutionary new platelet rich plasma therapy. These regenerative injection therapies provide pain relief by restoring pelvic stability. Working in tandem with the body’s natural healing process, they strengthen pelvic ligaments by stimulating new growth. Performed without general anesthesia, hospitalization or long recovery, this safe, no pharmaceutical approach can help women regain their active lifestyles – jogging, skiing, even horseback riding – and get back to living again.
Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study.
This is a case report of a 64-year-old white male with a 20 year history of unilateral hip pain that had become debilitating over the last several years. On intake, Harris hip score was rated as: Pain subscale = 10, Function subscale = 32, Deformity subscale = 4, Motions subscale = 4.775 with a total score of 50.8 out of 100. MRI of the affected hip showed severe degeneration with spurring, decrease in joint space, and several large subchondral cysts. The patient had been evaluated by an orthopedic surgeon and told he was a candidate for bipolar hip replacement.
METHOD: Two autologous nucleated cell collections were performed from bone marrow with subsequent isolation and transfers into the intra-articular hip using a hyaluronic acid and thrombin activated platelet rich plasma scaffold. Marrow samples were processed by centrifugation and lysis techniques to isolate nucleated cells.
CONCLUSION: This report describes partial by articular surface regeneration 8 weeks after intraarticular bone marrow transfer. Post-op 3.0T FGRE MRI showed neocortex formation when compared to immediate pre-op MRI and objective improvements were noted that coincided with subjective reports of improvement.