Are there viable knee osteonecrosis alternatives outside of joint replacement? Avascular necrosis a.k.a. osteonecrosis is a horrible disease of the bone where the structure often collapses. Having said that, we’ve successfully treated many cases by using a minimally invasive method to place the patient’s own stem cells into the area of dying bone. I’d like to highlight one of those cases this morning of a woman who developed this problem in her knee.
Osteonecrosis is what it sounds like, death of the bone. Basically, an area of bone can’t keep up with it’s normal maintenance to repair the usual damage caused by wear and tear. That spots begins to dye off and if left alone, the structure of this area collapses. The most common place we see this is in the hip, but sometimes it happens in other joints like the knee. Once it begins, it almost never resolves on it’s own and it can quickly advance, so early detection is critical.
The story of stem cells and this dreaded disease goes way back to the 90s, when orthopedic stem cell pioneer Herigou began using bone marrow concentrate rich in stem cells to help these patients. The technique of using a larger needle (trocar or trephine) to place stem cells into bones is thus well studied. Basically, the research shows that if you catch these patients early in the disease before the bone collapses (ARCO grade 1 or 2), the disease progression can be halted or even reversed.
KC was a 61 year old woman when we first saw her in 2013 who developed severe inside knee pain in late 2012. An MRI showed that the bone of her medial femoral condyle was dying off. As you might imagine, this is a pretty horrible thing to hear. By 2013, when she first saw us, the severe pain had subsided, but her doctors advised a knee replacement as it was only a matter of time before the bone collapsed. Instead of that major surgery, she chose to have our clinic precisely place her own stem cells into the area using a 15 gauge needle drill. She’s now coming back for some additional care on the arthritis inside the knee, but her old and recent MRIs are above. On the left, the dark area in the white dashed circle represents dying bone before the procedure, the right shows an MRI of the same area where bright and healthy bone now lives. This is the area where one of our physicians the year before had precisely placed her own stem cells.
The upshot? We’ve seen many patients with osteonecrosis/AVN that have been helped by a very precise injection of stem cells into the area of dying bone. While this procedure requires much more expertise than a simple joint injection, the MRI results often speak for themselves!