Can a simple injection of stem cells into an arthritic big toe make a difference? Big toe surgery recovery can be rough. When the big toe gets arthritis, it can cause the toe to become stiff and painful. Since we use the big toe to push off when we walk, the arthritis can impact your gait. The surgical solutions to this problem aren’t pretty. The time honored big toe surgery is fusion. This is where the big toe bones are fused solid with screws (see the “Rocky Horror Show” foot above). If you’re active, not only can the recovery from this big surgery be a problem, but since the big toe needs to be flexible for normal walking, your ability to walk will never quite be the same. Another option is joint replacement, which involves an amputation of the existing joint and insertion of a prosthesis-a huge surgery given the delicate tendons, nerves, and blood vessels around the joint. What if all of this protracted surgical recovery could be replaced by a simple injection?
RA is a 69 year old man who I first evaluated in 2010 for multiple issues. His big toe had been painful for years and he was told that the only option was a surgical fusion of the joint. He was an active man in his late 60s, so the premise of fusing the toe solid didn’t fit with his lifestyle. His big toe was swollen and bent. In Jan of 2011 (more than 2 1/2 years ago), he decided to undergo the Regenexx-SD stem cell procedure instead of surgery. This involved taking bone marrow stem cells and injecting them in his arthritic toe joint under exacting imaging guidance. He had no real recovery, since a big surgery wasn’t performed. As part of a recent registry drive to get in touch with patients who were more than 2 years out from their procedure, I contacted RA. He tells me that at about 2 months after the procedure, he was walking on the beach one day with his wife when he noticed that his big toe didn’t hurt anymore. It’s been almost 100% improved since that time.
Since there is very little likelihood of a spontaneous remission of severe arthritis in a big toe that would last more than 2 years, I’ll have to assume the injection of stem cells into this area has made a lasting difference. The upshot? A huge surgery to fuse or amputate the joint or an injection? You make the call… This is the new field of interventional orthopedics at its best-replacing big surgeries with small procedures performed through tiny needles!
Standard Platelet Rich Plasma versus Regenexx-SCP: Can we design a better platelet rich plasma? Yesterday I received this e-mail authored by a patient of Dr. Malanga’s of NJ Sports Medicine:
“My right ankle healed quickly. A week or two after the PRP, I stepped on a stone. In the past it would have caused a small sprain, but this time it didn’t. This has happened several times since.
I slightly twisted my left ankle a day or two after the procedure, so it’s taken longer to heal, but it too seems more resilient.
This is the longest I’ve gone without wearing an ankle brace in a year. I am super excited and very grateful to you for helping arrange this, to Dr. Malanga for learning the Regenexx PRP and administering it so gently, and to everyone at Regenexx for coming up with this awesome treatment. Other PRP treatments did nothing…”
So why would this woman, who didn’t respond to standard PRP, respond to the Regenexx-SCP procedure? First, to review, PRP means platelet rich plasma. This is a concentrated blood platelet injection which contains healing growth factors. This has become a very common orthopedic therapy for helping chronic injuries heal (like this woman’s unstable ankle). There are two main differences between standard PRP and SCP. To understand this comparison, think of PRP’s job as stimulating the local stem cells to work harder. Sort of like an espresso shot for those cells, which do the hard work of healing. As you know from personal experience, not all espresso shots are created equally. Having just returned from Italy, I can tell you that Italian shots definitely have more kick than Starbucks! In the same way, our lab studies have shown that standard PRP likely has too many contaminating white and red blood bells, which stem cells don’t seem to like. SCP has very few of these, so SCP seems to boost stem cells. To get back to our espresso example, you know that having a 3 shot cappuccino has alot more kick than the 1 shot version. The same holds true for PRP. Most standard PRP comes out of a little bedside centrifuge with a concentration of platelets of about 3X (3 times more than normal). SCP can easily be concentrated all the way up to 20X! Our research has shown that exposing stem cells to high concentrations of SCP makes them work harder, just like a triple shot latte has more kick than a single shot. The upshot? Standard PRP wasn’t designed from the ground up to make your stem cells do their best to heal. Our lab data has allowed us to design SCP to make stem cells act like they just had an Italian triple shot! Tre cappuccini per favore?
NOTE: Regenexx-SCP is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-SCP patients experience the same results.
Knee Stem Cells and Skiing and Hiking make a good combination. We treat many patients who want to be as active as possible as they age without having to get their joints replaced or major surgery.
DW is a 59 year old patient who is a huge propoent of “hot yoga” and frankly could pass for his mid forties. He has been treated with the Regenexx-SCP procedure in his shoulder and ankle as well as the Regenexx-C procedure for his left knee. His left knee has a bad ACL graft from an old surgery, meniscus tears, and moderate to severe patella-femoral (kneecap) arthritis. For the last few years he’s wanted to ski the Highland Bowl in Aspen (picture above), but his knee has prevented that from happening. While not all Regenexx-C patients will ever be able to do this, this is what he recently wrote me:
“The top of the lift is just off to the right of the picture below. Then you hike up the ridge for about 30 minutes to get to the peak (12,392 ft). Then it’s a wonderful 15 minute ski down to the bottom. I’ve been wanting to do this since I first started going to Aspen 6 years ago. My knee felt good all the way up and all the way down!”
His picture at the top is below! DW will be coming back for a second treatment of his knee and hopefully we can keep him skiing 50 plus days a season over the next decade!
NOTE: RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States.
Not all patients should expect to be able to ski this run after receiving Regenexx knee stem cell injections!
Is there an ankle fusion alternative? CB was a 39 year old woman when she was first seen in July of 2011 seeking an ankle fusion. In 2008 she was in a severe car crash where she sustained a compound fracture of her right tibia and fibula and required immediate surgery. Six days later she had a second surgery and then ultimately a third. She was told she needed an ankle fusion. I blogged on her about 6 months ago, after she received her 12 month registry follow-up form for a Regenexx-SD ankle stem cell procedure. Now here’s her e-mail from her 18 month follow-up:
“Hi there Dr. Hanson. I received my 18 month Regennex survey today.Happy to complete it. I’m still doing great and continue to be very thankful for my much improved quality of life on a daily basis .I took out time to go on the Regennex website today. Saw the video of you on ”Doctors”. You did a great job!!! You and Dr. Schultz are my hero. You both have made such a positive difference in my life. Hope you have had a wonderful day and a better tomorrow. “
Not all ankle patients get such great results, but we’re glad to hear that CB is doing well with her ankle fusion alternative. Is it possible she will need an update treatment at some point in the future? I think it’s more likely than not that she will, based on my many years of experience using stem cells in the ankle.
NOTE: Regenexx SD is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx SD ankle patients will experience the same result.
Can stem cells help a patient with not only ankle arthritis, but also multiple bad ligaments and tendons?
KS was a 47 year old woman with very severe ankle arthritis when she was first seen by our clinic in November of 2010. She had a 30 year history of bilateral ankle pain due to soccer injuries at a young age. Her MRIs showed multiple ankle ligament and tendon injures through the years as well as arthritis in multiple joints (including sub-talar). She was ankle brace dependent so the goal was to wean her off of braces. Dr. Hanson started at that point with the Regenexx-SCP procedure injecting into the deltoid ligaments, peroneus longus, and flexor hallucis longus, and main tibiotalar joint. In 2011 she had two Regenexx-SD stem cell procedures adding in the sub-talar joint as well, obtaining solid, but only partial improvement. In October of 2011 she underwent the Regenexx-C stem cell procedure into many of the same areas. Here is her progress from an e-mal she recently sent:
I have so wanted to tell you how thankful I have been for your work.
Even w a bit of occasional hip grumpiness after aqua classes (I’m not sure the hip stuff [is] related to the procedure), I wanted to write to tell you that I was able to walk on our beach area at the Beach house for about 2-3 miles a few weekends back. I haven’t been able to do that in years!
I’m continuing to spread your good work here, among my fellow athletes and at my aqua class, where u could probably pick up 2-3 new clients… Older people w old back, leg injuries… I continue to give out your cards and tell anyone who asks about the miracle stuff of stem cells…
Keep on !
One of your biggest fans”
Again, no miracles here, just a solid response to a expert application of new technologies!
NOTE: Regenexx-SD and Regenexx-C are medical procedures and like all medical procedures have success and failure rates. Not all Regenexx-SD and Regenexx-C patients can expect the same result. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.
Can an Achilles tendon PRP injection trump surgery? SD is a 55 year old woman who found herself in the worst possible place with an Achilles tendon tear. Unlike most torn Achilles tendons that snap and retract back like broken rubber bands, hers became shredded but didn’t snap. This meant that it had many good sized tears throughout the substance of the tendon. She tried to go into a boot and on crutches a few times, but every follow-up MRI showed no healing. Physical therapy was no help and two surgeons told her they wouldn’t touch this situation with a 10 foot pole, while one wanted to spend hours trying to sew back all of these tears. This surgery would have left her on crutches for months again and unable to fully use this ankle for between 6 months and a year. Her pre-treatment ultrasound images are above from May of this year when she was first seen in clinic (top row). I have pointed out the dark spots in the roundish tendon (seen on cross section) which represent tears. They are literally everywhere, which is certainly why the two surgeons told her they couldn’t help. I agreed to treat it with a type of special PRP that can’t really be found outside of a Regenexx network provider, 20 times more concentrated in healing platelets than are usually found in the blood (the 20X Regenexx-SCP procedure). This is because automated bedside PRP machines used by >99% of all physicians can only get to 3-14X concentration with the vast majority not concentrating over 7X. For the procedure itself, I took a 30 gauge needle (the same type they use to inject Botox into wrinkles) and used exacting ultrasound guidance to meticulously fill each tear. We did this twice, once in July and then again in October of this year. She wasn’t instructed to use any crutches and was told to work out as tolerated (don’t do much if it hurts from the injection, low impact exercise if it isn’t sore). The result? While her results are not necessarily experienced by all patients, she reports that she’s nearly pain-free and slowing increasing her work-outs under the direction of her PT. What’s very interesting are the follow-up ultrasound images I took yesterday in clinic (above on the bottom row). Note that the nasty dark tears are almost all gone and we now have something that looks like a normal Achilles tendon. The upshot? Open surgery on this patient would have been almost impossible, given that the tendon would have to be filleted open and then sewn back together in many areas, weakening the tendon and dramatically increasing the chance of rupture. Instead, all she needed were high skill injections of super concentrated platelets with a Botox needle!
NOTE: Regenexx-SCP is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-SCP Achilles Tendon patients can expect the same result.
KW is a 21 year old college level elite track athlete who sought our help in May of 2011 and had very positive results in our care. As doctors we can only continue to finetune our procedures through research and hope for these kind of results. Obviously not all Regenexx patients can expect these results from ankle stem cells procedures…this is KW’s personal story:
When KW first came to us she had a history of ankle pain for 5 months that had failed conservative care and a steroid injection. Her ankle MRI showed swelling in the main ankle joint bones and mild degenerative arthritis with chronic sprains of the main outside ankle ligaments (ATF and CF). The patient first had Dr. Schultz inject proliferants to tighten the lax ankle ligaments in May and then the Regenexx-SCP into the same ligaments in June. In August, once the ankle was more stable, Dr. Schultz then performed the Regenexx-SD procedure by placing her own stem cells into the large ankle joint (TT) as well as into the outside ankle ligaments. Her result? Here is an e-mail sent by her to Dr. Schultz by the patient:
”Hello Dr. Schultz,
It’s been a while since I have updated you on my progress and I felt that I had to share how well I have been doing.
I had my procedure done on my ankle last August. Until the past few months, I kept expecting something to go wrong or for my ankle to begin hurting again because it just felt too good to be true. However, I honestly can say that I believed I am healed and 100%. It took about 6 months post-injection for the pain and stiffness to stop, and since then I have been training to gain back my endurance and strength for running. I am participating in weight lifting, hurdle drills and most importantly back to running 60+ miles a week with NO pain or stiffness in my ankle joint.
I feel so blessed to have had this opportunity…I am applying to medical school this coming year, and it was your compassion and high quality of patient care that has really pushed me to do so. This treatment and the concept of stem-cells is fascinating, and I anticipate future advances in medicine and treatments involving stem-cells. Thank you for helping me run again and for strengthening a passion of mine!”
NOTE: Regenexx-SD and Regenexx-SCP are medical procedures and like all medical procedures have a success and failure rate. Not all Regenexx ankle patients will have the same result.