AVN Hip Stem Cell Treatment: How It’s Done…

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What is AVN?

AVN stands for avascular necrosis. This is also known as osteonecrosis. This is a disease where the stem and progenitor cells (repair crew) in bone can’t function and the bone begins to die off. The bone can collapse, which in the hip, can cause a square peg in a round hole. There is an AVN grading scale from 1-4 that’s discussed here (avascular necrosis staging).

Medical illustration showing the stages of avascular necrosis


Learn about Regenexx procedures for hip conditions.

Our Hip AVN Procedure Avoids Invasive Surgery

We’ve been treating hip AVN with stem cells longer than anyone else in the U.S., and through the years, we’ve seen this procedure do some amazing things, and we’ve also seen its limits. We’ve also seen a few different attempts to copy the original injection-based stem cell procedure either by substituting invasive surgery or by injecting magic stem cells IV or blind. Hence, we wanted to show everyone what’s involved in the actual precise injection that we use to help heal an AVN hip lesion.

The Original Hip AVN Procedure Goes Way Back

While many of the areas that we treat with stem cells, like low-back discs, facet joints in the spine, hip arthritis, knee arthritis, knee ACLs, and so on, were invented by our clinic and were firsts in the world when they were performed, that’s not the case with Hip AVN treatment. In fact, the first injection-based treatments for this dreaded disease were first accomplished by Hernigou and Gangji way back in the ’90s.

The disease itself is awful. Basically, a portion of the hip bone begins to lose its structural integrity. While the treatment is usually a major surgery to bore a big tunnel in the hip or to replace the joint, we’ve seen amazing results with just injecting stem cells into the lesion without significant surgery. Having said that, the original minimally invasive AVN hip stem cell treatment has been altered a bit to make it more or less invasive, so let’s look at those two variations.

If an Injection of Stem Cells into the Dying Hip Bone Works, Why Not Just Add Stem Cells into an Invasive Surgery?

As discussed, the procedure that we’ve been using for many years and the one described way back in the ’90s was to inject stem cells precisely under X-ray guidance into the AVN lesion in the femoral head. However, a few surgeons, not comfortable with this type of injection procedure, have begun to add stem cells into their usual Core Decompression Procedure. Why might this be an issue?

Medicine evolves from more to less invasive procedures for one simple reason: less invasive procedures produce fewer side effects and complications. In the case of an AVN hip stem cell treatment, the least invasive way to get stem cells into the bone lesion is through injection. So if that works, why take the risk of drilling a much bigger tunnel through the bone? There is no good reason, and one patient’s experience may tell us why there may be issues with that idea.

A few years back, I evaluated a patient with an AVN lesion of the hip who was interested in getting an injection of stem cells into the bone. However, for financial reasons, he chose to have a Core Decompression Surgery because the surgeon told him that she would just add stem cells with the surgery. He never got better and recently came in to be reevaluated for the issue. I was dumbfounded by his new MRI, as the lesion not only hadn’t gone away but had been replaced by a larger and over time growing area in the bone that looked very strange. In all of my years using the injection-based AVN hip stem cell treatment, I had never seen this type of growing lesion. The procedure either works to get rid of the dying bone, or if the condition is too far gone, it doesn’t work. I told him that while we would try to treat him at this late date, I was less certain of a positive outcome than I would have been if we had just treated his disease through a stem cell injection a few years back.

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The Magic IV or Blind Stem Cell Clinic

One recent stem cell treatment trend I’ve seen for hip AVN is that the patient is offered an IV infusion of usually fat stem cells or a blind injection of the joint. In fact, we had one such patient last year who had been given an IV infusion and then had the hip joint injected, blind without guidance. This therapy obviously didn’t work as the lesion is in a specific part of the hip bone and must be precisely targeted with stem cells.

The Real AVN Hip Stem Cell Injection Procedure

Hip AVN which is expressed in Arco 1-4, is time sensitive. Our intervention can save the Hip of young people who developed Hip AVN from a simple course of IV steroids for an asthma issue as a child, if we intervene in time!  

To show patients what the actual procedure looks like and how precise and technically demanding it is, we recently filmed a a quick look at a Regenexx Hip AVN procedure. The video is above. Note a few things about this injection-based AVN hip stem cell treatment:

  • This injection is a highly precise targeting of the bone lesion using C-arm fluoroscopy.
  • It’s a true minimally invasive percutaneous injection and not major surgery.
  • The size of the needle used to inject the cells is a fraction of the diameter of the tool used to bore a tunnel through the bone in a surgical Core Decompression.
  • This therapy is a procedure that you must be highly skilled and well trained to perform.

The upshot? We’ve likely treated more patients with an injection-based AVN hip stem cell treatment than any clinic or medical group in the U.S. The procedure can produce spectacular results in the right patients and provides limited benefit for the wrong patients. We wanted our readers to see how the injection is correctly performed and why adding magic stem cells into an existing surgery or injecting those cells IV or blind is either way too invasive or completely ineffective.

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. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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