Describes current options for treatment of arthritis including stem cell treatments, Platelet Rich Plasma, hyaluronic and steroid injections as well as arthroscopy and joint replacement.

2. You HaveTwo Roads toTake
Surgical Non-surgical

3. Which will you choose?
Surgical Non Surgical

4. What is Arthritis ?

5. What are the
signs of
Arthritis?

6. What are the
risk factors?

7. Interesting Facts
on Age and
Arthritis

8. ArthritisTrivia

9. Summary of
Arthritis

10. • BeingToo Active
NOT

11. What happens
with arthritis

12. Instability and
Arthritis

13. Response of
your Joint to
Arthritis
Damage = pain

14. Your Body’s
Response to
Damage
REPAIR = RELIEF

15. Joint
Homeostasis
Damage Repair

16. Summary
damage
pain
repair
relief

17. Quiz time
• A meniscus tear

18. How do we
reduce
damage?

19. Items causing
damage

20. Weight Control

21. Weight Control
tips

22. Bad Exercise/
Activity

23. Good Exercises

24. Bow legged
Correction

25. Correcting the
bow

26. Shoes make a
difference

27. What is proper
shoe wear ?
PushTest-

28. What is a proper
shoe?
TwistTest
NOT

29. What is a proper
shoe?
SqueezeTest

30. Nutritional
Deficiencies

31. Correct
Nutritional
Deficiencies

32. Glucosamine
Yes or No?

33. Summary

34. QuizTime
is a

35. Turning onThe
Repair of your
joint

36. Gel Injections

37. Gel Injections

38. Gel Injections

39. Gel Injections

40. GelInjections

41. Summary of Hyaluronic Acid
Injections

42. Quiz time

43. Steroid
Injections

44. Steroid
Injection

45. Steroid
Injections
temporary

46. Steroid
Injections

47. QuizTime
average

48. Summary of Steroids

49. Platelet Rich
Plasma (PRP)

50. Platelet Rich
Plasma Growth
Factors
They act like fertilizer for
your joints.

51. Platelet Rich Plasma (PRP)
Safety
Efficacy
Efficacy
*Teitze, DC et al. entitled “The effects of platelet rich plasma in the treatment
of large-joint osteoarthritis: a systemic review.” (Physiology and Sports Medicine 2014,
May;42(2) 27-37)

52. Platelet Rich
Plasma
Duration

53. Platelet Rich
Plasma for soft
tissue issues!
tendonitis bursitis
sprains or
tears

54. Platelet Rich
Plasma

55. Summary of PRP

56. QuizTime

57. Plasma
Proteins
Proteins

58. Plasma Proteins
A2M IRAP
*FrizzieroA, Autolgous conditioned serum for the treatment of
osteoarthritis and other possible applications in musculoskeletal
disorders. Br Med Bull. 2013: 105: 169-84.

59. Plasma Protein
IRAP
*Attur M, Plasma levels of interleukin-1 receptor antagonist (IL1Ra) predict
radiographic progression of symptomatic knee osteoarthritis. Osteoarthritis
Cartilage. 2015 Nov;23(11):1915-24
IRAP is used by many race
horses to improve
performances.

60. Benefits of Blocking Interluekin-1
***Dinarello, CA et al, Treating inflammation
by blocking interleukin-1 in humans; Semin
Immunol. 2013 Dec 15 25(6) 469-84.

61. Plasma Protein
a2M
Weng S et al, Identification of a2-macroglobulin as a master inhibitor of cartilage-
degrading factors that attenuates the progression of post traumatic osteoarthritis,
Arthritis Rheumatol. 2014 Jul: 66(7) 1843-53

62. A2M

63. PRP Plus

64. PRP Plus

65. Bone Marrow
Concentrate
Stem Cells

66. Bone Marrow
Concentrate Stem
Cells
300%
90%

67. Bone Marrow
Concentrate
Stem Cell

68. Bone Marrow
Concentrate
Stem Cell
platelet
rich plasma.

69. Bone Marrow
Concentrate
Safety
Safety-
*World J Gastroenterol. 2014 Oct 14;20(38):14051-7
**Lalu MM et al, Safety of Cell Therapy with Mesenchymal
Stromal Cells (SafeCell): A systemic Review and Metanalysis of
Clinical Trials. PLoS One. 2012 Oct 25 7(10) e47559.
***Herniguo P et al, Cancer risk is not increased in patients
treated for orthopedic disesases with autologous bone
marrow concentrate. J Bone Joint Surg Am, 2013 Dec 18:
95(24) 2215-21

70. Bone Marrow
Concentrate
Stem Cell
Convenience

71. Bone Marrow
Concentrate
Stem Cell

72. Bone Marrow
Concentrate
Stem Cell
Efficacy (Does itWork?)
one
injection more
two
surgeries.
*Ref- Autologous bone marrow-derived mesenchymal
stem cells versus autologous chondrocyte implantation: an
observational cohort study. Nejadnik H., American
Journal of Sports Medicine 2010 Jun;38(6):1110

73. Stem Cells improve
outcomes of common
surgeries
improve
**Wong, KL. et al Injectable cultured bone marrow-derived
mesenchymal stem cells in varus knees with cartilage defects
undergoing high tibial osteotomy: a prospective, randomized controlled
clinical trial with 2 years' follow-up. Arthroscopy 2013
Dec;29(12):2020-8
***KohYG et al, Adipose Derived Mesenchymal StemCells with
Microfracture vs. Microfracture Alone: 2-Year Follow up of a
Prospective RandomizedTrial, Arthroscopy, 2016 Jan, 32(1) 97-
109

74. Bone Marrow
Concentrate Stem
Cell For Hips
Hernigou, P, et al, Cell Therapy of hip necrosis with autologous marrow grafting , Indian J
Orthop.2009 Jan-Mar; 43(1): 40-45

75. Bone Marrow
Concentrate Stem Cells
for Knee Arthritis
Centeno C, et al, Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and
without adipose graft, Biomed Res Int. 2014;2014:370621

76. Bone Marrow
Concentration Stem
Cell therapy compared
to Hyaluronic Injections
Stem Cell group did better!
Vega A, et al,Treatment of KneeOsteoarthritis with Allogeneic Bone Marrow Mesenchymal
Stem Cells: A Randomized ControlledTrial,Transplantation, 2015Aug;99(8); 1681-90

77. Bone Marrow
Concentrate Stem
Cells for Arthritis
Larger Groups
Centeno, C et al, A dose response analysis of a specific bone marrow concentrate treatment protocol for knee
osteoarthritis, BMC Musculoskelet Disord. 2015; 16:258

78. Long-Term Results Bone Marrow
Concentrate StemCell
Emadedin M., et al, Long-Term Follow up of Intra-articular Injection of Autologous Mesenchymal Stem
Cells in Patients with Knee, Ankle or Hip Osteoarthritis, Arch Iran Med. 2015, Jun;18(6): 336-44

79. Stem CellTherapy and Meniscus Repair
HanaYu, et al, Meniscus repair using mesenchymal stem cells- a comprehensive review, Stem Cell
ResTher. 2015; 6(1): 86.

80. LongerTerm Results of Stem CellTherapy
for arthritis of knee and hip
1128
54 months
91% had at least 50%
improvement
Michalek J, Autologous adipose tissue-derived stromal vascular fraction cells in patients with
osteoarthritis, CellTransplant, 2015 Jan 20. doi: 10.3727

82. Arthroscopic
Surgery

83. Safety
Efficacy
*Hagino, T et al Complications after arthroscopic knee
surgery. Achieves of Orthopedic Trauma Surgery , 2014
November; 134(11):1561-4
**Herrlin, SV et al Is arthroscopic surgery beneficial in
treating non-traumatic, degenerative medial meniscus tears?
A five year follow-up . Journal of Knee Surgery, Sports,
Traumatology and Arthroscopy 2013 Feb;21(2):358-64

84. Arthroscopic
Surgery

85. Arthroscopic
Surgery

86. Joint
Replacement
Surgery
What is it?

87. Joint Replacement
• Safety :
16%
3.4 %
10.9%

88. • Reliable
• Reproducible
• Durable-

89. Patient
Satisfaction
after Joint
Replacement
27%- 30%
*Lam, YF et al, A Review of the Clinical Approach to
Persistent Pain Following Total Hip Replacement,
HongKongMedJ , 2016 Dec: 22(6): 600-7
**Wylde, V et al, Total Knee Replacement: Is it Really and
Effective Procedure for All?; Knee, 2007, Dec 14 (6): 417-23

90. Joint
Replacement
Costs
Cost :

91. Joint
Replacement

92. Convenience of
Joint
Replacement
Require someone to help 24/7 for
3 weeks

93. Stem CellVs. Knee Replacement

94. Stem CellVs. Knee Replacement
Stem Cell Group had
Faster improvement

95. Stem CellVs. Knee Replacement
Knee Replacement Group
had
Higher
Longer
Higher
More
Longer
More medical complications

96. Stem CellVs. Knee Replacement
higher patient
satisfaction:
70% pointed to the stem cell
knee

97. Success for Cell BasedTherapy
Am I a candidate forCell
BasedTherapy?
OR
If your joint is stable with no or very rare episodes of catching or
giving away, you can consider cell based therapies.

98. Success for Cell BasedTreatments
Am I a candidate for cell
based therapy ?
OR
If your joint has only rare episodes of swelling and you do not require draining more
than 4 times per year, you can consider cell based therapy

99. Am I a Candidate forCell
Therapy ?
OR
If you have mild to moderate bowing of your joint and you do not
notice the bow under your pants, you can consider cell based
therapies

100. Success for Cell BasedTherapy
Am I a candidate for
Cell Based
Treatments?
OR
If you have mild to moderate loss of motion of the joint and can dress
yourself without any aids, you should consider cell based therapies.

101. Have more than two surgical risk
factors
If you have more than two of these risk factors, you should consider
cell based therapies

102. Success for Cell BasedTherapy
Am I a Candidate for Cell
BasedTherapy?
If you are not willing to undergo the risks, commitments and inconveniences
of joint replacement surgery you can consider cell based therapy

104. Lower Risk
Everyone’s welcome!

105. • Must also figure in time lost
from occupation
may be
• Payment plans available

106. Knee Arthroscopy Bone Marrow Stem CellAnd

107. Benefits of Stem CellTherapy with
Surgery
Proven Benefits
Less Expensive
Less Painful-
More Convenient-

108. Which did you choose?
Surgical Non Surgical