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Top Questions

The best way to get started is to call 763-767-7177 between 8am and 5pm Central Time Zone. You can also start the process by completing the Regenexx Candidate Form. This will give you initial information on setting up a patient evaluation with a doctor.

This is on a case-by-case basis and although we have before, it would be at the advice of the doctor to treat more than one area. One of the many things that set Regenexx procedures apart from all other stem cell therapy being offered is dosage; to ensure the best possible outcome the doctor takes many factors into consideration, including your stem cell count. Click here to learn more about Regenexx.

Call us at 763-767-7177 to schedule a free evaluation with Dr. Crider or Click Here Schedule an Appointment.

Our registry based research has shown that, for stem cell procedures, older age does not adversely impact outcome. We also perform a cell count and viability on every bone marrow harvest, and we find that even elderly patients produce high numbers of healthy stem cells using our protocols.

That depends on which procedure is performed.

For example, for most joints, you can expect 3 days of significant down-time followed by a slow return to normal activities over 6 weeks. While you may be asked to wear a brace, very few of our procedures require crutches. Another way to think of your recovery is the Rule of 20's: You can do 20% of your normal activity the first week, 40% the second week, 60% the third week, etc, so that you're at 100% by the fifth (or sixth) week. If you're having more than 2/10 pain you may need to slow your progression.

The same day procedure involves taking your bone marrow, isolating and concentrating those stem cells over about two hours, and reinjecting the cells the same day.

The cultured procedure uses the same bone marrow harvest, but then grows those cells to larger numbers over a period of a few weeks, to be reinjected at a later date. This is not FDA compliant in the United States, so it is only performed at the Cayman Islands location.

Many mechanisms have been put forth, including long-term blocking of cells that destroy the joint, rescue of cells that fix the joint, and replacing lost native stem cells that maintain the joint. Stem Cells also secrete signals that decrease inflammation and pain or improve bloodflow to an injured area.

No, while we have seen MRI evidence of cartilage growth in mild and moderate arthritis, we generally don't see it with severe arthritis. Despite having negligible change in cartilage thickness, many of these patients still have excellent improvement in pain and function, suggesting that there is more to arthritis pain than just cartilage thickness.

Because the procedure protocol will vary from person to person and because each person will have a unique condition to be treated, the pricing of procedures can vary considerably from patient to patient. An evaluation will give you a better idea of condition, treatment, and costs specific to your condition. The chart below provides a general idea of the procedures and where they fall in terms of cost and severity of conditions treated. Platelet procedures cost considerably less than stem cell procedures.

If you do not see a condition listed that identifies your area of pain, please call to discuss your situation with Dr. Crider to see if Regenexx® can help you. 1-763-767-7177

No, Regenerative Medicine procedures are not covered by Medicare or insurance companies at this time. Some providers are improperly billing orthopedic stem cell procedures to insurance as bone marrow transplants for cancer, which is illegal. We do provide itemized receipts if you would like to try to submit to your insurance for reimbursement. You can also use an HSA/FSA pre-tax. We are not charging you or your insurance for our new patient visits or followups at this time.

No. Both are regenerative medicine procedures, but Stem Cells comes from your bone marrow and PRP is concentrated platelets from your blood. The differences between these two therapies is outlined (here) (link to PRP vs Stem discussion). Furthermore, Regenexx has developed a patented protocol for concentrating the platelets from the plasma, allowing us to achieve higher concentrations and purity than a typical bedside centrifuge can create. We have renamed the Regenexx PRP product Super Concentrated Platelets (SCP) because it is 3x as concentrated as a standard PRP product with none of the red blood cell contaminants. (link to infographic of PRP vs SCP differences). Similar protocols also allow us to concentrate bone marrow stem cells into much higher numbers than the bedside centrifuges can deliver.

When we first began offering orthopedic stem cell therapy in 2005 as part of an IRB-approved medical study, we were one of the few clinics in the world treating orthopedic problems with stem cells. When we began treating everyday patients in 2007, this was still the case, and- despite the explosion of stem cell clinics in the past few years- we remain the leaders in the field. We've continued to refine our protocols for processing your stem cells by hand, which continues to create a better product than any automated bedside machine can replicate. We've also fine-tuned our injection protocols based on our extensive experience over the past 15 years. The 90,000+ procedures tracked in our Outcome Registry speak to the benefits of having your procedure with an expert in Interventional Orthopedics.

General

If your hematocrit is below 30 or your hemoglobin is below 10, we may not be able to perform the procedure. If your hematocrit is between 30-36 or hemoglobin below 12, we may try to limit the IV blood or marrow draw amounts and will have you follow-up with your family doctor. In patients who have somewhat low platelet counts, we have the unique ability to concentrate the cells up to 20x to achieve adequate platelets counts in your PRP.

We originally conducted clinical trials from 2005 - 2007, which were the first orthopedic stem cell procedures performed. Since that time, Regenexx has performed more of these procedures than any other clinic or medical group. The same-day procedure that is currently performed in the United States was developed in 2010 and has been continually improved since that time. In patients who have somewhat low platelet counts, we have the unique ability to concentrate the cells up to 20x to achieve adequate platelets counts in your PRP.

Are these embryonic stem cells?

No, they are simply your own adult stem cells. We only use autologous (your own) cells.

Are umbilical cord, placental, or amniotic stem cells better than adult stem cells?

Umbilical cord stem cells are stem cells isolated from a baby's umbilical cord, amniotic cells come from the fluid that surrounds the baby, and placental tissues are also isolated from byproducts of the birth process. The basic science studies done on these cells are done using fresh live cells or else culture expanded cell lines, which are illegal to use clinically per FDA guidelines. There have been almost no studies published on the actual product which are available for injection in the US, which have been processed and frozen and flash-thawed at the bedside. While fresh or cultured umbilical or amniotic tissues do have live and functional stem cells, attempts to grow viable cells out of the thawed-out end-product have shown no live cells. Study results from fresh or culture-expanded cells cannot be applied to the available products of frozen or non-culture-expanded cells. Furthermore, the idea that adult bone marrow stem cells decline as you age is false; while they do decline in the first few months of life, beyond that your stem cell reserve is fairly stable. (could show the graphs from the link above here). We get excellent cell counts and cell viability from adults of all ages. Using your own, fresh cells has the added benefit of avoiding rejection or incompatibility with other people's cells or the higher risk of bacterial contamination that comes with factory-processed products.

Are there different types of adult stem cells?

Yes, there are many types of adult stem cells, each of which has potential to become different types of tissue. Hematopoetic stem cells (HSC-CD 34+) are found in the blood or bone marrow, and they give rise to various types of blood cells. Outside of a handful of cardiac, oncologic, or vascular applications, they are not well studied in orthopedics. The vast majority of what you see being billed as 'stem cells' from bone marrow (where the cells are injected the same day as collected) use machines which mostly collect these blood-type hematopoetic stem cells. The type of adult stem cell that is most often seen in research as being associated with orthopedic tissue repair is a mesenchymal stem cell (MSC). MSCs can't generally be harvested from blood, and special techniques are needed to isolate them from bone marrow. Fat tissue contains many MSCs, but these are distant cousins to the type obtained from bone marrow and aren't as useful for orthopedic applications.

What are there different types of Mesenchymal Stem Cells (MSC's)?

For orthopedic applications, two main types of MSCs have been used, bone marrow derived and adipose (fat) derived. Bone marrow MSCs are taken via a needle through a bone marrow aspiration. The bone marrow aspiration procedure sounds like a big deal, but we are consistently told by patients that the procedure is very comfortable, as we use plenty of lidocaine. Our procedure is different than a bone marrow transplant for cancer, which is much more painful.
The second type of MSC is derived from fat tissue (adipose). This can be obtained via liposuction. For orthopedic applications, fat derived MSCs consistently and dramatically under-perform bone marrow derived cells. In studies of cartilage repair, bone repair, and soft-tissue repair, bone marrow derived MSCs are much more adept at these tasks. This makes sense, as they perform this function naturally (homologous) everyday. For example, if you break a bone, it's these bone marrow MSCs that help mend that bone. In addition, for surgical micro fracture to repair small amounts of knee cartilage damage, it's bone marrow MSC's that are released to do that job.

Doesn't fat (adipose tissue) have more stem cells than bone marrow?

Yes and No. First, many adipose stem cell clinics dramatically over-estimate the number of stem cells in their processed fat. Basically, what physicians believe to be cells are actually small globs of fat tissue. Second, the proprietary Regenexx stem cell isolation method dramatically increases the number of stem cells isolated from bone marrow (based on our lab studies).
Still, on a weight to weight basis, fat can contain more mesenchymal stem cells than bone marrow, but the problem is that they just don't work as well for orthopedic applications. In select cases, the Regenexx-AD knee stem cell procedure we can offer the best of both worlds, using both bone marrow and fat. But given that bone marrow stem cells have so much more evidence backing up their use, we typically choose to go with bone marrow over fat.

What are Exosomes?

Exosomes are the cellular messages that stem cells send out to neighboring cells directing them what to do. When we inject your stem cells, they release their own exosomes in response to your specific injury. However, many companies are now growing stem cells in a lab and collecting the random messages that they send out while growing in the dish. Those exosomes are then bottled and sold for a variety of indications. Regenexx does grow cells in culture at the Regenexx Cayman location, but chooses to throw away that culture media and the random exosomes it contains because we believe that the cells will secrete the proper signals only in response to your specific injury once it's in your body. There are also regulatory concerns with using exosomes, as they haven't been tested as drugs and may not meet FDA criteria for using human tissues.

Because an x-ray will only show the condition of the bone, not the soft tissue, the doctor needs an MRI to accurately evaluate the condition of the whole area. If a patient is unable to have an MRI, a CT arthrogram is acceptable. We will review an x-ray for non-union fractures only.

The doctor will need the most recent MRI available. The MRI should be without contrast and less than two years old. If you've had surgery or a scope done since having the MRI, we would need an MRI that was taken after the operation/procedure.

Mesenchymal stem cells will stop proliferating when they physically contact each other (otherwise known in cell culture lingo as 'confluence'). Culturing these cells, it becomes obvious that once they reach that point, they refuse to continue to grow (proliferate). This is because they are repair cells and when an area in need of repair is fully covered, they get the signal to stop growing. In patients where we have ongoing MRI surveillance of the re-implant sites, there has been no evidence of overgrowth where the regeneration has surpassed 'expected optimal growth'.

Unlike embryonic stem cells, adult stem cells do not generally keep growing, even in culture. For example, most patients whose stem cells we grow to bigger numbers in the lab will lose their ability for continued cell growth after just a few weeks. In addition, the same body signals that would tell these cells to stop growing in healing a normal fracture or ligament tear are still present in your body.

MSC's do stay localized to the injection site across multiple studies. This is likely linked to the fact that they generally do not circulate in the bloodstream like other adult stem cell types and are primarily found resident in the tissues they serve.

Safety & Compliance

Certain types of medications have been found to negatively impact stem cell function in the lab. In addition, we generally see that many prescription medications will reduce stem cell number. Statins are the primary culprit which is commonly prescribed, and you should discuss with your doctor whether it is safe to take a break from that medication.

We generally recommend that you stop these before the procedure. For example, if you take Coumadin, you need to have the OK of your family doctor or cardiologist to come off this drug and an INR (blood clotting test) that is in the normal range before pursuing this procedure. If you take other blood thinners such as Plavix, you should be off this drug for 72 hours prior to the procedure. Your family doctor or cardiologist may also need to be consulted to ensure that it's safe to come off of this medication. If you take a daily baby aspirin, then you need to come off this one week before the procedure.

If your clotting times are normalized by taking clotting factors, then there should be no problem performing the procedure.

Approximately 15 years.

Using the HHS OHRP guidelines for complications reporting, our complications to date have been in the mild to moderate category and rare. This means that either the complication (like transient swelling) required no medical treatment (Mild), or if it did require medical treatment, the treatment was simple (Moderate-like a patient who failed the procedure who ultimately decided to get the knee replacement that he or she was planning before the procedure). We have published the world's largest (to date) safety and complications tracking study of adult stem cell use in patients. This study did not show any serious stem cell related complications and it did not show that any patient developed a stem cell-related cancer. In addition, our most recent safety paper was named the best of its type by a meta-analysis that appeared in the prestigious medical journal, Osteoarthritis, and Cartilage. There is always a small risk of bleeding and infection with any injection therapy, although we take all precautions to decrease those risks. View Safety Study

No, an analysis of the published research shows that liposuction is riskier than a bone marrow aspirate. Fat is a structural tissue that must be mechanically liquified in order to remove it. This is done by inserting a wand underneath the skin and moving it back and forth to disrupt the fat tissue. This also disrupts the blood vessels and nerves within the tissue, causing more bruising and pain. In contrast, bone marrow is a liquid that is inside your bone, and it is minimally disruptive to insert a needle into that bone to withdraw the marrow.

The basic science on adult stem cells shows that if the cells are kept in culture for short periods, there is no risk of the cells becoming cancerous. We have published the world's largest (to date) safety and complications tracking study of adult stem cell use in patients. This study did not show any serious stem cell related complications and it did not show that any patient developed a stem cell-related cancer. Finally, we maintain an extensive complications tracking database with patient contacts at specified times. We have seen no evidence of significant complications at these re-implant sites.

No personalized cellular treatment is “FDA Approved”, because they are not Food, Drugs, or Devices. The procedures that Regenexx does in the United States are “FDA Compliant” because they are performed as a Same Day procedure, for homologous use (bone marrow for orthopedics), with minimal manipulation (processing only isolates and concentrates your cells)

Each of the Regenexx procedures available in the United States involves the patient's own bone marrow or blood, and the Regenexx network of doctors only treat musculoskeletal conditions. Further, none of the Regenexx procedures available in the United States involves the culture expansion of the patient's cells to create larger number of cells. Thus, the Regenexx procedures available in the United States generally fall into the following regulatory exemptions:

  • For our procedures involving concentrated bone marrow, minimally manipulated bone marrow for homologous use is not subject to FDA regulation as a human cell, tissue, or cellular or tissue-based product (HCT/P); 21 CFR 1271.3(d).
  • For our procedures involving autologous blood (such as PRP), practitioners who are licensed by law to prescribe or administer drugs and who manufacture blood products solely for use in the course of their professional practice are not subject to FDA regulation; 21 CFR 607.65.
  • Procedures involving the removal of an HCT/P from a patient and the implantation of that same HCT/P back into the same patient during the same surgical procedure are not subject to FDA regulation; 21 CFR 1271.15(b).

Regenexx is proud of its history of regulatory compliance and is deeply familiar with the regulatory environment in which it operates. If you have any questions about our regulatory compliance, please feel free to ask and we will be happy to speak with you in further detail.

Medications

Certain types of medications will negatively impact the stem cells. In addition, we generally see that many prescription medications will reduce stem cell number.

We generally recommend that you stop these before the procedure. For example, if you take Coumadin, you need to have the OK of your family doctor or cardiologist to come off this drug and an INR (blood clotting test) that is in the normal range before pursuing this procedure. If you take other blood thinners such as Plavix, you should be off this drug for 72 hours prior to the procedure. Your family doctor or cardiologist may also need to be consulted to ensure that it's safe to come off of this medication. If you take a daily baby aspirin, then you need to come off this one week before the procedure.

If your clotting times are normalized by taking clotting factors, then there should be no problem performing the procedure.

We produced the Regenexx Advanced Stem Cell Support Formula to support healthy stem cell function and cartilage production.

Effectiveness / Outcomes

Regenexx® stem cell procedures have been studied extensively for more than a decade and our patients are part of the world's largest human mesenchymal stem cell re-implantation database for orthopedic purposes. We regularly publish outcome data from this patient registry and make it available to the public.

Our analysis of patients who have had a second procedure shows that very often a second procedure can help continue and improve the success a patient has from our regenerative treatments.

Insurance / Coverage

No, these procedures are too new to be covered yet. Don't let someone fool you, PRP and stem cell injections have no insurance coverage at this time.

Some health insurance plans may cover the initial evaluation. If your plan does, and we are part of your insurance carrier network, we will bill the carrier. If not, there will be a consultation fee for the initial face to face consult.

We recommend that you contact your insurance carrier for more information about your specific coverage details.

Procedure - What to expect

The results should become apparent over 1-3 months but sometimes can take as long as 6-9 months.

Many patients ask why we need to draw blood and how much is taken. Blood is drawn from a vein in your arm and the amount drawn can vary significantly based on the type of procedure and your body weight, we also do a blood draw for the post-injection portion of our stem cell procedure protocol. The growth factors that we use to grow your stem cells and enhance your procedure are contained in your blood platelets. These same growth factors and blood platelets are used for our platelet rich plasma and platelet lysate procedures. More information on platelet procedures can be found here.

The cells are isolated in the lab using a proprietary separation technique. For the same day procedure, this isolated stem cell fraction is placed right back into the body. For more details on the stem cell procedure, click here.

Patients often confuse a bone marrow aspirate with a more involved and more painful bone marrow biopsy.

We only perform the less involved and much more comfortable bone marrow aspirate. This is a short (20 to 40 minute) in office procedure where the skin and tissues are numbed and a needle is used to withdraw marrow blood, which contains the stem cells. One site on each will be numbed and three samples are taken from each site. Because the area is extensively numbed, 88% of our patients report that the procedure is very comfortable and would do it again.

To better access how our patients feel about this procedure, we ran questionnaires on 44 consecutive patients undergoing marrow draws (primarily in Jan-Feb 2009). 86% said they had no to mild discomfort. 88% said that the procedure was either less uncomfortable or about what they thought it would be. 88% also said they would do it again without hesitation.

A properly performed marrow aspirate procedure should not be uncomfortable to the vast majority of patients.

About as painful as a typical shot in a doctor's office. To make you as comfortable as possible, we do typically pre-medicate with oral Vicodin and valium. We also use lidocaine injections at the skin and ropivacaine (a cartilage-safe relative of lidocaine) for deeper numbing. If you are still anxious about the pain of injections, we have nitrous oxide available, which you can breath in to control your level of medication, much like at the dentist's office. We also have IV sedation available for select cases which expect to be more painful, such as when we inject stem cells directly into the bone.

There is virtually no down time with this outpatient procedure. . You can walk right out of the clinic the same day any procedure is completed. For all blood-derived procedures (SCP, PL), you will only need to come in for one day for treatment.

All of our patients walk out of the clinic. However, having someone drive you for a medical procedure is never a bad idea. On occasion, a local nerve block may be used, which could impair your ability to drive safely, so you should consult with Dr. Crider about your specific treatment and protocol to ensure that it will be safe for you to drive if you wish to do so. Also, if you took the pre-medications of Vicodin and valium than you would not be safe to drive and should have a driver.

Recovery / Post-Procedure

The best things you can do to improve your stem cell count and viability is through healthy lifestyle. We encourage a diet that is high in fresh fruits and vegetables, whole grains, and lean proteins. Try to avoid junk foods that are high in saturated fats or highly refined sugars. Avoiding tobacco is essential, and we recommend against any more than one drink of alcohol per night. Maintaining an active lifestyle before your procedure may improve your stem cell yield. After the procedure, we recommend you avoid ice, as that decreases platelet degranulation and inflammation, whereas we want to allow that swelling to take place as the first step of the healing process. Instead, heat can help to relax muscles and bring in bloodflow. Do not soak or submerge for the first 24 hours, but showering is ok.

Some of our patients will require a second or even third procedure. Our usual protocol involves 1-3 injection cycles, typically spaced apart by 3 months at the soonest or possibly waiting a year or two before patients choose to repeat the procedure. Most patients get a single procedure, particularly for less severe injuries.

This depends on the type of procedure. However, all of our procedures are designed to promote as much early activity as possible. Here is a general guide: Bone healing procedure (for fracture non-union or avascular necrosis): You must be off the area on crutches until the pain from the procedure subsides. You can then move toward slowing increasing activities over the next few weeks.

Total time off the area for most patients is 1-3 weeks with normal activities at about 6 weeks. The only exception is when there is an existing rod or plate stabilizing the fracture site, in these cases you will be allowed more activity more quickly. Joint procedure. If there is more minimal cartilage loss, low impact activities would be encouraged immediately after the procedure. Full high impact activities would be expected at 4-6 weeks. Partial tendon/ligament/muscle tear: Low impact activities would be encouraged immediately after the procedure. Full high impact activities would be expected at 4-6 weeks.

Yes, we have developed our own supplement based on lab tests with human mesenchymal stem cells and their response to various nutritional supplements.

In general, we always try to look at more than one injured part. As a result, it's very likely we will recommend other types of conservative care to restore normal biomechanics. This might include physical therapy, different types of myofascial release, or specific home exercises.

Conditions Treated / Not Treated

If you do not see a condition listed that identifies your area of pain, please call to discuss your situation with Dr. Crider to see if Regenexx® can help you. 1-763-767-7177

When we first began offering orthopedic stem cell therapy in 2005 as part of an IRB-approved medical study, we were one of the few clinics in the world treating orthopedic problems with stem cells. When we began treating everyday patients in 2007, this was still the case, and- despite the explosion of stem cell clinics in the past few years- we remain the leaders in the field. We've continued to refine our protocols for processing your stem cells by hand, which continues to create a better product than any automated bedside machine can replicate. We've also fine-tuned our injection protocols based on our extensive experience over the past 15 years. The 90,000+ procedures tracked in our Outcome Registry speak to the benefits of having your procedure with an expert in Interventional Orthopedics.

Pricing / Cost

Because the procedure protocol will vary from person to person and because each person will have a unique condition to be treated, the pricing of procedures can vary considerably from patient to patient. An evaluation will give you a better idea of condition, treatment, and costs specific to your condition. The chart below provides a general idea of the procedures and where they fall in terms of cost and severity of conditions treated. Platelet procedures cost considerably less than stem cell procedures.

Regenexx® at Nura

7400 France Ave S.
Edina, MN 55435

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