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My View:

Dr Sheinkop makes some great points which MUST be considered…

Total Joint Replacement or Stem Cells

By Mitchell B. Sheinkop, M.D.

Let me share with you projections for hip and knee replacement surgeries and let you draw the conclusions. By 2015, the demand for total knee arthroplasties is expected to double. The demand for hip revision procedures is projected to double by the year 2026. Those numbers are slated to rise further as baby boomers continue to age.

Every day starting this year, for the next 19 years, 10,000 members of the baby boomer generation will reach age 65. By 2030, boomers are expected to have 3.48 million total knee replacements (up 673% over today’s levels) and 572,000 total hip replacements (up 174%).

Assume, if you will that a total joint will last an average of 15 years. Now you may better understand my interest in stem cells; the statistics cited above are frightening and it is easy to foresee how the government must alter health care financing of joint replacements. The  global charge for a hip or knee replacement today is about $40,000; a revision is twice that; and an infected revision may cost $125,000.

What you probably don’t know is that Medicare caps are already scheduled to go into effect at the end of the year starting with physical therapy. Medicare beneficiaries will have a physical therapy cap of $1,870 due to take effect in 2012. These therapy caps were created in the 1997 Balanced Budget Act to save resources needed to balance the federal budget. Congress has allowed some exceptions based on diagnosis, clinician evaluation and judgment but these exceptions will end unless Congress repeals the $1,870 cap.

Given the economic picture I have described, there is ample reason for government and the FDA to facilitate stem cell clinical studies and trials. Yet, I see little if any movement in the world of arthritis. Any clinical therapeutic efforts are few and far between.

The first step is the Platelet Rich Plasma course of care. My office is involved in such treatment options. Remember though, it will take up to a year to measure the benefit. Where are we on stem cells? They are now the standard of care in the large animal vetinary medicine world and having an impact on the management of dysplastic hip or acquired knee arthritis in dogs. In a study,113 horses with recurrent and recalcitrant tendinopathy were injected with their own stem cells. 98.2% returned to racing. As far as humans are concerned, click on WWW.Regenexx.com to read about patient experiences from the original stem cell based musculoskeletal practice in the U.S.

To assure my reader of fairness and balance in the field of reconstructive orthopedic surgery and that I haven’t lost track of the world of joint replacement; a manuscript which I co-authored “Early Clinical Results Of A High-Flexion, Posterior-Stabilized, Mobile Bearing Total Knee: A United States Investigational Device Exemption Trial”, has been accepted for publication in The Journal of Arthroplasy.

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