The first step involved a lot of data gathering. Starting in January 2017, we began collecting articles about the stem cell revolution. We reviewed 59 articles about stem cell therapies and 84 research studies on this fascinating topic to prepare for this series. We also monitored a variety of discussion forums to learn first-hand from current patients about the good and bad of current practitioners and stem cell treatments.
The final list of doctors was carefully researched and checked against mentions on discussion forums dealing with orthopedic knee issues. The result of this practitioner research is summarized below.
Dr. Chris Centeno
Regenexx Centeno-Schultz Clinic
403 Summit Bl. #201
Broomfield, CO 80021
(303) 429-6448
https://www.centenoschultz.com
When it comes to any type of medical treatment, the most significant challenge is finding the right doctor. Based on his pioneering application of stem cells in 2005 and prodigious blog posts on the topic, our research revealed one clear-cut leader — Dr. Chris Centeno.
In 2005, Centeno and Dr. John Schultz founded Regenexx in Broomfield, Colo. Around 2014, Jason Hellickson, a former insurance brokerage executive from Des Moines, Iowa made an initial investment in Regenexx. On July 11, 2017, the company announced the successful merger with Harbor View Medical and the assumption of the Regenexx CEO role by Hellickson.
On Jul. 18, 2017, Regenexx filed Form D with the SEC to raise $10 million from outside investors to accelerate company growth.
The original Centeno-Schultz Clinic in Broomfield, Colo. is now part of the Regenexx network of orthobiologics clinics, headquartered in Des Moines. There are more than 60 Regenexx clinics worldwide, all said to offer highly trained, musculoskeletal physicians specializing in interventional orthopedics.
Centeno bills himself as both the “CMO” (Chief Marketing Officer) of Regenexx and its Chief Science Officer. Despite that lofty billing, Centeno’s blog is not easy to find. When you google “knee stem cell therapy blog,” the Regenexx Des Moines blog shows up on page six of search results, Regenexx Cayman Islands on page seven, and Centeno’s primary Regenexx blog, not until page eight.
After reading Centeno’s blog posts for many years, yours truly decided to pay him a visit in Colorado in September 2021. Dr. Centeno personally examined me using ultrasound imaging and arrived at the following diagnosis:
- OA – Severe left knee medial compartment OA.
- MCL instability – Left MCL instability
- Extension lag – Left knee extension lag due to med ant femoral osteophyte
- Deltoid instability – Left Deltoid instability
- Spondylolisthesis – Low back pain with a history of spondylolisthesis
- Radiculopathy – Likely S1 radiculopathy (a numbness running down my leg in this case).
Dr. Centeno is qualified to make that assessment based on his extensive published insights. Centeno recommended a Regenexx SD left knee single joint injection using their tried-and-true BMA/PRP extraction and injection procedure (see “Stem Cell Treatment For Knees” for more information). The cost, including lumbar spine procedure, was $10,735.
Regenexx uses a data-based approach to stem-cell therapy, including a patient registry that prompts patients to report their post-op progress or side effects. This outcomes database contains tens of thousands of records on Regenexx procedures performed by its network physicians, a decided plus in the study of procedure effectiveness.
The additional complication of my lumbar spine led me to consult Regenexx’ “The Spine Owner’s Manual.” This 138-page e-book contains a treasure trove of information, and the company also offers a 101-page “Knee Owner’s Manual.”
After this initial diagnosis, a number of other doctors were interviewed to receive the proverbial second opinion.
Dr. Joseph Purita
The Institute of Regenerative Medicine
660 Glades Rd. #460
Boca Raton, FL 33431
(561) 391-5515
https://stcell.com
On Jun. 29, 2011, USA Today published a story about the remarkable comeback of New York Yankees pitcher Bartolo Colon. The story has been removed from USA Today’s site, but here are a few key passages:
“Colon has not completed a full season since 2005 and sat out 2010 to rest his aging and injured right arm. But this season, his fastball is back. His ERA, 3.10, was among the tops in the league. On May 30, six days after his 39th birthday, he pitched his first shutout in five years, hurling his final pitch at 95 mph.
What lit the fuse on his fastball? An infusion of stem cells, says Joseph Purita, founder of the Institute of Regenerative and Molecular Orthopedics in Boca Raton, Fla., who gave Colon the controversial treatment in the Dominican Republic before baseball season began.”— USA Today, Jun. 29, 2011
In 2017, the American Academy of Anti-Aging Medicine (A4M), called Purita “a pioneer in the use of stem cell therapies and platelet-rich plasma (PRP) injections.” It’s not entirely clear when Dr. Purita began offering stem cell treatments but based on anecdotal evidence it was around 2010, with some patients reporting receiving PRP injections in 2009. Purita also used to offer Lipogems adipose (fat) stem cells but reportedly dropped that practice due to its expense.
Purita offers other regenerative medicine therapies including human growth hormone (HGH) and hormone replacement therapies like testosterone, both substances banned by Major League Baseball since 2005. There is no way to know if Colon received these therapies in the years before his 2012 blossoming.
During a telephone consultation, Dr. Purita said he believed that stem cell therapy would be beneficial for two to three years before I would need a partial knee replacement (PKR). His stem cell regimen calls for an initial Florida visit for bone marrow aspirate (BMA) harvesting and injection. Two additional Boca Raton trips would be required for PRP booster shots at three-to-six-week intervals. The quoted cost was $8,000 for both knees, a treatment strategy originally recommended by Dr. Carlo Tremolada (see below).
Travel expense would be a major factor, with each trip costing about $1,500 for hotel and airfare from Las Vegas. Anyone living close to Miami might consider Dr. Purita. Reviewers on RateMDs.com gave Purita 3.29 out of five stars. Some of the reviews cite Purita’s brusque, time-pressed demeanor and lengthy office waits. Early reviews were largely negative but were boosted by more positive ones later on, in particular three five-star reviews on August 26, 2018.
Dr. Carlo Tremolada
Image Regenerative Clinic
Via Pietro Mascagni 14
20122 Milano, Italy
+39 02 76280736
https://www.istitutoimage.it
Dr. Carlo Tremolada is the inventor of LIPOGEMS, a device used in the harvesting of stem cells from adipose (fat) tissue, using a technique called MFAT (micro-fragmented adipose tissue). The LIPOGEMS device mechanically processes adipose tissue typically obtained from a patient’s stomach area via liposuction, eventually producing 8–10 cc of MFAT, which is then reinjected in the knee or other area in need of stem cell therapy. To learn more about MFAT, read Why Have a Stem Cell Treatment?
During a Zoom call, Dr. Tremolada said I would be an excellent candidate for his MFAT procedure since I was a grade 2 on the lateral side and a grade 3 on the medial side. He ventured to guess that due to left knee osteoarthritis (OA) my right knee would sooner or later also succumb to the stress of supporting the left leg, and offered to inject both knees for $8,000 with booster shots needed after two to three years.
Dr. Arnold Caplan, known as the father of mesenchymal stem cells because he first discovered MSCs, speaks highly of Dr. Tremolada in this video:
Dr. Arnold Caplan, who discovered mesenchymal stem cells discusses Dr. Carlo Tremolada and the LIPOGEMS MFAT procedure at a conference in Japan.
Since studies show a response rate of 45% at 12 months after a single intra-articular injection of autologous MFAT, Tremolada thought that multiple LIPOGEMS treatments might help me stave off a total knee replacement (TKR) for three to five years. He cautioned, however, that it could take as long as nine months to notice a difference. When you add travel expenses, a potential 10-day trip to Italy could easily boost the total cost past $15,000, and considering the risk of a negative reaction, this option became less attractive over time despite Dr. Tremolada’s obvious pedigree.
Dr. Harry Adelson
Docere Clinics
1389 Center Dr. #340
Park City, UT 84098
(435) 604-0438
https://www.docereclinics.com
One doctor receiving patient buzz early on was Dr. Harry Adelson of Docere Clinics in Utah. Adelson received a degree in naturopathic medicine, the science of using natural remedies, including herbs, to help the body heal itself, in 1999. Three years later, Adelson opened Docere Clinics, which the company claims was focused from day one on “100% regenerative injection therapies,” primarily prolotherapy (in prolotherapy, a sugar or saline substance is injected into a ligament or tendon, where it acts as an irritant and causes a brief inflammatory healing reaction). An FAQ on Docere’s website sheds more light on its regenerative medicine background:
“In February of 2010, Dr. Adelson visited the clinic of orthopedic surgeon and leader in clinical stem cell medicine, Joseph Purita, M.D. in Boca Raton, Florida, to learn regenerative cell therapy for musculoskeletal pain conditions. Upon return to Docere Clinics, Dr. Adelson began utilizing these therapies right away and has enjoyed years of successfully helping people with these elegant and safe modalities.”
A telephone consultation with Dr. Adelson confirmed that the meniscal space had narrowed, but there was no bone on bone. However, he observed that my lower back was “really chewed up.” When I asked Adelson whether he still offered SVF (Stromal Vascular Fraction) treatment, which is not approved by the FDA, he referred me to a pending FDA lawsuit targeting Beverly Hills physician Mark Berman.
Stromal Vascular Fraction (SVF)
Stromal vascular fraction (SVF) uses the patient’s fat (adipose) tissue which is then processed to break stem cells free of collagen bonds. Because these fat extractions come from the patient’s own body, they’re labeled “autologous.” However, due to the external processing, the FDA considers the processed fat a drug, and it’s therefore illegal.
Unfortunately, Dr. Berman died of Covid-19 on April 19, 2022. More details about his death and the FDA lawsuit can be found in this L.A. Times article.
Dr. Adelson recommended “the kitchen sink” treatment and concluded the call by telling me his office manager, Linda Morgan, would get back to me with an estimate. The Docere kitchen sink treatment costs $21,060, which Morgan steadfastly maintained is the only treatment Docere offers. However, if I wanted a bargain-basement treatment (my words, not hers 😁), she suggested I consult Dr. Crispino Santos at Regenerative Stemcell Institute in Las Vegas. A search on Dr. Santos produced a few internet results, including a two-star rating based on 28 reviews on Healthgrades. While I appreciated the spirit and intent behind the recommendation, I decided to pass. Incidentally, the “kitchen sink” does not include PRP, which Docere no longer offers.
How times have changed in Park City. In June 2013, one former patient of Docere Clinics claimed in a forum post that Dr. Adelson charged “$1,400 for injecting two knees.” On the plus side, Adelson does use fluoroscopy and ultrasound guidance for BMA extractions and articular injections.
Dr. Carlos Guerrero
Stemwell Medicina Regenerativa
Carrera 13 # 118 – 08
Bogotá, Colombia
+57 350 783 6166
https://stemwell.co
Without consulting a provider in one of Latin America’s top medical tourism destinations, Colombia, no review of stem cell clinics would be complete. Why Colombia? It appears to be a popular resource for U.S.-based clinics that want to extend their practice in a country that enjoys more liberties without the ever-present eye of the FDA. Phoenix, Ariz.-based BioXcellerator, for example, has a well-staffed treatment center in Medellin, Colombia, led by Chief Medical Officer Dr. Karolynn Halpert.
Dr. Carlos Guerrero was recommended by a family member who lives in the Caribbean. Guerrero is an orthopedic surgeon whose Stemwell clinic offers both BMAC and allogenic umbilical cord injections, involving tissues taken from different individuals, as opposed to “autologous” tissues, which come from your own body.
Stemwell charges $4,100 for a complete stem cell treatment that includes anesthesia, a physiotherapist, and even testosterone cream and ascorbic acid (vitamin C). With costs like these, you can quickly see why Colombia has become South America’s medical tourism capital.
Unfortunately, Dr. Guerrero is a firm believer in his own orthopedic skills and was dismissive of needing fluoroscopic guidance during extraction and injection, even going so far as to mention that Regenexx’ Dr. Chris Centeno is not an orthopedic surgeon.
Fluoroscopic X-ray machines cost upwards of $250,000, so not many doctors can afford them. Fluoroscopy, and ultrasound for that matter, have transformed orthobiologics, not only because doctors are now able to place needles precisely but also because it lets them access difficult-to-treat areas like the spinal canal. Read more about fluoroscopy and ultrasound devices in Why Have a Stem Cell Treatment?
Travel expenses add to the cost of treatment in Colombia. However, an optimal 10-day Bogota visit to adequately culture stem cells can cost far less compared to most U.S. cities. Guerrero says a Stemwell clinic treatment requires a minimum five-day stay. Travel logistics and the lack of advanced imaging guidance made choosing Stemwell challenging. While a well-trained, experienced orthopedic surgeon might be able to inject a knee without guidance, the tricky placement in the spine is another story.
Dr. Kevin Stone
The Stone Clinic
3727 Buchanan St. #300
San Francisco, CA 94123
(415) 563-3110
https://www.stoneclinic.com
San Francisco-based Dr. Kevin Stone is best known for the articular cartilage paste graft, a procedure he developed in 1991 that uses a patient’s own bone, cartilage, and marrow cells to regenerate damaged cartilage. The procedure relies on a microfracture technique that makes holes in the bone to create bleeding, thereby releasing marrow cells into the defect and encouraging cartilage growth.
Stone’s articular cartilage paste graft is also called an autograft — a procedure that uses a patient’s own tissue for surgical reconstruction. By contrast, an allograft uses tissue from another person, which takes longer to incorporate into a recipient’s body. The easiest way to remember is that “auto” means self, as in autonomy or autoeroticism, while “allo” in Greek means “other.”
While Stone’s autograft is designed to repair arthritic defects in the knee joint, this technique is usually reserved for single focal defects, like an ACL tear, in younger patients who possess good alignment and an intact meniscus rather than widespread cartilage loss, wear and tear in advanced-age patients.
During a telephone consultation, Dr. Stone minced no words. Unlike earlier diagnoses, Stone said my “bone-on-bone” condition could be repaired by patching the defect with an artificial meniscus, but he felt that a partial knee replacement (PKR) was a sounder approach. Listening to my worries of lingering pain and risk of possible infection, Stone said that 98% of his PKR patients had no pain and infection risk was very rare.
Dr. Stone uses the Stryker MAKO knee surgery robot (Kalamazoo, Mich.), and trains other physicians on the system. According to Stone, the arthroscopic PKR procedure lasts about one hour, thanks to the MAKO, with an additional 1-3 hours for post-op recovery.
As might be expected, The Stone Clinic is an out-of-network provider, so the PKR cost for self-pay patients is $21,000, excluding:
- Surgical facility fee
- Anesthesiologist
- Imaging and supplies
- Physical therapy or sports rehab
- Specialized injections to augment healing
However, Consultation Coordinator Priscilla Soberanis said she would be happy to submit a claim for the ambulatory surgery center costs.
Unfortunately, The Stone Clinic also uses the Hale Health mobile app, which offers a terrible customer experience, referring the user to a browser-based site to upload health records but then locking them out of that site with an “Unauthorized” message. And that was just one of four incomprehensible issues encountered during the use of the Hale app:
Hi Priscilla:
I have been trying to upload my MRI images using your Hale app, and here’s what I experienced;
- If I select “Files” on uploader.vivacloud.io, I get a “Waiting files” message that never goes away.
- If I select “Folders and Disks” and choose my Dicom folder in iCloud, it only wants to go further down the directory, never allowing me to send the entire folder as implied.
- If I select “Zip files,” the app asks me to download VIVA ONE to my MacBook computer. However, Hale does not allow me to log into my account via the web, only via iPhone.
- Finally, if I transfer the link you sent me to upload the files to my MacBook, I get “{“status”:401,”statusText”:”Unauthorized”}” message.
You really have to review your Hale app upload procedures. Hale has no customer support link, so I can’t contact them directly.
BTW, I just noticed that your message says that images can only be uploaded from a computer, so please see #4 above.
Neither the patient coordinator nor Hale Health responded to these concerns.
Dr. Josh Goodwin
Regenexx Las Vegas
100 N. Green Valley Pkwy. #325
Las Vegas, NV 89074
(702) 986-0921
https://regenexxlasvegas.com
Each previously listed option required travel costing at least $3,000, if not double that. Dr. Josh Goodwin represents Regenexx in Las Vegas. I told him about my extensive stem cell research and my conversation with Dr. Tremolada about MFAT. He said that adipose stem-cell treatment had its place and that a doctor at Regenexx headquarters practiced it when needed, like for a multi-site application of stem cells when a BMA extraction simply does not deliver enough stem cells.
Goodwin was also the first doctor to bring up intraosseous injections in the subchondral bone, which is reported to improve long-term results. Since no travel is required, Dr. Goodwin is, by far, the best option for anyone living near Las Vegas.
The complete Regenexx Las Vegas procedure is documented in Part IV of our stem cell treatment series.
Read next: Part IV. Eye-Opening Knee Stem Cell and PRP Journey
