Hip AVN and Stem Cells: Difficult Choices for a JRA Patient
JM is a 33 year old with a long history of juvenile rheumatoid arthritis (JRA) who was seen in January of 2009 for AVN of the hip. At that time he had been in remission from the JRA for about 10 years and had been diagnosed at the age of 18 months. He already had his right hip replaced due to joint damage from the JRA and didn’t want another hip replacement. He initially came to us for a stem cell treatment of left sided hip arthritis, but on initial exam his MRI showed stage 1-2 AVN in the bone, so we redirected treatment at the bone rather than the cartilage, as treating cartilage didn’t make much sense if the bone would eventually collapse underneath the cartilage. Stopping the advancement of the AVN or osteonecrosis was therefore our main focus. As a result, he underwent a percutaneous core decompression of the hip with a Regenexx-C bone procedure on 1/29/09 (needle placed under x-ray guidance into the AVN bone lesion). He is now 2+ years out from the procedure and just sent us an e-mail this week (some of the info was personal or about complex health choices, so this is redacted):
“…the pain in my left hip is 50-60% better with that one treatment…”
JM now has a bigger quandry. Because of his long history of active JRA, many of his joints are failing. We didn’t treat the cartilage so it’s difficult to know if we could have helped that problem with Regenexx-C. Because of his severe JRA, he’s left with alignment issues in the hip and is trying to decide the best way to proceed. JM’s result brings up a key point that we always discuss with AVN patients. Our primary goal is to treat the bone collapse with a secondary goal of treating cartilage. If we catch the disease early, our clinical experience tells us we may help both. However, for JM, his cartilage loss began in many joints (including this hip) due to the JRA. The upshot? For our approach to AVN to be a total success, we need to see these cases when they are at stage 1-2 and before serious cartilage loss occurs in the joint. Our experience has been that in patients with early AVN stem cells halt the progression of AVN, but in cases of severe cartilage damage for other reasons, patients may only have be partial improvement in their pain. We’re trying to help JM decide on his best options going forward.