We have always prided ourselves in being transparent about our results. Through the years, while we’ve featured patients who have done well using our procedures, we have also featured patients where the procedure didn’t work. This morning I’d like to highlight a recent patient with severe hip arthritis whose case was a Regenexx procedure failure, but first it’s important to understand how and why hip and knee arthritis differ.
How Hip Arthritis Differs from Knee Arthritis
Most patients would think that hip and knee arthritis are the same disease; after all, they’re both “arthritis.” To understand this difference, you first need to comprehend what usually constitutes arthritis, which is a disease where the cartilage in a joint wears away and the bones react by growing bone spurs. In knee arthritis the disease generally follows this typical progression. However, in hip arthritis things are frequently different.
In comparing hip and knee arthritis, the critical differences are the speed of onset, the extent of bony involvement, and range of motion of the joint. Hip arthritis comes on very fast. Oftentimes from the moment the patient notices significant pain until the joint develops severe arthritis can be a matter of months to up to two years. In knee arthritis the joint usually slowly gets worse over many years. Also, in hip arthritis the bone usually dies off quickly, leaving large voids called bone cysts. In knee arthritis this very rarely occurs. Finally, in hip arthritis there is a rapid and significant loss of range of motion of the joint, while in knee arthritis there can also be loss of range of motion, but it’s usually much less and comes on more slowly.
Why Hip Arthritis Differs from Knee Arthritis
So is there something that accounts for these big differences between the two joints? One theory based on research is that the hip joint has a much lower number of natural stem cells to aid in its upkeep and repair. Another reason for the difference could be the ball-and-socket shape of the hip joint that causes much more pressure on a much smaller area than the more flattened knee joint.
Our Transparency on Patient Outcomes
We have always believed in transparency in discussing outcomes with our patients. For example, we’re one of the few clinics in the world that uses stem cells that has always required our physicians to provide candidacy grades (good, fair, poor), just like you would get with any other medical procedure. In addition, we have spent heavily on registry-based outcome research and posted those annual reports online as well as published this data. Finally, we’ve never been shy about discussing a Regenexx procedure failure on this blog.
To determine candidacy grades, we’ve mined the data in our patient registry to give us guidance about who does well and who is less likely to respond. In hip arthritis, for example, we’ve noted that patients with poor range of motion as well as older patients have a higher chance of a treatment failure. However, this is data collected on many patients. So for example, while our data shows that older age means a decreased likelihood of a a successful treatment, it doesn’t mean that all older patients will do poorly. In addition, it also doesn’t mean that all young patients will do well. These are just averages and statistical analysis on a group.
Over the past several years, we’ve published more data on how hip arthritis responds to stem cell treatments than anyone else worldwide. In fact, nobody is even a distant second. As an example, we’ve published several patient infographics online (see 2013, 2014, and 2015). In addition, we published the world’s largest experience with hip arthritis and stem cells in the peer-reviewed medical literature. What’s interesting about these data sets is that they represent all patients—those who responded and those who had no benefit.
Finally, we’ve never been shy about highlighting patients who didn’t get results. See here, here, here, here, here, and here for some examples. We have also discussed extensively that, all things being equal, hip arthritis patients don’t respond as well as knee arthritis patients. That has also included discussion of specific patient treatment failure after a hip stem cell injection procedure.
Our Recent Hip Arthritis Treatment Failure
XX is a 65-year-old Hollywood professional with a history of a back problem, legs that are different lengths (leg-length discrepancy), and severe hip arthritis. His back had a spondylolisthesis, which means that one vertebra had slipped forward on another. His different-length legs were likely one of the things that contributed to his hip arthritis.
He had tried a cortisone steroid injection, which provided mild temporary relief. He also had tried epidural steroid injections in the past for his sciatica. Finally, physical therapy was no help, and he needed to take narcotics and walk with a cane due to the pain.
Based on the above, a thorough exam, and a review of his imaging, his Regenexx physician documented this in his notes:
- I discussed conservative, injection, and surgical options with risks and benefits at great length today.
- Patient is poor SD candidate (poor ROM, age >55)
Despite this pessimistic candidacy, XX chose to proceed with both a Regenexx-SD procedure for his hip and a Regenexx-DDD procedure for his low back. Despite the best efforts of his physician, his treatment was a failure, and he had no relief of his hip pain nor improvement in his function.
The upshot? XX was told he was a poor candidate based on our registry-based research and scientific publications, and sure enough, our prediction was correct for this patient. Does this mean that all hip arthritis patients don’t respond? No, our registry-based research also tells us which patients are more likely to have a good result. In the end it’s this transparency that sets Regenexx apart from many of the clinics out there. We try to be as honest as we can with our patients, and while we’re proud of what we do and have no issues shouting it from the rooftops, we also go out of our way to make sure loads of information is available to patients about how all patients fare so that they can make an informed decision!
To find out if you might be a candidate for a Regenexx stem cell procedure, complete our Regenexx Procedure Candidate Form online.