Looking to treat severe knee medial compartment OA

[silver_maple]

Ubercool,

Prompt and fulsome response by Dr Goodwin earns respect. Good to learn osteoporosis does not result in complications with bone marrow harvest.

The two So Korean products that are winding through trials are JointStem by Nature Cell/Rbio and the temporarily named SMUP-IA-01 by Medipost.

JointStem is autologous adipose based with an element of culturing but no genetic enhancement. Akin to what Dr Centeno has been doing in the Caymans for ~ 10 years. JointStem appears to have progressed very far with the Korean FDA and trials are underway in the U.S. To the best of my knowledge Dr Centeno has not initiated cultured trials in the U.S. This is just a news release:
https://www.einnews.com/pr_news/5414538 ... f-the-knee

SMUP-IA-01 has been billed as "2nd generation" by Medipost after the first generation Cartistem failed to sell well for a number of reasons. SMUP-IA-01 is injectable, Cartistem is not. SMUP-IA-01 is allogeneic cord blood-derived.

https://www.medi-post.com/stem-cell-the ... /12/36934/

I am just monitoring, I endorse neither of these treatments and in fact am skeptical of both. I don't believe we are anywhere near to restoring native hyaline cartilage in all its four zonal variations via stem injections. But we've got to keep trying. Biotech has realized the demand will only grow. I am slightly more hopeful re gene therapy but there are many problems there currently, including safety. It's going to take time, possibly a long time. There is no way to do a 5 year follow up in 2 months.

There is lots of activity in the OA space, apparently 80+ companies pursue various therapies. A free high-level summary of a 60-page 2021 OA drug-focused pipeline report is available here. JointStem is listed - culturing triggers classification into a drug.
https://www.researchandmarkets.com/repo ... joca220prd

Best.

[ubercool]

Great info, silver_maple, very useful and all bookmarked.

Thought I would provide an update. Today, I was told by Chad Hanson's Desert Orthopedic clinic that they will no longer accept my insurance, so I guess I'm out of luck there. I had already substituted him in the meantime for Dr. Steven Nishiyama at the same clinic because he specializes in robot knee-replacement surgeries.

Oh well, that means that my mind has been made up for me. I'm scheduled for Regenexx prolotherapy on April 11, BMAC extraction on April 13, and PRP injections on April 21.

Wish me luck.

[silver_maple]

Thanks for the update, ubercool. What you've decided to do has no meaningful downside so from a risk perspective you should be ok. The upside in your case of severe KOA is debatable, esp. the prolo part.

Things have been rather quiet in terms of stem cell experience reports over the past year or two. I am sure people are having stems, they are just not reporting on this board.

Personally I am coming close to the annual PRP refresh my doc recommends and I intend to do (last PRP I did was on Jun 15, 2021 - bilateral). Haven't booked anything yet but getting PRP on short notice is easy in my jurisdiction. PRP has been discussed at length here so won't get into it. Generally, less potent than stems but helps somewhat with the skewed homeostasis of arthritic knees.

Trust you will report post-op. The admin could guide whether to continue this thread or start a new one in a different section (e.g. post-op diaries or injections into the joint).

Best.

[ubercool]

Yea, well prolo is bundled in the price, so might as well try it.

BTW, your doctor, Thomas Vangsness, is now on Centeno's s..t list:

https://regenexx.com/blog/doctors-misco ... gulations/

Thanks for the update, ubercool. What you've decided to do has no meaningful downside so from a risk perspective you should be ok. The upside in your case of severe KOA is debatable, esp. the prolo part.

Things have been rather quiet in terms of stem cell experience reports over the past year or two. I am sure people are having stems, they are just not reporting on this board.

Personally I am coming close to the annual PRP refresh my doc recommends and I intend to do (last PRP I did was on Jun 15, 2021 - bilateral). Haven't booked anything yet but getting PRP on short notice is easy in my jurisdiction. PRP has been discussed at length here so won't get into it. Generally, less potent than stems but helps somewhat with the skewed homeostasis of arthritic knees.

Trust you will report post-op. The admin could guide whether to continue this thread or start a new one in a different section (e.g. post-op diaries or injections into the joint).

Best.

[silver_maple]

Thanks for this tidbit of info, ubercool, wasn't aware. This is a regulatory debate that I am not qualified to comment on. I could not get the full article in AJSM that is in Dr Centeno's crosshairs. I have read a fair bit of hardcore FDA regulations and in his analysis Dr Centeno does use the key relevant terminology (i.e. homologous use, minimal manipulation, same procedure, HCT/P, etc) and appears to have a point. Extensively annotated as well. Further, he certainly has done battle with the FDA and I would think among the bruises he has taken (e.g. having to move cultured offshore) he is highly likely to know the bounds of what is acceptable practice in the U.S.

Good luck with the procedure! I trust you will report post-op.

[ubercool]

Good luck with the procedure! I trust you will report post-op.

Thanks, I will be posting my experience in the Post-op diaries. Tomorrow I will be getting my Regenexx stem-cell procedure. I ended up skipping the prolotherapy, due to a car issue. Given your feedback that it does little anyway, I guess that's OK.

Thanks again for the wishes.

[ubercool]

I don't know if anyone is reading my post in my post-op thread, so I thought I would post a two-week out report here:

On April 13, I had a BMAC treatment at the Las Vegas Regenexx clinic run by Dr. Josh Goodwin. Here are some general observations.

I have had pain in my knee only once since the BMAC injection, although it can feel a bit sore after walking a lot. Before my procedure, I had recurring pain after going up or down the stairs, etc. I can't begin biking until late May, so that will be the real test.

BTW, I have a True Innovations DPS 3D Insight Gaming Chair and I was able to sit in it for six hours, so the lumbar PRP appears to be working.

[ubercool]

Thought you would enjoy an update. Yesterday, I saw Dr. Chad Hanson, a former Steadman Clinic alumni, who has 18 years of experience and is board certified in both Orthopaedic Surgery and Orthopaedic Sports Medicine, with no negative background data.

Once he examined my left leg, he immediately noticed it was slightly bowed. I guess four decades of knee OA will do that to you. Anyway, he pretty quickly recommended a TKR. He says I'm a good candidate for the off-shelf version of a knee implant, due to my low BMI, but said I could opt for a customized Conformis implant for $5,000 more.

Searching this forum, I could not find anything positive about Conformis but as MDAL observes only complainers visit this forum. Then again, their stock trades for $0.26, down from the $20s after its 2015 IPO, so the stock market believes the company has little upside.

I tentatively scheduled the operation for the first week of October, but still not sure I want to proceed that quickly. No actual pain in my knee unless I move the wrong way, which explains my reluctance.

[gaoshanfelix]

The thing with knee replacements is quite easy - they work well if you have a high bone density. The lower your bone density the worse they work - so the younger you are the better. But if your healthy, never have been overweight for longer periods - your bones should be in better shape than the bones of an average (average sadly is nowadays for 50 year olds around 25-27BMI) 50 year old - plus being low body fat your knee replacement doesn't have to carry too much weight.

One main reason for MACI and Co. not to be offered to +55 year olds - is that they usually do not have the strenght to go through rehab. They don't have the strength to walk 3-4 km a day on crutches without ever falling/slipping (but being fully sedentary isn't good - you need to keep your fitness) up. I think for a very fit 70 year old in the US - Denovo NT could be try - I am not sure Osteotomy together with Denovo NT would be worth it vs the rather predictable outcome of a TKR. Osteotomy plus Denovo NT will make the rehab even harder - and if your leg axis isn't straight anymore any kind of cartilage restoration will fail rather sooner than later.
The more I read about Maci and Co. (with your age only Denovo NT has big promise) it is essential that you train for 2 hours 5 days out of 7 after surgery - inluding at least 90 minutes of low AND high aerobic training - and at least once weekly some anaerobic activity. Get HGH (not in the knee, just in bellyfat or your butt) shots once every 14 days would likely help but be another considerable expense. On one hand it may help the cartilage chondrocytes to grow in - but much more it will help you do regenerate better from training and manage a higher training load. On your 2 recovery days every week you still want to be active and take some walks, leisure bike rides, whatever. It's a big misconception of some people here that any cartilage surgery you risk doing too much. The real risk is doing something too early or falling/crashing. But without being highly active the surgeries will not have a good chance.

With a PKR/TKR recovery is way easier and getting back on a bike should be easily possible.
Also look into BFR training (no matter what surgery you decide for) - the more active you can stay the better.


And yeah I would stay the hell away from those snake oil stem cell people. And personally I think there are very few 70 year olds who could do the rehab after cartilage surgery - their advantage usually is being retired so they can dedicate their full time to it. Their disadvantage is that 95% at least haven't been doing enough sports the last 20 years so could not get active enough again (especially if knee pain stopped them from staying active). Also with knee replacement staying active will help a lot - because staying active means better bone density. But the level of activity can be much lower and falling/slipping with your crutches will hurt you, but not hurt the knew knee much.

I think all the doctors telling you stuff besides TKR/PKR are pretty much quacks. It's really only a very small percentage of 70 year olds (low 70, not high 70) who have the fitness means to go through a cartilage surgery rehab. It's those whose goal would be to after surgery do 100 miles bike rides at least once a month, or maybe even run a marathon below 4:30 hours again.

[ubercool]

Thanks for the info @gaoshanfelix. Unfortunately, I'm not under 50, but the good news I have a BMI of 21.5, muscle mass of 76.5% and bone mass of 4%. I will make sure to pay attention to PT.

Here's an interesting article that Centeno posted, which rebutted an article written by Vangsness, which should be of much interest to you @silver_maple

https://regenexx.com/blog/rebutting-mis ... d-shapiro/

[ubercool]

I thought I would post a comment to this thread prior to my six-month report in Post-op Diary. Yesterday, I went biking and completed a 3.2-mile course. I know it may not sound like much but that is the longest I have been able to bike since aggravating my knee in early 2021.

And the best news is, no knee pain! Thought you might appreciate that bit of feedback, @silver_maple!

[ubercool]

Hi people, my TKR surgery is scheduled for next Wednesday. Just got a call from a medical equipment company that wants me to rent two devices:

1. Cold therapy machine with an ice mold that helps with healing: $250 for a three-week rental.
2. CPM leg machine that helps with regaining range-of-motion and kickstarts PT: $200 for a three-week rental.

Are any of you able to give some advice on whether these devices are worth it?

[RGB]

Hi Ubercool. I have some experience of something similar to the cold therapy machine when I had my patellofemoral replacement. For the first 10 days or so I used a cryocuff which basically autocycled between cold and normal temperature. I can't remember the cycle times. It was great and I would have preferred to use it for a few days longer. After that, flexible icepacks were sufficient. I had 3 so that there was always one cold and iced my leg 3-4 times a day after the first fortnight for another 3-4 weeks.

I've also used a CPM machine after one of my (failed) cartilage operations. I'm no expert but it seems unnecessary for a TKR, unless you have arthrofibrosis issues. Getting a range of motion is very important but I'd have thought there are other (and better) ways to do that and I don't think you need the constant movement over long periods that a CPM gives you. Happy to defer to someone with more knowledge though. Good luck.

[ubercool]

This is good to know, thanks so much. I will research the cryo cuff. Sounds useful even now.

Hi Ubercool. I have some experience of something similar to the cold therapy machine when I had my patellofemoral replacement. For the first 10 days or so I used a cryocuff which basically autocycled between cold and normal temperature. I can't remember the cycle times. It was great and I would have preferred to use it for a few days longer. After that, flexible icepacks were sufficient. I had 3 so that there was always one cold and iced my leg 3-4 times a day after the first fortnight for another 3-4 weeks.

I've also used a CPM machine after one of my (failed) cartilage operations. I'm no expert but it seems unnecessary for a TKR, unless you have arthrofibrosis issues. Getting a range of motion is very important but I'd have thought there are other (and better) ways to do that and I don't think you need the constant movement over long periods that a CPM gives you. Happy to defer to someone with more knowledge though. Good luck.

[Paranoid]

Hi people, my TKR surgery is scheduled for next Wednesday. Just got a call from a medical equipment company that wants me to rent two devices:

1. Cold therapy machine with an ice mold that helps with healing: $250 for a three-week rental.
2. CPM leg machine that helps with regaining range-of-motion and kickstarts PT: $200 for a three-week rental.

Are any of you able to give some advice on whether these devices are worth it?

Things seemed to be going well for you in the previous update. What made you schedule the TKR?

Good luck with the surgery!