By Mark Walter, M.D.
Many of us are excited about stem cell orthopedics and its potential. After all, who wouldn’t be interested in a very safe, minimally invasive treatment that uses your own stem cells and growth factors (from your fat and blood) to heal many painful and troublesome orthopedic problems? Not only is it safer but for certain types of problems, the results with stem cells may be much better!
Can stem cells fix everything? Of course not. But it can fix at least 80% of common orthopedic problems like knee or hip arthritis, disc problems in the back or neck, rotator cuff or shoulder arthritis and many other degenerative conditions or injuries. The treatment is minimally invasive and super safe. In my own practice, my protocol is done in a single day as an outpatient procedure. You walk in, we take a little blood and about 60-120ccs of fat in a painless harvesting procedure (with only local anesthesia). You take a break and relax while we prepare the stem cells. Then we inject the stem cells and PRP in and around the specific area involved. And you walk out. The whole thing takes 3-4 hours, start to finish. Yes, you’ll be a little sore for a day or two but downtime is minimal and you can return to activities of daily living within 24 hours.
What’s the downside? The main risk is you may pay your money (because it’s so new, stem cells are not yet covered by any insurance!) and it may not work as hoped.
Sound too good to be true? Actually, it’s not, but there is a big caveat. To get the best results you need to do the treatment properly. The field of stem cell orthopedics has grown rapidly over the last decade and of course, as with any new field, there is no standardization and much misconception and misinformation. It is also true that many doctors who are attempting to do these treatments do not have the right training or background to do it properly. I call them dabblers! They may mean well but their lack of knowledge, training and experience in regenerative orthopedics can greatly jeopardize the outcome. If someone has had a stem cell procedure and if the outcome of the treatment was poor, the first question is: who did it? And what type of stem cells did they use? Certainly, when it comes to healing, there can be poor biologic outcomes, but far more common is poor diagnostic and injection technique, improper selection or preparation of the stem cells or regenerative solution, and failure to educate the patient properly for follow-up and rehab.
There are three major determinants of the outcome of any stem cell orthopedic procedure. First and of prime importance, you need to make the correct diagnosis of the primary pain generators and inject them properly. Good medicine starts with the right diagnosis! For this, you need the right doctor with the right background and skill set. Make no mistake, regenerative orthopedics is a highly specialized field that is a totally different specialty than conventional surgical orthopedics. The outcome, as with any skilled procedure, will totally depend on the training, skill and knowledge of the practitioner.
The best regenerative doctors will have mastered a highly effective technique called Prolotherapy. It is a little known fact that the majority of pain actually comes from micro tears in the attachments of ligaments, tendons and joint capsules. These loose attachments and the resultant joint instability, are crucial concepts to understanding the pain picture in a patient. Unfortunately MRI and ultrasound are not sensitive enough to make these distinctions and really the only way to make a precise diagnosis and prioritize the primary pain generators in any given patient, is with a technique called palpation interrogation. If I palpate a specific site on a specific structure and it reproduces the pain, we call this the “jump sign”. The bigger the jump sign the more important that specific structure is in the pain picture and the more crucial that we address that exact spot with injections.
Second, you need to use the right kind of stem cells and prepare them properly. For our purposes, autologous tissue (from your own body) is far safer and more effective than any other type of stem cells. In my experience, freshly prepared, DNA-matched stem cells are far more effective than umbilical tissue from a donor. There are two sources of autologous stem cells- fat and bone marrow. I prefer fat since it’s easier to get and fat has a higher concentration of mesenchymal stem cells, which are the precursors of ligaments, tendons, cartilage and bone.
Finally you need the right follow-up and rehab program to give the stem cells the best healing environment to work optimally. After the stem cells are placed they live and continue to grow for at least 4-5 months. If, for any reason, a patient is slow to respond and fails to progress after 6-8 weeks, we usually suggest one or two PRP boosters at weeks 6-12 to help reignite the stem cells. The treatment plan for any given patient needs to be individualized depending on the severity and urgency of the problem, number of joints or regions injected, timeline and availability/willingness to come for several visits etc. If the problem is severe, I usually recommend to start with a stem cell/PRP combo to all affected regions, since this gives us the best chance for a rapid and substantial improvement. After all, I only get one chance to make a first impression. I want to turn every patient into a huge success case— and as quickly as possible!
Proper rehab is also important for optimal healing. The patient needs to use and move the areas involved without over-loading the attachments. If needed, painkillers such as tylenol and tramadol can be quite helpful to ease pain while the patient heals, but pharmaceutical anti-inflammatories are to be avoided as they interfere with healing. Good nutrition, reducing stress and proper sleep hygiene also help the healing process.
If you or someone close to you has a serious orthopedic problem I urge you to consider the stem cell option. If you do the treatment properly and optimize all the above factors, your chances of success are 80-85% for a long-lasting, great result. In the end it’s all about quality of life. This is the medicine of the future!
About Dr. Walter
Mark Walter, M.D. has pioneered the field of regenerative orthopedics for the last 22 years and is considered one of the top stem cell orthopedic specialists in Florida. Dr. Walter completed his MD degree at McGill University (1980) and went on to do five years of post-doc work in regenerative orthopedics with the world famous Hackett-Hemwall foundation (in association with the University of Wisconsin). He is a master Prolotherapist and a leading proponent of offering patients non-surgical alternatives for serious orthopedic issues. Dr. Walter has just released his new book Stem Cell Orthopedics- A New Way to Fix Joint, Back and Neck Problems (available on amazon).
For additional information, to book a phone or in-person consultation or reserve a seat at an upcoming free seminar (given monthly) please call Dr. Walter’s office in Sarasota at (941) 955-4325, text the Stem Cell Hotline at (941) 376-2100 or visit us at regenortho.com.
Stem Cell Orthopedics
(941) 955-4325
regenortho.com