Osteonecrosis Treatment Without Surgery? This Is a Tough One…

by Chris Centeno, MD /

avascular necrosis treatment without surgery

Yesterday, I treated a patient at our licensed Grand Cayman advanced practice site who had at least 11 sites of a dreaded disease known as osteonecrosis. Her disease is so severe that she fractured her knee femur bone just by using a kickboard for a single lap in the pool. The orthopedic surgeons back home weren’t quite sure what to do, so we were literally her last hope. In addition, there was no place on earth she could have gotten this many areas treated with this many stem cells.

What Is Osteonecrosis?

Osteonecrosis is where the bone dies and loses its structural support or, put more simply, turns to mush. It’s also known as avascular necrosis, which harkens back to a time when we thought all of this was mostly caused by the lack of blood supply. For the most part, that’s not usually true. Most cases seem to be caused by chemical poisoning of the cells that maintain bone.

The most common causes of osteonecrosis are alcoholism, anti-inflammatory steroid use, osteoporosis drugs, and chemical exposure. Of these, the single most common cause of osteonecrosis that is easily preventable is steroid use. What’s crazy is that if you take a common oral corticosteroid, like Prednisone, for just 10 days, your risk of getting the disease goes up 380%. If you find yourself on this stuff for a year, it goes up more than 21,000%!

The most common place osteonecrosis impacts bone is in the hip. The disease can advance quickly as we’ve seen hips go from a small amount of disease to collapse in a matter of months. Sometimes we’ll see multisite disease where both hips and say a shoulder or a knee are involved. What’s even rarer are cases where there are many, many sites.

My New Multisite Osteonecrosis Patient

The patient is a family doctor who was suspected of having an autoimmune disorder, so she was placed on four months of Prednisone. Ultimately her doctors didn’t think she had the disease and she was taken off the drug, but a few months later, she began to have left knee pain. When an MRI showed osteonecrosis, this began an odyssey of increased pain in other areas and finally osteonecrosis being diagnosed in both knee femoral condyles, both tibias, both ankle talus bones, both wrists, both shoulders, and one distal radius. Her disease is so severe that she fractured her knee femoral condyle by trying a lap in the pool with a kickboard.

So what can be done for this patient? Well, traditional orthopedic surgeries like core decompression and bone grafting are out of the question due to the number of sites and the fact that some can’t be treated this way. We’ve been using bone marrow concentrate (a same-day stem cell procedure) to treat osteonecrosis of the hips, knees, and shoulders for more than a decade. We’ve treated hundreds of patients through intra-osseous injection (into the bone), but there is no way to get enough material to inject all of these sites at once. While you could try other cell types, like fat, stromal vascular fraction is illegal in the U.S., and 99% of the world’s research on stem cells healing osteonecrosis lesions used bone marrow stem cells.

Ex-US Stem Cell Options

What this patient needed was the ability to grow stem cells in culture to bigger numbers. While that’s available at different sites around the world, regrettably, there is a steep drop-off in physician skill once you leave the U.S., and that’s reflected in these clinics. As I’ve blogged before, when you go to a Banana Republic stem cell clinic, you get the local yocal doctor as U.S. physicians aren’t allowed to be licensed in these countries.

The other issue here is that there is no advantage to open orthopedic surgery to place stem cells in these sites as this just adds risk multiplied times 11. All that’s required based on the existing research is getting the stem cells to the spot, which can be done through a precise injection into the bone using fluoroscopy. The problem is that even in Europe, the number of physicians who have experience in this type of bone injection would be few and far between. In fact, there are only a handful of physicians in the U.S. and elsewhere who have performed these procedures and likely none have done this many sites.

In the final analysis, the only place on the face of the earth that could culture expand her bone marrow cells (i.e., grow them to bigger numbers to cover all of the areas) and had US licensed physicians who had done many of these bone-injection procedures was our licensed Grand Cayman Advanced Stem Cell Practice site. Hence, the above images. Let me explain.

The Images

Due to the number of sites that needed to be treated asap (meaning waiting with this disease is almost always a bad thing), we decided to focus on the four knee bones and two hip bones (6/11 sites) this trip. The images above show precisely placed trocars into the hip femur bones with one of those also showing the radiographic contrast in the osteonecrosis lesion (top left). The other images are of microtrocars placed into the knee bone sites. This was two per bone, one on each side. I also injected that fracture line from the kickboarding incident.

To get a sense of how these procedures are performed, see this video below:

The upshot? In the end, I’m proud to say that, hopefully, we will be able to help this poor woman. We are literally her last option. While she has the other sites left to treat, hopefully by early summer we’ll know how all of this is working.

The Regenexx-C procedure is not approved by the USFDA and is only offered in countries via license where culture-expanded autologous cells are permitted via local regulations. 

21 thoughts on “Osteonecrosis Treatment Without Surgery? This Is a Tough One…

  1. Jan Tucci

    I have had stem cells…in both knees with Regenex in 20015 and right hip in 2016
    I began statin therapy to control cholesterol…I found a profound joint sensitivity. Is there a place I can get data on the effects Crestor or Rapatha…many sources have no info…

  2. Barbara

    Horrific side effects as you have pointed out and yet some doctors hand out steroids like candy!

  3. Edith(Edy)Johnson

    Wow! How fantastic.

  4. Rhonda Taylor

    I went to the regenexx in Houston Texas and they said that my hip bone was too wore out and the stem cells would not work for it I didn’t quite understand him but to me I was left with no options I was diagnosed with r a o a and lupus I’ve been in a wheelchair for 2 and 1/2 years do to and Mobility or contractures of both knees and something wrong with my hips and it’s stopping them from opening and closing sure there’s a few calcium deposits I’m only 40 and want to know is there any advice you could give me my imaging’s are still at the Houston location

    1. Regenexx Team

      Rhonda,

      Sorry it was determined stem cells would not work in your case. Medical history, the issue itself, and our extensive Registry data go into Candidacy decisions and are for the benefit of the patient. Dr. Quaraishi would be the best person to advise what else might be helpful.

  5. Bob

    My osteonecrosis was healed by PRP-therapy (it is now stable). What is the difference between MSC and PRP? Do you think MSC would be better than PRP?

    1. Regenexx Team

      Bob,

      PRP (platelet rich plasma)is a platelet product made from concentrating your blood and contains growth factors. MSC’s (Mesenchymal Stem Cells) are stem cells and are the type needed for orthopedic repair. PRP can give a boost to the stem cells within a joint. Stem cells are used when there are not enough stem cells within a joint, and have the greatest regenerative potential. Please see: https://regenexx.com/blog/is-prp-a-stem-cell-treatment/

  6. Gary Eyre

    What is the reason the FDA is giving for not approving the harvesting and growth of more stem cells in the U.S.A.? What is being done to get approval? Is there push back from the pharmaceutical companies?

    1. Regenexx Team

      Gary,
      The FDA’s position is that culture expanding stem cells are more than minimally manipulated, therefore a drug subject to the drug approval process. This explains: https://regenexx.com/blog/using-common-orthobiologics-explain-fda-1271-regulations/

  7. Bob

    Thank you for your answer.
    So, MSC`s should be better to heal osteonecrosis than PRP?
    How dangerous/safe are MSC`s? Can MSC`s lead to cancer?

    1. Regenexx Team

      Bob,

      Yes, Bone marrow stem cells are the standard of care for Osteonecrosis. We can only speak for our own procedures, and we’ve not had a cancer issue related to treatment.

  8. Bob

    About how many cases of Osteonecrosis have been treated by Regenexx? And how many cases were healed?

    1. Regenexx Team

      Bob,
      We have treated hundreds (100+). Our success rates are similar to those reported by Hernigou, so dependant on ARCO grade.

  9. Bob

    Where do I find the reports of Hernigou and his success rates?
    Is this treatment in each Regenexx-Center available or only on the Caymans?

    1. Chris Centeno Post author

      Hernigou’s papers are here: https://www.ncbi.nlm.nih.gov/pubmed/?term=hernigou+osteonecrosis+hip Only certain US centers (and Cayman) offer this type of therapy.

  10. Bob

    Thank you, very interesting.
    I come from Europe, is this treatment also available at your center in Europe or only in the USA?

    1. Regenexx Team

      Bob,
      Our Brussels Regenexx Provider Dr. Janusas treats Osteonecrosis, but with same day procedures.

  11. Bob

    So the difficult question for me is: How much better is the therapy on the Caymans than the day procedures? Would it be worthy to go to Grand Cayman? Or do the day procedures have a good outcome, too?
    And what are the day procedures? PRP? Are there any studies concerning the efficacy of the day procedures, too?
    Sorry for so many questions, and thank you so much for your answers.

    1. Chris Centeno Post author

      Bob, the big advantage for Caymans is hip OA and disc bulges or needing to treat many sites at once. The same day procedures consist of isolating bone marrow stem cells from bone marrow aspirate and re-injecting. The studies are many, see https://regenexx.com/stem-cell-research/

    2. Regenexx Team

      Bob,

      We treat osteonecrosis with our same day procedure regularly. This patient was unique in that there were 11 avn areas to be treated which necessitated more stem cells than could be accomplished with a same day procedure. The use of same day bone marrow concentrate in the treatment of osteonecrosis has been well published by Phillipe Hernigou. Please see: https://regenexx.com/blog/avn-hip-stem-cell/

Comments are closed.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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