About REGENEXX SD PROCEDURES
We provide Regenexx SD procedures using a person's own bone marrow to provide symptom relief and functional improvement. We use a specialized technique to remove bone marrow from the patient’s hip bone. This bone marrow contains a myriad of growth factors and bone marrow concentrate. Once harvested, the bone marrow is filtered, then concentrated in an FDA-approved device, and finally injected into the patient’s area of damage with ultrasound guidance for precise placement. This treatment uses the body’s own repair mechanisms and growth factors to promote healing, improve function, and provide pain relief. Generally speaking, this treatment appears to be more effective for more advanced joint or tendon degeneration and is a good next step if platelet-rich plasma therapy (PRP) is not successful.
This minimally invasive procedure is done under local anesthesia. The bone marrow harvesting may cause some discomfort, but is generally well tolerated. The entire process will take a little over an hour, and most patients will have minimal restrictions following the procedure.
Not all patients are candidates for the Regenexx SD treatment. Schedule a consultation today to find out whether you are a candidate.
What Is a Regenexx Same-Day (SD)
The Regenexx cellular therapy protocol is called a same-day procedure because the bone marrow containing growth factors is harvested and re-injected on the same day.
For most patients, however, the recommended protocol is a series of injections of different orthobiologics that happens over the course of about a week, depending on each unique situation. These injections include a prolotherapy pre-injection, the same-day bone marrow extraction and re-injection procedure, and a blood draw and post-injection of multiple Regenexx’s proprietary platelet-rich plasma concentrations.
This process applies to procedures for the knee, hip, shoulder, hand, wrist, foot, ankle, elbow, and spine. The process for spine conditions includes an extra step of antibiotics given to reduce the risk of infection along with an epidural containing platelets.
First Day (Pre-injection)
Your first visit involves an injection of a special hypertonic dextrose solution that creates a mild inflammatory environment that is conducive to healing. The purpose of this part of the procedure is to cause the same kind of acute inflammation that might occur during an injury. To use a farming metaphor, this step is like tilling the soil. Your first visit will take between 30 – 40 minutes.
Second Day (BONE MARROW
On the morning of your bone marrow therapy procedure, you will lie on your stomach on the procedure table where a local anesthetic will be applied. The physician will then draw bone marrow from the back of your iliac crest using precise image guidance. The doctor will draw from both hip bones. Some patients will be given an oral sedative to help ease anxiety and relax the muscles prior to the bone marrow draw. The procedure we use is called a bone marrow aspirate, which is significantly less invasive than a painful bone marrow biopsy. This draw takes 30 – 60 minutes. The bone marrow aspiration process is often described by patients as being only mildly uncomfortable and is typically well tolerated.
While your cells are being processed by a Regenexx lab technician, you will have some downtime to relax and to eat lunch. The re-injection of bone marrow into the site of the injury takes place between 3 – 8 hours after the bone marrow aspiration. Local anesthesia is used to numb the area, and the bone marrow concentrate is precisely re-injected using real-time imaging guidance (ultrasound or fluoroscopy). Patients may be asked to stay in the clinic 30 – 60 minutes after re-injection. This procedure typically takes 60 – 80 minutes.
SCP is a super-concentrated version of platelet-rich plasma, a concentrated blood-platelet injection that contains healing growth components that increase the activity of the bone marrow. It is created in our on-site orthobiologics lab by a skilled technician who can include more of the blood components that encourage and support healing while removing other components that cause unnecessary inflammation and discomfort. Blood is drawn from a vein in your arm and processed and prepared in our lab for re-injection within 24 hours. The blood draw takes 15 – 30 minutes.
During a second visit, SCP is injected into the treatment site and works in conjunction with your re-injected bone marrow. Platelet lysate (PL), which is the growth factor isolated from your blood platelets, may also be used to act as an immediate release of helpful growth factors versus the slow release from the whole platelets contained in SCP. This procedure takes 20 – 30 minutes.
The bone marrow growth factor and cellular injection produces a micro-injury in the joint. As a result, expect the joint to be sore for 1 – 3 days. Your physician may prescribe pain medicines that will not hinder the healing caused by the procedure. Patients can additionally take Tylenol but are asked to avoid NSAIDs. The goal is to allow the bone marrow to attach and then to protect them while they differentiate into various tissues. For this reason, you will be asked to keep the joint as still as possible for 30 – 60 minutes after the procedure. Do not take a bath for three days, but a shower 12 hours after the procedure is fine. For the first day after, you should limit activity on the joint. Wear all recommended braces or boots.
Most patients report a modest improvement in the first month. You will notice that as time goes on, your pain that occurred before is less severe and frequent. Most patients are able to resume light activities after 5 – 7 days. Usually, at 6 – 8 weeks, patients begin to resume a more vigorous exercise schedule. Most of our very active patients are able to return to their regular routine in six weeks and push their performance to higher levels in 8 – 12 weeks. Improvements will continue throughout this time period. Most patients notice continued healing over many months. Our outcome data suggests peaking at 1 – 2 years out. Results vary by patient and depend on the condition of the area treated, age, and general health.
Cellular Therapy Reviews
"Excellent treatment and results, Had 3 rotator cuff tears which Dr. Lehman treated with plasma and stem cell injections. 4 months later no pain and full range of motion! Much better option than surgery! Highly recommend Dr. Lehman and her expertise."- Anonymous / Vitals / Dec 05, 2020
"Had 3 rotator cuff tears which Dr. Lehman treated with plasma and stem cell injections. 4 months later no pain and full range of motion! Much better option than surgery! Highly recommend Dr. Lehman and her expertise."- J.H. / Healthgrades / Dec 05, 2020
REGENEXX SD PROCEDURE FAQs
Where do these cells come from?
Bone marrow is the source of many growth factors and cells that Dr. Lehman uses. She harvests the bone marrow from the posterior iliac crest (the back of the hip). There are several sources of cells, and you should be sure to have a discussion about this with any provider of cellular treatment.
What do published studies say about bone marrow cellular treatment?
Regenexx is unique in that it maintains an active patient registry that continually pings patients about their progress or side effects post-procedure. As a result, we keep records on tens of thousands of Regenexx procedures performed by physicians in our network in our outcomes database. Nobody else on earth has tracked as many orthopedic cellular therapy results for as long as Regenexx. See Patient outcomes here.
Peer-reviewed published data demonstrate that many patients treated with this procedure have had pain relief and functional improvement. Those patients have also shown that this is a safe procedure with no increased risk of cancer. Small published cases have shown healing of knee meniscus tears, areas of bone death (avascular necrosis), and shoulder rotator cuff tears.
If you’re considering a Regenexx SD procedure using your own bone marrow concentrate, you’re probably aware that most orthopedic surgeries are invasive, painful, and involve risk. Additionally, many have long recovery periods. Questions always arise about whether orthobiologic treatments are "proven." It is very important to know that only 20% of orthopedic surgeries are proven. Read link: NY TIMES ARTICLE and this publication THE EVIDENCE BASE FOR ORTHOPEDICS AND SPORTS MEDICINE.
What is the cost?
The cost can vary, depending on the treatment area. Regenexx procedures are not covered by your insurance company. This is an out-of-pocket expense.
Who is not a candidate for this treatment?
- Patient with cancer history (such as prostate cancer or breast cancer) not in remission for at least five years
- Certain other malignancies or blood-borne diseases that you are being treated for
- Patient with any current infection
- Patients on anticoagulation who cannot stop
- Patients with multiple medical issues may not be good candidates (low testosterone, low vitamin D, hypothyroidism, diabetes, smoker). This a partial list, and there are other conditions that may limit your candidacy for treatment.
Can I fly/drive home that day?
If you are flying (and you are not the pilot), you may fly home the next day. If you are driving, you should have a driver, as there can be some mild to moderate discomfort in the first few hours following the procedure.
Where is this treatment offered?
This procedure is done in a clean environment in our office procedure room.
What should I do if I think I am a candidate?
Schedule a consultation with Dr. Lehman for an appointment to review your radiology films (x-rays), conduct a physical exam, and determine if you are a good candidate or not.
What about amniotic or umbilical cord products, or exosomes?
The FDA is currently stepping up enforcement and policing of manufacturers and medical providers in this space. Dr. Lehman is very interested in educating and keeping her patients safe. She will provide her expert clinical and scientific recommendations to a patient's particular situation.