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Lowering the Standard of Care for Knee Stem Cell Procedures

POSTED ON IN Knee BY Chris Centeno

standard of carefor knee stem cell procedures

I just examined a patient who has knee arthritis and had a bone marrow stem cell procedure at another local clinic. While it didn’t work and I can’t guarantee him that our more sophisticated procedure will work, I thought reviewing what he received would help explain why his prior procedure was below the standard of care for knee stem cell procedures. Let me explain.

What This Patient Had Done

The patient had a bone marrow concentrate procedure, where bone marrow was taken from the back of the hip and the stem cells were concentrated and reinjected in his knee. The goal was to help his knee arthritis pain and function. This works well in most patients, but in his case, he got no results.

How Was His Treatment Below the Standard of Care for Knee Stem Cell Procedures?

Drawing the Stem Cells

To get the stem cells, a bone marrow aspiration (BMA) is performed. That means that after numbing, a special type of needle is used to draw bone marrow aspirate from the pelvis. Most physicians these days that perform a BMA take shortcuts. The problem is that how the BMA is performed determines how many stem cells the doctor starts with, which determines how many stem cells the doctor can inject.

One of the shortcuts taken by physicians is to only take cells from one site of the bone marrow. This is far easier for the doctor, but it tends to shortchange the patient. Why? Going to more bone marrow sites and drawing smaller volumes helps increase the stem cell number. In this patient’s case, the doctor took a shortcut and only went to one site and drew a higher volume, likely dramatically reducing the number of stem cells that were taken from the area. So this patient began his procedure with a handicap. For more on the published data that supports drawing lower volumes from multiple sites, see my video below: 

Looking at the Whole Patient

This patient has right-sided knee pain, but his history and exam screams that there are other issues. For instance, he can’t walk around a store without leaning over a shopping cart. When his chiropractor manipulates his back, his knee pain gets better. He also had a fall many years ago that likely injured his right SI joint ligaments. Finally, his nerve exam shows problems. So this patient needs his back treated as much as his knee. Was that done? Nope.

No Dosing

In medicine, dosing is everything. On the low end, you need to give a patient the right minimum dose or the treatment is worthless. In this case, there was no attempt at providing that right dose because the doctor had no way to measure it and didn’t know what that dose should be per knee. That’s very different from the procedure this patient will get here, where we will measure the dose of his cells and make a decision on whether we have only enough to treat one knee or have enough to treat both.

Blind Injections

Once it comes time to reinject the cells, you need to make sure they get to the right spot. At the other clinic, this patient got a blind injection, meaning the doctor didn’t use imaging guidance to make sure he was actually injecting these cells in the knee joint. Here at our clinic, we will use both X-ray and ultrasound to ensure the cells get placed in the right spot.

The upshot? While I can’t guarantee that we can help this guy, we can plug the holes in his previous treatment. So hopefully that makes all the difference!

    comments

    R.H. Gunning, M.D. says

    I just became aware of patients reportedly getting "stem cell therapy" at the office of a local chiropractor here in Wadsworth, Ohio. Is this no longer a procedure limited to physician specialists? And could this trend, if real, be contributing to increased risk of procedure failures?

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    Chris Centeno says

    Dr. Gunning,
    Yes, it is a very real trend, and yes it's both bad for the field of regenerative medicine, and bad for patients. Regenexx procedures are limited to Regenexx Providers who are all Physicians. Please see: https://www.regenexx.com/trust-regenexx-network-physicians/

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    William Lund says

    I have had Stem Cell treatment in both knee medial areas performed at the Hood River clinic by Dr. Rigert. As well I just had the same day treatment on my knee ligaments by Dr. Markle in Denver . Still healing but some small improvement in pain in medial area!!
    Keep hoping!!

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    Chris Centeno says

    William,
    Good news! Please keep your Doctors updated, it's an important part of Regenexx treatment.

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    Robert Mulvaney says

    Are all the Regenexx clinics equal in their procedures and outcomes re Stem cell treatment?
    Should one go to Dr. Centano's Denver clinic to receive and obtain the best stem cell procedures?
    Do you monitor all Regenexx clinics re following Regenexx procedures? Do you keep statistics on each Regenexx provider and their patients outcomes over time?
    Is one Regenexx Clinic superior to the others?
    Which Regenexx clinics have the best results re over time satisfaction of their patients?

    replies

    Chris Centeno says

    Robert,
    All patients are entered into the Registry and tracked at specific time points for pain, function, percent improvement, etc. at 1, 3, 6, 12, 18, 24 months and every year thereafter, up to 20 years. The registry includes all Regenexx procedures done by all Regenexx Providers and is not broken down by Clinic. Those Stats can be found on the Regenexx website, under "Outcomes". The Regenexx Network of Doctors all recieve the same training, and there is ongoing training yearly. Please see: https://www.regenexx.com/trust-regenexx-network-physicians/ If for you it’s important to come to Colorado to be treated by one the 6 doctors at the Centeno Schultz clinic, we’d be glad to make that happen. The Regenexx Team at 888 525 3005 is very skilled at matching patients with the Doctors best suited for their particular issues. If you submit you the Candidate form on the Regenexx website, www.regenexx.com, you will be contacted by them.

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    Jane Kibler says

    I'm in need of this for my knees, but is it approved by the medical thing?? Dealing with a sore back at the present time because I turned quick and wow... didn't think I could screw up my back muscles so easily.

    Is this precedure painful? I'm reaqlly a chicken, but I do not want need surgery. It works for some and others I've seen are no better.

    replies

    Chris Centeno says

    Jane,
    It wouldn't be uncommon for a back issue, even one with few symptoms, to negatively affect knees. All procedures are performed with needles, so they feel similar to injections you'd normally get from a Doctor. Regenexx procedures are FDA compliant, which is the clasification stem cell procedures, like surgery, are eligible for. Our website is wealth of information, including Outcomes. Please see: https://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

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    Vicki Shoap says

    Once this patient of your post is treated by Regenexx, it would be most interesting to hear about results. Would you please let us know if the second time works?

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    Chris Centeno says

    Vicki,
    We'll do our best! Patient outcome blogs generally result from a patient contacting us with an update.

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    Erma. M. says

    I live in California which Regenexx clinics would you recommend near Burbank CA. That trained with you and use same procedures as you do. Thank you much ...
    erma. m.

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    Chris Centeno says

    Erma,
    There are 2 within 10 miles of Burbank! They are http://www.healthlinkcenter.com/ and http://blechermd.com/contact/ Here is the entire Interactive List: https://www.regenexx.com/find-a-physician/

    replies

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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