Stem Cells For Avascular Necrosis (AVN) of the Femoral Head (Hip)

Stem cell treatments for avascular necrosis (AVN) of the hip are not new, just newer applications.

AVN of the femoral head is the most frequent location, and the hip is the most common joint affected by avascular necrosis (AVN). Stem Cell Therapy has been applied alone, or in combination with a less effective form of transferring stem cells via core decompression.

The femoral head is the top portion of the femur which together with the acetabulum creates the hip joint. The hip is basically a ball and socket type joint. If the femoral head becomes necrotic in AVN, then the femoral head may collapse, which can result in a rapid secondary degenerative arthritis. This is often why total hip joint replacement is often recommended.

Stem cells may be used as alternative strategies to hip joint replacement, or to possible delay hip replacement until a more remote future date. This scenario is important in younger patients and athletes, who wish to continue with their chosen sport.

Core decompression is essentially drilling or micro-fracture into the necrotic area. This attempts to alleviate elevated intraosseus pressure, as well as to allow bone marrow fluid to seep into the decompression drilled areas. Bone marrow is 95% whole blood, and only a fraction of that is stem cells, therefore a regenerative effect is not frequently seen. The area of core decompression may fill in with abnormal tissue instead of new bone. Core decompression is associated with months of recovery as most hip surgeries are. Other surgical measures for AVN include vascular grafts and total hip replacement.

Stem Cell Therapy with concentrated cells may have several types of cells, including mesenchymal stem cells, hematopoietic stem cells, muse cells, endothelial progenitor cells, other progenitor cells, pericytes, and various blood cells. This stem cell concentrate is more effective at creating new blood vessels and forming new bone cells. This can be viewed as a Regenerative Medicine tenet: repair and regenerate.

Not all cases of hip AVN are the same. Some are caused by different factors. Trauma induced AVN of the hip is not the same as excessive corticosteroid induced AVN. The presentation may be a single hip, both hips, or multi joint such as a hip and a knee or hip, knee, ankle. Bilateral presentation can always occur in multi joint AVN.

Due to different presentations of AVN, different causes, and inter-patient variability the treatment of AVN is not uniform for each patient. In fact, each patient should have a specific treatment plan developed for their own particular needs, goals and desires. Future desires and sports should always be assessed when planning treatment with stem cells. Realistic goals should be discussed, as well as adaptation for successful results.