A Hip AVN Stem Cell Scam

by Chris Centeno, MD /

As you might have noticed, I’ve started a new “Stem Cell Botched” series, the goal of which is to educate patients and physicians about the difference between high-quality, regenerative interventional orthopedics and just bad care with stem cells. So today let’s look at a patient who was diagnosed with hip avascular necrosis (AVN), or osteonecrosis, and how this patient had care that was below the standard of care using fat stem cells. First, let me define hip AVN.

What Is AVN?

AVN/osteonecrosis occurs when the blood supply to the bone is interrupted or obstructed causing the bone to die. Well, at least that’s the old conception. We now know that in many cases, the bone dies off because the stem cells in the bone that normally keep it healthy die off, become sick, or are too few in number to keep up with normal wear and tear.

Today I’m going to focus on AVN of the hip, but it can also occur in other areas, such as the knee, shoulder, and so on. It is a terrible disease that typically presents as hip pain at an early age and comes on quite suddenly. From there, the femoral head (the ball part of the ball-and-socket hip joint) dies quickly with bone collapse typically occurring within a few months to a year.

The traditional approach to AVN is commonly a surgery, such as a core decompression or hip replacement. With core decompression, a tunnel is drilled into the bone with the intention of “decompressing” the “high-pressure” area, which the surgeon may believe is causing the AVN. More recent research, as stated above, disputes the notion of how this surgery works, instead now focusing on bringing some local healthy stem cells to the area to properly maintain and heal the bone. Obviously, if there is nothing to “decompress,” an injection of stem cells will work just as well as a surgery. Hip replacement, of course, is a highly invasive surgery that involves replacing the hip joint with an artificial joint, and it is associated with many complications.

In 2016, I shared another trend I’d been encountering: fat stem cell treatments for hip AVN offered as either an infusion or as a blind injection (meaning without imaging guidance) into the hip joint. This leads us to the patient case I want to share with you today.

A Hip AVN Stem Cell Scam by Physicians Blindly Injecting Fat into His Joint

First, it’s important to understand that while we didn’t invent hip AVN bone marrow stem cell injections (that honor goes to Phillipe Hernigou of France), we’ve done hundreds of these since 2006, so we often get referrals from physicians to evaluate difficult issues. It’s also important to understand that the goal of my Botched Stem Cell series is to promote quality standards for stem cell therapies. With that being said, let’s take a look at a patient I evaluated this week.

The patient had developed hip pain while working out. He initially saw a physician and was diagnosed with mild to moderate AVN, at about stage 2. He was offered a hip replacement.

What’s bizarre about the recommendation for a hip replacement is that hip AVN is a disease that has been treated successfully with X-ray–guided bone marrow stem cell injections since the ’90s. So this is not a new technology, but despite that, it’s not done very much in the U.S. because surgeons prefer to do big invasive surgeries rather than stem cell injections. In addition, the big surgery is paid by insurance and the stem cell injection is not.

The patient, over the next year, then made the rounds with two physicians who blindly injected his hip joint with fat stem cell treatments. There are a few problems with these treatments, which are outlined in my exhibits below:

Exhibit 1

Blind injections (without imaging guidance): Injecting the hip joint blind is below the standard of care. There is no reason physicians should be performing blind injections in the hip or elsewhere. What’s the chance that they made it into his hip joint? Less than 50/50.

Exhibit 2

Why inject into the hip joint when the main problem isn’t usually in the joint, it’s in the bone? So injecting the joint (i.e., not in the bone) will do little to help the bone.

Exhibit 3

Using fat stem cells: We have three decades of data on AVN and bone marrow stem cells. Why in the world would you inject fat? It makes no sense; we have very little data that shows injecting fat into bones will help bones, but we have tons of data supporting bone marrow.

The patient eventually saw a physician who did inject bone marrow stem cells into the bone, and then he finally made his way to us. While he eventually got proper treatment, his first two treatments were a hip AVN stem cell scam with little chance of improving his condition. He lost valuable time, which is critical in a hip AVN case, and he may not completely heal now because of that lost time.

The upshot? It’s hard for patients to understand that a huge part of whether their stem cell procedure will be successful or fail has to do with getting the cells in the exact right spot! Hence, blindly injecting stem cells somewhere in the vicinity of the hip joint to treat a bone disease that must be precisely injected under real-time X-ray guidance is nonsense.

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7 thoughts on “A Hip AVN Stem Cell Scam

  1. Tony Vanbang

    Thank you, I learned a lot from you.

  2. abdul kabeer khan ,karachi city ,pakistan ,

    HI DOCTOR CHRIS CENTENO MD ,MY LEFT KNEE JOINTS PAIN ,SWELLING ,DIFFICULTY IN MOBILITY AND DAILY ACTIVITIES . X RAY /MRI SCAN RESULTS SHOW THAT CARTILAGE AND MENISCUS ARE DAMAGED .THEY RECOMMEND PARTIAL REPLACEMENT .I AM INTERESTED IN ADVANCE STEM CELL TREATMENT.I AM NOT ON WHEEL CHAIR OR USE OF CANE.I REQUEST TO BE TREATED BY YOU SIR AND YOUR HOSPITAL. I HAVE ALREADY GOT USA VISA FOR TREATMENT .PLEASE LET ME KNOW ON PRIORITY PLEASE.

    1. Regenexx Team

      abdul,
      Great that you already have a US Visa for treatment. The first step would be to establish Candidacy. We will have someone contact you to help with that process.

  3. Helen Mckeen

    Would you still do this treatment if osteoporosis was an issue?

    1. Chris Centeno Post author

      Yes, we have healed non-union fractures in patients with severe osteoporosis.

  4. Yvette Sparrow

    Good morning
    I have osteomalacia, which has been treated (Vit D level was 6 and is now 60). This caused acetabular protrusio. This causes much pain and during flare ups I struggle to walk without aids.
    I
    I have been advised to have hip replacements by 3 different specialists, but I have heard about stem cell therapy.

    Is there somebody reputable in Cape Town who provides such therapy, and would I need bone marrow stem cells or fat stem cells for my osteomalacia problem. The osteomalacia has also worsened my scoliosis (curve approximately 55degrees).

    Kind regards
    Yvette

    1. Regenexx Team

      Hi Yvette,
      Unfortunately, there is no one we can recommend in South Africa at this point in time. We are working on getting a Regenexx Provider there. In the upper left, there is a “Regenexx Clinic” link to all US and International locations. http://www.regenexx.com

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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