Looking to treat severe knee medial compartment OA

[SuspectDevice]

I only know of one person who had stem cells about 5yrs ago (Regenerex??? $10,000 here in Oz) in her knee and several times I asked her did it help, and her answers were evasive & vague, which makes me think it did not. She was a keen runner back in the day.

I had a few rounds of PRP for my knees at a pain clinic (PFPS - which really turned out to be chronic synovitis/loss of tissue homeostasis) and it did not help. Mind you, I was largely mis-diagnosed by every expert I saw. Had to work it out for myself in the end.

[ubercool]

I was examined by Dr. Chris Centeno at the Regenexx clinic in Broomfield, Colo. Centeno bills himself as the "CMO" (Chief Marketing Officer) of Regenexx. After my ultrasound examination, Centeno disappeared to have a good laugh with colleagues in the adjoining office.

I only know of one person who had stem cells about 5yrs ago (Regenerex??? $10,000 here in Oz) in her knee and several times I asked her did it help, and her answers were evasive & vague, which makes me think it did not. She was a keen runner back in the day.

I had a few rounds of PRP for my knees at a pain clinic (PFPS - which really turned out to be chronic synovitis/loss of tissue homeostasis) and it did not help. Mind you, I was largely mis-diagnosed by every expert I saw. Had to work it out for myself in the end.

[SuspectDevice]

I was examined by Dr. Chris Centeno at the Regenexx clinic in Broomfield, Colo. Centeno bills himself as the "CMO" (Chief Marketing Officer) of Regenexx. After my ultrasound examination, Centeno disappeared to have a good laugh with colleagues in the adjoining office. It gave me an uneasy sense of foreboding.

The front office staff is also unusually poor at follow-up, which suggests mismanagement.

Scary isn't it.

I recall visiting a sports doc & knee surgeon who works with one of the national Rugby League teams, and who is supposed to be the 'go-to' knee guy for professional players in Australia....and weekend warrior like me.

To be fair, his analysis of my gait, running, jumping etc using video analysis was very thorough, but when I mentioned the possibility of synovitis to him, he gave my knees a quick prod, said they had no swelling and dismissed it out of hand.

But that's what I had.

Your knees do not necessarily swell with the Dr Scott Dye diagnosis of 'loss of tissue homeostasis' (which the wider profession call PFPS, which is not really a diagnosis, but code for "your knees hurt mostly at the front but we don't know why").

[ubercool]

Medical providers are now in a quandary, 20-40% of their patients now come armed with more information than they have. Clearly, the go-to knee guy curled up when you told him something he should have known. Shame on him.

I was examined by Dr. Chris Centeno at the Regenexx clinic in Broomfield, Colo. Centeno bills himself as the "CMO" (Chief Marketing Officer) of Regenexx. After my ultrasound examination, Centeno disappeared to have a good laugh with colleagues in the adjoining office. It gave me an uneasy sense of foreboding.

The front office staff is also unusually poor at follow-up, which suggests mismanagement.

Scary isn't it.

I recall visiting a sports doc & knee surgeon who works with one of the national Rugby League teams, and who is supposed to be the 'go-to' knee guy for professional players in Australia....and weekend warrior like me.

To be fair, his analysis of my gait, running, jumping etc using video analysis was very thorough, but when I mentioned the possibility of synovitis to him, he gave my knees a quick prod, said they had no swelling and dismissed it out of hand.

But that's what I had.

Your knees do not necessarily swell with the Dr Scott Dye diagnosis of 'loss of tissue homeostasis' (which the wider profession call PFPS, which is not really a diagnosis, but code for "your knees hurt mostly at the front but we don't know why").

[Dave33]

Medical providers are now in a quandary, 20-40% of their patients now come armed with more information than they have.

Where did you get this statistic from?

[ubercool]

Hi people, here's an update on my knee procedure research.

1. Dr. Carlo Tremolada and I spoke a few weeks ago. He likened the regaining of knee functionality to a pregnancy. It will take nine months before I really begin to feel a difference. He mentioned that my knee was not in terrible shape with a "3" on the right side and a "2" on the left side. Unfortunately, I failed to take notes so I may have that all wrong. Given that input, he thought I was a good candidate for MFAT, which should let me postpone a TKR for at least three years.
2. Dr. Joseph Purita called me this past Wednesday. He also believes that stem-cell therapy would be beneficial for my knees. His treatment requires an initial visit to Florida for the harvesting and injections that also rules out pool or ocean use for three days(!), kinda ruining that trip. It would also require two more trips to Boca Raton to receive PRP booster shots at 3-6 week intervals. Purita also thought the therapy might help for 2-3 years.
3. Dr. Kevin Stone's assistant just informed me 10 days later that they still hadn't received my x-rays, so will have to track those down on Monday.
4. A local clinic is still waiting for my referral so I can see Dr. Chad Hanson about a TKR. Hanson trained at the Steadman Clinic and Philippon Research Institute in Vail, CO one of the top orthopedic sports medicine clinics.

While I would love to visit Italy to see Tremolada, I just don't think that's a good idea at this point in time. Travel is such a hassle, why even the UK requires a Covid test for transit passengers! Also, don't want to risk having a negative reaction far away from Milan.

What do you folks think about Purita?

[silver_maple]

Thanks for the update, ubercool.

On Dr. Purita: I have no personal experience but his name has popped up in the forum in the past. Search the archives. I seem to recall he dabbled in human growth hormone in the past but may have had his knuckles rapped. Flying cross-country for follow-up PRP shots, an extremely generic procedure, seems like an overkill to me.

On MFAT: This is a fairly low surgical skill and hence low surgical risk procedure. Basically referring to the liposuction part, which is relatively the trickiest part. Fine to be choosy about the MD based on personal rapport, possibly price, but outcome variability as a function of MD skill is likely low, although in fairness I have not seen studies on this. TKR is a whole different ball game and there surgical skill is very important.

On TKR: It's unlikely you'll avoid TKR. All we are trying to do here is postpone TKR by 3-5 years as a longevity hedge based on current revision expectations. But keep in mind that there is also an optimal age for TKR. There are studies on that, most putting it in the 70-80 year range, with early 70s being the most favourable time. See this meta analysis for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667791/. Something to discuss with Dr. Hanson, perhaps.

Best.

[SuspectDevice]

Hi people, here's an update on my knee procedure research.

1. Dr. Carlo Tremolada and I spoke a few weeks ago. He likened the regaining of knee functionality to a pregnancy. It will take nine months before I really begin to feel a difference. He mentioned that my knee was not in terrible shape with a "3" on the right side and a "2" on the left side. Unfortunately, I failed to take notes so I may have that all wrong. Given that input, he thought I was a good candidate for MFAT, which should let me postpone a TKR for at least three years.
2. Dr. Joseph Purita called me this past Wednesday. He also believes that stem-cell therapy would be beneficial for my knees. His treatment requires an initial visit to Florida for the harvesting and injections that also rules out pool or ocean use for three days(!), kinda ruining that trip. It would also require two more trips to Boca Raton to receive PRP booster shots at 3-6 week intervals. Purita also thought the therapy might help for 2-3 years.
3. Dr. Kevin Stone's assistant just informed me 10 days later that they still hadn't received my x-rays, so will have to track those down on Monday.
4. A local clinic is still waiting for my referral so I can see Dr. Chad Hanson about a TKR. Hanson trained at the Steadman Clinic and Philippon Research Institute in Vail, CO one of the top orthopedic sports medicine clinics.

While I would love to visit Italy to see Tremolada, I just don't think that's a good idea at this point in time. Travel is such a hassle, why even the UK requires a Covid test for transit passengers! Also, don't want to risk having a negative reaction far away from Milan.

What do you folks think about Purita?

Just re-reading your initial posts again, how bad is it if you cycle or walk for more than 15mins? Just minor discomfort or serious pain and loss of function?

My experience & reading tells me that letting anyone do anything inside your knees should be a last resort.

[ubercool]

Thanks for the replies, silver_maple and SuspectDevice, much appreciated.

Well, I have an additional complication. My back has reared its ugly head in a major way. That led me to review Centeno's "The Spine Owner's Manual" (https://regenexx.com/resources/ebooks-and-reports/the-spine-owners-manual/#gref) again. Even when you don't have spine issues, there is a lot of information in this 138-page e-book, and he also offers a 101-page e-book for the knee (https://regenexx.com/resources/ebooks-and-reports/the-knee-owners-manual/#gref).

In any event, reading the Manual, I ran into this item on page 60: "Thirteen papers show that bone marrow stem cells are better at producing cartilage than fat stem cells, while none show that fat stem cells are better than bone marrow." There is a link to an article where you can download an infographic linking to those 13 papers: "Fat vs bone marrow stem cells for arthritis," (https://regenexx.com/blog/fat-vs-bone-marrow-stem-cells/).

Now I realize, he hasn't updated that story since 2015, and many current papers exist that suggest adipose tissue stem cells (ASCs) do work for the knee and back, but Centeno's point is that these 13 compare BMACs head-to-head with ASCs. He does need to update this infographic, however, since this particular study, "Stem cell therapy in discogenic back pain," (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989932/) lists nine papers on the use of adipose tissue in stem-cell therapies.

These infographics, Regenexx also has one on knee treatments, underscored one point, Centeno has written far more papers about stem-cell therapy than any of the three doctors I'm currently speaking to:

Centeno (16)
Tremolada (3)
Purita (1) (https://aspire-medical.eu/wp-content/uploads/2016/06/Purita_wPaper_2016-Update.pdf)

silver_maple, in terms of your TKR study, I found another one that brought up one particularly interesting stat:

"TKA is a successful treatment for osteoarthritis of the knee with an expectable revision rate of less than 5% within 10 years and a long-lasting functional improvement of more than 30% in any assessment score." [Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome - PubMed](https://pubmed.ncbi.nlm.nih.gov/21258774/#:~:text=Conclusion%3A%20TKA%20is%20a%20successful,30%25%20in%20any%20assessment%20score.)

But I'm with you both. I don't want anyone to mess with my knees too much right away, since I can still walk with some pain, and will try to postpone TKR as long as possible, which leaves Centeno as the only possible back/knee solution.

Let me know your thoughts.

[ubercool]

Medical providers are now in a quandary, 20-40% of their patients now come armed with more information than they have.

Where did you get this statistic from?

Dave33, in research we divide the population into quintiles, which are approximately fifths. On one end of the spectrum are people who say/do something, and at the other end of the spectrum is the quintile that does nothing. So, when you see this stat, "22 percent of millennials say they have 'no friends,'" you really learn nothing because 22% of the general population would most likely not friend anyone.

So, I'm guessing that the two top quintiles of knee patients, 20-40%, will be savvy enough to confront their providers with some stats. Everyone in this forum belongs to these two quintiles, the informed.

[ubercool]

OK silver_maple, I followed your advice and did a deep dive into this forum on the early days of stem-cell use and learned a lot. It also explains why it took me so long to update this thread. Here's what I found.

Purita
RateMDs.com gives Purita a rating of 3.29 out of five stars. Many of the posts cite his brusque, time-pressed attitude, and lengthy office waits. Early reviews were largely negative, but were boosted by more positive ones later on, in particular three five-star reviews on August 26, 2018.

I found only one positive case study, Pier2043594 who documented her entire journey, which, she said, resulted in "NO knee pain in 6+ months." She also reported losing 60+ pounds, which may have contributed to the lessening of pain. Upshot: "I truly think I turned the corner when [Purita] did the lavage [with PRP]."

But perhaps the most incisive observation that surfaced from both Pier and RateMDs reviews is that there is very little follow up, either before or after treatments, which suggests a lack of success metrics. NickCat11 concluded in another thread, "The reviews for him aren't promising and it seems like this is due to taking on more patients than he can handle, not so much his technical skill."

Despite these observations, MDAL said "Dr. Purita…I believe is one of the best in the field at the moment."

One of the strangest things, though, is that USA Today pulled the story featuring Purita's treatment of New York Yankees pitcher Bartolo Colon from the web. The article, entitled "Doctors offer unapproved stem cell therapies" written by Steve Sternberg (dated 6/29/2011) is nowhere to be found. PM me if you want a copy of it.

Regenexx
One thing I loved is the back-and-forth between MDAL and Dr. Chris Centeno in the "Is Regenexx joking with us?" thread. MDAL ended up apologizing profusely, while Centeno deftly handled the grenades tossed at him.

One recurring observation made by Sturge08 is "considering how many procedures Regenexx claims they have performed (5,000), I can only count on one hand how many non-Regenexx blog testimonials there are."

It's a well-accepted truth that 90% of stem-cell recipients will never post on Knee Guru and of the remainder, you are more than likely to only hear from the complainers.

I was only able to find three Regenexx success stories: Stonie, rob8647932, and fastglycolytic.

Then again, that was out of a sum total of 11 early reports (2009-2014), with this breakdown:

Regenexx Positive: 3
Regenexx Negative: 2
Docere Positive: 1
Docere Negative: 1
Purita Positive: 1
Stem Cell Positive: 3*

* These people used a variety of providers, and more often than not added HGH to the therapy mix.

There is a lot more data that I'm still processing, but another way to use a forum like this is to analyze search results as a measure of "buzz" much the way Google Trends is used. Here are the results:

Dr. Joseph Broyles: 60
Dr. Allan Dunn: 39
Dr. Harry Adelson: 30
Dr. Chris Centeno: 30
Dr. Joseph Purita: 27
Dr. Khay Yong Saw: 21

I literally read hundreds of posts to gather this information, and I may have missed key facts, so let me me know what I need to add/change. My next posts will focus on what works, potential poster bias and other doctors. Thanks so much for reading.

[ubercool]

I don't think anyone here will be able to read your MRI, and not from just one slice…do you have an X-ray showing the joint space from the front?

Hi vickster:

I finally got x-rays and I'm posting a front-view image, as you requested. Let me know if this helps.

[vickster]

No expert but you have less medial joint space on the left knee which would tally with advanced arthritis

[ubercool]

No expert but you have less medial joint space on the left knee which would tally with advanced arthritis

Would a partial knee replacement be an option?

[vickster]

You'd need to ask a surgeon
They might want to scope first to assess the other compartments, given your age maybe a TKR would be advised. Partials seem more for younger patients as they offer the option of revision later to TKR