Regenexx stem-cell procedure to treat severe knee medial compartment OA

[ubercool]

Hello good people, starting my post-op diary after posting about my lengthy research process in The Waiting Room:

https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=79491.0

I will be undergoing a Regenexx Same-Day Stem Cell Procedure in Las Vegas tomorrow to treat both my left knee OA and mild degenerative bulging of the L3-L4 and the L4-L5 discs in my lumbar spine. Here’s how Regenexx describes the treatment (please note I skipped the first day’s prolotherapy):

The second day of the treatment is the stem cell injection. You will first be prepared for the bone marrow aspiration which entails taking bone marrow from the back of each of your hips (iliac crest). The bone marrow aspiration process is often described by patients as being only mildly uncomfortable and well-tolerated. You will lie on your stomach on the procedure table and an area at the back of your hip will be numbed. A special needle will be used to draw marrow blood out of this area. X-ray or ultrasound will be used to ensure the optimum location. This will be done on both sides of your hips.

A few hours later you will receive your stem cell injections. The doctor will reinject your stem cells and natural growth factors from your blood platelets using advanced imaging guidance into the area in need of repair (real-time fluoroscopy or musculoskeletal ultrasound, using your MRI as a map for the injection). This allows the doctor to pinpoint the exact location of the injection, as well as the dispersion of the cells into the tissue.

I will let you know tomorrow afternoon how I feel.

[jgardner]

I hope the odds are with you in Vegas tomorrow. Good luck!

[ubercool]

I hope the odds are with you in Vegas tomorrow. Good luck!

Thanks so much. The procedure went very well:

10:00a
I was checked in by an extremely friendly and proficient medical assistant Nina. She asked me a few questions and then pricked my hand for a small blood sample.

10:10a
Lying face down on the OR table, Gebauer Spray & Stretch, an instant topical anesthetic and skin refrigerant was applied to my back to numb the skin and make it feel cool. The injection area was then prepped with EcoVue, a water-soluble ultrasound gel that wipes off easily and acts as a conductor between skin and fluoroscopic transducer.

Dr. Goodwin then numbed the three areas on each side of the back and used an 18-mm canula to aspirate bone marrow from my iliac crest, using x-ray guidance (fluoroscopy). A total of four 30-ml syringes, about 120 ml in total was harvested. That’s before it was processed in the centrifuge.

When the needle hit bone it felt mildly uncomfortable but strangely enough, it was more noticeable on the right side compared to the left. Even the drilling of the bone was barely noticeable.

11:30a
Correction: Nina extracted 12 vials of blood that were mixed with my bone-marrow extract to be injected later.

1:00p
After the bone marrow aspirate was processed, I moved to the OR room where I received an IV of Propofol. While I was asleep, the concentrated bone marrow aspirate was injected into my knee.

11:30p
As I’m writing this, the bandage around my knee feels very tight, which is bothering me. Hobbling around on crutches is very cumbersome. I would hate to think of what it would be like if I had a partial knee replacement.

More tomorrow.

[ubercool]

Yesterday I removed my bandages and started using just one crutch to move around. While sleeping, I experienced occasional minor discomfort while turning but outside of that, nothing major to report.

Considering that 12 vials of blood were mixed with my bone-marrow extract, it’s kind of amazing that my knee was only slightly swollen. The four incision points in my knee are small and, I believe, will largely disappear over time.

I have been taking one fluid ounce of Regenexx Advanced Stem Cell Support Formula each day with food. This 32-oz. bottle was provided free of charge with my procedure (unlike the $375/mo. Dr. Purita charges for supplements).

Today, I’m not feeling any pain in my knee and have been putting occasional weight on the knee while still relying on one crutch.

For those of you who would like to see Dr. Josh Goodwin speaking about his background and the Las Vegas clinic while providing general Regenexx information and its research, watch this YouTube video:

https://youtu.be/WLSmomIi7aE

Unless there is anything significant to report, my next major update will be after my PRP knee and lumbar injections next Thursday, April 21.

[silver_maple]

Ubercool,

Thank you very much for starting this post-op thread! You have a good detailed style that reveals a disciplined mind. What you are doing is a service to many throughout the world.

Glad things seem to be going well so far. Many of us here are anticipating the updates to come and wish you a successful outcome.

1) "Nina extracted 12 vials of blood to be used for my PRP treatment next week." ... "Considering that 12 vials of blood were mixed with my bone-marrow extract..." Can you please clarify, did you have only bone marrow aspirate concentrate (BMAC) injected or a mix of BMAC+PRP?

2) "...it’s kind of amazing that my knee was only slightly swollen..." The volumes of BMA and blood ("raw material") extracted is typically several times higher than the end products injected - BMAC and PRP. During/after centrifugation undesirable bits are discarded. You do not mention the actual volume injected.

3) Did Dr. Goodwin tell you what to expect in terms of recovery milestones over the next 3-6-12 months?

4) "The four incision points in my knee are small..." A little surprised by this as I normally do not associate injections with incisions. Was it perhaps some big needle gauge?

5) "...have been putting occasional weight on the knee while still relying on one crutch..." Did Dr. Goodwin's post-op instructions include advice to be non-weight bearing for any particular length of time or was it fine to weight bear from day 1 as tolerated?

Think if you had done this in Italy while on vacation. It's better to be close to, or at, home. There are have been post-op stories in years past when people travelled internationally, although typically younger guys (e.g. 30s).

Best!

[ubercool]

Hi silver_maple, thanks for the good wishes and flattery. Here are some answers to your questions:

• I already corrected my earlier post. Those 12 vials Nina collected were mixed with my BMAC and injected in the afternoon, so it was indeed BMAC with a mix of PRP.
• I only have photographs and videos to reconstruct the actual procedure, and will confirm this with Dr. Goodwin but it appears that the BMA and PRP concentrate netted four syringes. The exact quantity is to be confirmed.
• The recovery milestones are as follows. Goodwin wanted me to use crutches to keep weight off my knee for 2-3 days. I largely quit using them today, which was three days out. Regenexx says, “most patients are able to resume light activities after 5-7 days and more vigorous exercise at 6 to 8 weeks. Our outcome data suggests [continued healing] peaking at 1-2 years out.” The bad news: “Alcohol can have a profound, negative impact on stem-cell function. A glass of wine with dinner is not a problem, but more could pose a risk to stem cells. THC in marijuana can also promote bone formation over cartilage, so marijuana should be avoided two weeks before and 2 to 4 weeks after your procedure.” In terms of results, “most patients report a modest improvement in the first month.”
• Photos show the doctor only injecting one spot, the lower front, right of my left knee. I’m going to assume that the other marks on my knee were due to local anesthetic shots.
• No specific advice about weight-bearing from this clinic, however, a more detailed guide is available from another Regenexx clinic, Mountain View Rehabilitation Medical Assoc., which states:

Inflammation (Days 1 to 7): For joints, you want to protect them and limit weight bearing if a lower extremity joint has been treated. This may be easy to do; as you may have a natural limp or “antalgic” gait (your body does this to reduce pressure on the area to allow healing). If you don’t have this, then taking a bit of weight off this area as you walk is a good idea for the first two days

Proliferation (Day 4 to week 6): During this phase new tissue, collagen, and the building blocks for the injured tissue is being laid down. The first tissue to form during this stage (first two weeks) is delicate and then it progressively gets stronger. Generally, any exercise or activity that causes greater than 2/10 pain should be avoided as this is a sign the new tissue is being over-stressed. For lower extremity treatments you can start to walk normally — if you were set up with a brace or a boot for the procedure, use this during activity. Avoid all contact sports as well as jogging, running, or sports that involve impact on that joint. Bike riding is fine as are stationary bikes, elliptical machines, pool exercises, and swimming. Yoga and Pilates are fine with modifications if needed.

I feel fine now, my knee is still swollen, around 5 mm, and I know that walking a lot, like Costco last night, is not recommended, so I just rode the shopping cart.

Ubercool,

Thank you very much for starting this post-op thread! You have a good detailed style that reveals a disciplined mind. What you are doing is a service to many throughout the world.

Glad things seem to be going well so far. Many of us here are anticipating the updates to come and wish you a successful outcome.

1) "Nina extracted 12 vials of blood to be used for my PRP treatment next week." ... "Considering that 12 vials of blood were mixed with my bone-marrow extract..." Can you please clarify, did you have only bone marrow aspirate concentrate (BMAC) injected or a mix of BMAC+PRP?

2) "...it’s kind of amazing that my knee was only slightly swollen..." The volumes of BMA and blood ("raw material") extracted is typically several times higher than the end products injected - BMAC and PRP. During/after centrifugation undesirable bits are discarded. You do not mention the actual volume injected.

3) Did Dr. Goodwin tell you what to expect in terms of recovery milestones over the next 3-6-12 months?

4) "The four incision points in my knee are small..." A little surprised by this as I normally do not associate injections with incisions. Was it perhaps some big needle gauge?

5) "...have been putting occasional weight on the knee while still relying on one crutch..." Did Dr. Goodwin's post-op instructions include advice to be non-weight bearing for any particular length of time or was it fine to weight bear from day 1 as tolerated?

Think if you had done this in Italy while on vacation. It's better to be close to, or at, home. There are have been post-op stories in years past when people travelled internationally, although typically younger guys (e.g. 30s).

Best!

[ubercool]

Quick update, last week, on Apr. 21, I had PRP in both my knee and my back. My lumbar procedure was done under “twilight” anesthesia. The first few days my back felt remarkably better but I only have mild bulging discs, so an ideal area to treat.

My knee has felt better overall, but I did experience some pain last Wednesday. Dr. Goodwin tells me that it will take time before the knee improves given its diagnosis. I guess I won’t really know how my knee is doing until I start biking on Memorial Day weekend.

Preliminarily, I can report that all that PRP research Centeno cits is right. It helps.

[ubercool]

It's been a month, since my knee stem-cell therapy. I can report that I have had a few days where a wrong move would bring back some minor pain, but I’ve generally been pain-free.

Before, my knee would be sore 75% of the time. In two weeks, I will begin riding a bike and I plan to begin walking to the park next week. Of course, walking to do shopping, going to Starbucks, getting gas, etc. involves little effort or pain, except for the price at the pump.

In terms of my lumbar PRP treatment, I punish my back a lot because I work on my computer 14 hours a day but despite that, it's definitely better now.

[ubercool]

Today, went for a 55-minute walk covering 1.15 miles. The pace was slow as you can imagine, my knee feels a little sore now, so I'm icing it.

Probably a little too aggressive for a first-time walk, but I think it went well considering.

[silver_maple]

Thanks for updating us, ubercool. For your case research points to statistically significant pain improvement up to the 3 month mark, then maybe a little more improvement months 4-9, plateauing from there, and finally wearing off after yr 2. Varies by individual, of course.

Watched Dr Goodwin's video you linked to, thanks. I find it on the optimistic side, hope you at least match, hopefully exceed expectations.

I trust you will keep the updates going, needn't be frequent. I'd rather get a quarterly update over 2 years than weekly for three months and then nothing. Your call, of course. If you can keep it weekly for 2 years perfectly fine.

I'd like to underline there is absolutely no shame in reporting a treatment that failed to work. This is equally valuable information. Certainly you are out some money and you want it to work but the truth is paramount.

Don't want to hijack your thread but wanted to re-iterate what I have written here before. A secondary objective of my getting repeat PRP shots was to heal a degenerate meniscus tear. Six or seven PRP shots failed to achieve that, confirmed by MRIs 20 months apart. I subsequently found a study that had tested this hypothesis, with the same result - doesn't work. Nevertheless this week I got bilateral PRP refresh shots as I pursue the primary chondro-protective and homeostatis maintenance objectives in my still mildly, but slowly degenerating, arthritic knees.

Best.

[ubercool]

Thanks for the info and support silver_maple.

It has been two months, 60 days to be precise, since my stem cell treatment.

On Tuesday, June 7, I bicycled three miles and my knee was sore for two days and occasionally bothers me since. A few weeks earlier, on May 16, I walked one mile and the soreness lasted about the same time, maybe longer.

Dr. Goodwin recommends prolotherapy for both back and knee. I know you think it’s not going to do anything but Centeno thinks it might help and it’s included free as part of my post-op care.

So two months out, both my knee and back remain unimproved when it comes to pain, although I am able to bicycle, albeit with minor pain. No “significant improvement” as you say could happen. Doing back exercises and applying ice packs help but note that I did not receive a BMA treatment for my spine, only PRP. Goodwin also reports that the registry indicates that two PRP treatments are more effective for the back.

[skishikes]

Hi ubercool.

I saw your post about having gotten a Regenexx procedure, so thought I'd start my own, about how my Regenexx procedure has gone:  https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=79776.0 , so people who are considering this, have an additional data point.

I'm sorry to hear that your procedure has not made any improvement in your situation.

I'm less than a month from the start, of mine, so to early in the process to report anything.  I am keeping my expectations in check, and your post confirms that the whole stem cell thing is a gamble....but still feel..nothing ventured nothing gained. 

Time will tell, and I will update my post....good or bad.  I could find so little, detailed  first person accounts, from people who have had this done, that weren't part of the marketing of the office that was performing the procedures.  So I really appreciated finding your post.

[ubercool]

Thanks @skishikes for adding your own updates, they are very thorough, and better than mine.

Last week, I had prolotherapy on both back and knee, which was included free as part of my treatment. Felt good for about two days but then on Saturday evening, I got up from the couch and experienced a very sharp pain in my knee. I had to use crutches to get around for two days to avoid the pain. I can walk gingerly now, but that definitely was a setback.

So, 76 days out I cannot report any definitive improvement in both my back and knee. I have an appointment with an orthopedic surgeon, Dr. Chad Hanson,  on July 26, so I'm sure he will recommend a PKR to address my knee.

Hi ubercool.

I saw your post about having gotten a Regenexx procedure, so thought I'd start my own, about how my Regenexx procedure has gone:  https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=79776.0 , so people who are considering this, have an additional data point.

I'm sorry to hear that your procedure has not made any improvement in your situation.

I'm less than a month from the start, of mine, so to early in the process to report anything.  I am keeping my expectations in check, and your post confirms that the whole stem cell thing is a gamble....but still feel..nothing ventured nothing gained. 

Time will tell, and I will update my post....good or bad.  I could find so little, detailed  first person accounts, from people who have had this done, that weren't part of the marketing of the office that was performing the procedures.  So I really appreciated finding your post.

[ubercool]

Here’s my 90-day report:

• Knee – Just made a bad move this morning again and my knee reminded me that I’m still not 100% — or 50% for that matter. So, has the knee improved? Not really.
• Back – Did the PRP treatment of the spine help? Not really either. I did a few PT sessions at ATI with their largely disinterested staff. Now I know why author Cathryn Jakobson Ramin called them “PT Mills” in her book, “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.” (https://www.amazon.com/Crooked-Outwitting-Industry-Getting-Recovery/dp/0062641786)

I do exercises twice a day and that is the best therapy so far.