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Author Topic: Stem cells and Cartifill  (Read 12856 times)

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Offline Lottiefox

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Stem cells and Cartifill
« on: January 05, 2010, 07:49:30 PM »
Hi all

Further to recent press releases in December regarding the use of your own stem cells and a collagen gel called Cartfill that had been used to save the leg of a climber in Kent, I've booked a consultation on the 19th with Anan Shetty, the OS who is the only UK surgeon using this technique. His comments so far indicate that this repair technique can be done arthroscopically, in one procedure and has less recovery time than ACI yet is suitable for areas such as the patella. Its clearly VERY new, and that raises questions about the durability/success rates/complications/outcomes/rehab etc. But, it sounds interesting enough to check out with the man himself. Ladle on the stem cells, mould some pliable gunk and slap it into the defects.....result!!!  ;) My kind of gut reaction is that it might be too soon to jump into using this technique until more is known, but on the other hand ACI is still relatively new as well...as are many cartilage repair technqiues. I'm also very encouraged by the success of stem cells alongisde MFX in the US and via injections (Regenexx..)

Any particular questions that people think need to be asked? I am thinking of this for significant lateral patella wear and a small focal medial femoral sondyle lesion. Other surgeons have recommended the whole range between debriding, MFX, OATS for lesion to ACI on the patella. The last OS said that my tibia and femur alignment was OK, but clearly I don't track perfectly or else I'd not have worn out a large chunk of my patella at the age of 40...although this was all aggravated by trying to run too far, too soon, to fast last summer....d'oh!  ::)

This is Mr Shetty's work:

http://www.skypressoffice.co.uk/SkyNews/Resources/showarticle.asp?id=2885

Thanks for reading,

Lottie  :D

Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #1 on: January 06, 2010, 01:25:03 PM »
hey,

congrats on the appt! i too am excited by this development. at 25, i have a huge hole in my left knee cartiledge, and this is the kind of treatment ive been waiting for (even though as you said, its untested, its worth a shot. the best ive been offered is a mosaic of bone/cartiledge on the back of my knee). one question, howd you get the appt? is it on the NHS, or private? if the latter, how much are we talking? (im still young, and paying of uni debts!)...

thanks in advance,

Nathan
Nathan

Trying to be positive over my knee...

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #2 on: January 06, 2010, 01:35:59 PM »
another question, can you ask him if the treatment is suitable for my condition, and how long does he envisage it lasting for? aslo, if it fails, is it the end of the world, or does the stem cell glue just disintegrate?
Nathan

Trying to be positive over my knee...

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #3 on: January 06, 2010, 02:26:40 PM »
Hi Nathan

I am going privately for speed, I just called his secretary at the Spire Alexandra Hospital in Kent and made an appointment, No GP referral required and its 120 for the initial consultation. I guess you might struggle with an NHS referral specifically for cartifill as it hasn't been approved by NICE yet so isn't an NHS treatment but you could always try! Where is your defect? I'll try and sound him out in general about what type of things he thinks the technqiue will help and certainly I want to know what happens if it fails.

Thanks for the reply,

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #4 on: January 06, 2010, 07:39:00 PM »
thanks for the reply. let me know how it goes if thats ok, and untimatly the costs of the whole thing! i have emailed mr shetty and left a message for his PA, but no reply. im guessing theyre mega busy, but i just hope his treatment is the golden fleece it purports to be. when is your consultation?

my injury started a a tear in the meniscus o the back of my left knee, and has gradually become bigger over time. i will try an NHS referal this friday through choose and book, like you say, its worth a shot! otherwise im thinking i might 'choose' the chelsea and westminster hospital, although to be honest its a shot in the dark as i cant find anywhere which 'reviews' departments! my doctors also quite young, so shes unlikely to have an opinion...

cheers mate, its good to know theres others out there... Nathan

Nathan

Trying to be positive over my knee...

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #5 on: January 14, 2010, 09:39:42 AM »
hey lottie,

hope you and your knee are ok. i am fine but my knee is having a bad couple of weeks :(

I dont suppose youve had your consultation yet with mr shetty re carifill?

i actually got through to mr shettys PA the other day who gave me the figures: 125 for consultation and  6500 for treatment. im considering but not sure if i can pay so much for an unproven treatment. Though from what i read it sounds amazing, and if the stories are correct your cartilidge is as good as new...what are your thoughts? nath
Nathan

Trying to be positive over my knee...

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #6 on: January 14, 2010, 10:27:34 AM »
Hi Nathan

Sorry to hear the knee is not behaving. I see Mr Shetty next Tuesday the 19th so will message you when I've had a chat. It is indeed not cheap and it isn't NICE approved yet so the NHS are some way off offering it. But, a basic scope is around 3500 so in some ways the Cartifill isn't that bad...if it works. As you say, there is little in the way of long term study and peer review on the process yet, but I hope to have a better understanding of it, its pitfalls, success prognosis etc after next week.

Will let you know!

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #7 on: January 14, 2010, 10:43:55 AM »
Thanks for the message Lottie,

Good Luck and I look forward to hearing from you!

All the best, Nathan :)
Nathan

Trying to be positive over my knee...

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #8 on: January 19, 2010, 07:37:39 PM »
Hi all,

Just an update on this. I had my consultation with Mr Shetty today at the Alexandra Hospital in Kent. He is, without doubt, an incredibly pleasant and helpful individual. Friendly, informative, down to earth and spent over an hour with me instead of the scheduled 30 minutes. Answered loads of questions, showed me numerous DVDs of surgeries (eeeek!!!! :o), showed me research papers, gave my knee(s) a good going over, and was generally someone that I would feel very comfortable with in terms of him getting my knee with surgical implements. He has worked under Steadman and various other US cartilage gurus and began looking at the role of stem cells some 18 years ago now.

His work is definitely different to many other OSs. However he comes from the background of general cartilage repair and as such, Cartifill is, as he says, another tool in his range. He still does MFX, OATS, ACI, etc etc. Where he differs is that currently he is the only UK surgeon doing Cartifill work using your own stem cells and the collagen paste. He says that this substance bonds quickly, stays put, and so far has an 80% success rate. It is so sticky that for patella work you don't even need to be in a straight leg brace after the surgery. Cartifll "can" be via scope, but it depends on the location. For patella work it is an open procedure, with 6 weeks PWB and a fairly strict PT regime over the subsequent months (nothing you wouldn't expect). It is suited to defects up to 3cm or so, and evidence indicates the paste integrates with the surrounding cartilage rather than forming its own lump. Clearly the work is new, but failure usually means the top surface breaks down as would normal cartilage rather than you finding a 3cm lump of putty flying around your knee. He has a very forward thinking approach to the whole cartilage regeneration field and repair.

In terms of my knee - well, I could be suitable for it. My damage is primarily patella certainly in terms of symptoms. He'd look at the OCD lesion as well, thats only <1cm so Cartifill could well be suitable. He was incredibly encouraging about the overall integrity of my knee and actually made me feel there was hope rather than it being an arthritic old joint ready for the bin! To determine suitability is lengthy (and costly - although there are ways of getting the NHS on board apparently....). He needs CT and X-rays to look at tilt/lie/drift etc of the patella, something else (a dissection scan?!) and then a T2 MRI scan of the relevant bits. A T2 is like the Terminator of all MRI scans - its all coloured and amazing and actually shows the cartilage through all of its levels and dimensions. Then it is mapped acros to other scans and he determines eactly how much silly putty to make, what shape, and it is specific to your knee. Awesome. Based on the T2 he can tell if Cartifill is suitable or else it would be ACI.

I also picked his brains about the direct stem cell injection being carried out in the US and Korea. He thinks this is equally exciting and believes it can work. The UK however won't entertain licencsing it. At the moment.

So, I'm pretty encouraged. I have some decisions to make. I've spoken with Regenexx's OS on the phone and they have rated me a candidate for their stem cell injections - but its 3 trips of 8000 miles each way! However, it is getting encouraging results and hey if it fails, I've had 3 holidays (with needles and I'm due a postponed honeymoon!) and have only lost the money rather than having been down a failed surgical route. If Regenexx failed, surgery would then be the next step and based on today, Mr Shetty is my man. I trust him. That's quite important and I've not felt it with the other OS I saw.

Decisions. I hear the Rocky Mountains are nice though.....
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #9 on: February 16, 2010, 06:32:03 PM »
Hi all

For anyone interested, I'm having the T2 mapping and a CT scan on my leftie this Thursday at the Alexandra Hospital in Chatham. After these are done and Mr Shetty has reviewed them I'll know if I'm a Cartifill candidate, an ACI candidate, and if I also need any form of alignment work doing at the same time. (I suspect I might do as I'm a bit wonky  ::))

The scans will also be informative for Regenexx so seeing as I'm funding them myself I shall be getting the images onto disc asap and seeking Dr Centeno's view in Denver at the same time. More in depth information will aid him in his prognosis as to how much improvement their direct injection procedure may bring as the T2 shows not only areas of damage, but the depth and extent of it plus information on surrounding cartilage.

I'm feeling positive that things are moving towards decision time. But quite scared in case Mr Shetty does a sharp intake of breath at the results and waves a shiny metal implant at me!  :o ;)

Thanks for reading,

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Vickster

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Re: Stem cells and Cartifill
« Reply #10 on: February 16, 2010, 06:42:59 PM »
All the best Lottie - hope it gives all the necessary answers and you know how to move forwards :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Dad3

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Re: Stem cells and Cartifill
« Reply #11 on: February 16, 2010, 06:53:25 PM »
Way to go Lottie.

I hope it works out for you  ;)

You've got more than a vested interest in the being a trail blazer for this procedure. Lets all hope it gives you what you need.

Craig
RT Knee collapsed 08/2009
MRI 10/2009 - torn ACL
Arthroscopy and MFX - 10/2009
ACL and OATS 11/2009
RT knee lateral release, mosaicplasty and medial reefing - 22nd September 2010.
Still not 100% OK :(

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #12 on: February 16, 2010, 08:51:33 PM »
Thanks Craig and Vicks - your support is much appreciated, I'm looking forward to actually making a decision - when I do so I think I'll write it in blood on my kneecaps so I remind myself to stay firm in my choice!!  ;D :P

I'm really pleased that Mr Shetty is the first OS who really seems to want to take the time to do the best for ME and my specific knee issues. Plus he has some fabulous gruesome surgery DVDs that he shares with people. A Cartifilled patella looks like a big awesome smooth boiled egg! (with copious strawberry jam around it  :o)

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline nathansknee

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Re: Stem cells and Cartifill
« Reply #13 on: February 17, 2010, 04:21:50 PM »
hey lottie,

Wow- havent updated for a while on here. went to see mr shetty last week- what a lovely bloke. basically, he says he can help me, maybe not with cartifll, but possibly a similar 'glue' technique involving stem cells. exciting stuff. Ive now been referred to the alexandra on the NHS (whooooooppppiiieeee!) so i dont have to worry about how much this will all cost at least. going for consultation scans etc 5 march :S

Hes already advised me against a knee replacement (im 25, and although i sometimes act like 60, i think id rather wait a while until having that!)....however, like you ill probs need some reallingment work as im also wonky.

good luck, and all the best in your treatment...keep us informed!
Nathan

Trying to be positive over my knee...

Offline Lottiefox

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Re: Stem cells and Cartifill
« Reply #14 on: February 17, 2010, 05:42:19 PM »
Hi Nathan

Excellent news!! I'm so glad that Mr Shetty feels he can help. It is also very positive that the NHS have referred you; I shall be seeing my GP on the 4th March and if the scans tomorrow show a possible surgical route I want to take I'll be getting the ECN referral going as we don't want to fund the treatment itself. Scans we can cope with, operations no! I've been assured that I can still seek the NHS referal if and when I want to go ahead - it does kind of depend on what Mr Shetty recommends as to whether we go surgical or regenexx...

Exciting times - keep me posted too!

lottie  ;D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....