Welcome to the Hip Osteonecrosis BMC Club Yale!
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One of the trends of the last 5 years is seeing more and more universities add the use of PRP and Bone Marrow Concentrate to their day-to-day patient offerings. One of those treatments that we’ve been using for more than a decade is a Bone Marrow Concentrate injection to treat Osteonecrosis of the hip. Now Yale is touting that they’re adding the surgical version of this treatment, so let’s dig into that news.
What Is Osteonecrosis?
What if you woke up one morning with your hip hurting and this pain kept getting worse over time? You go to the doctor who tells you that the bone in your hip is dying and if you leave it like this, the joint will collapse and you’ll need a hip replacement. That’s Osteonecrosis.
We used to think that this disease was largely caused by a poor blood supply to the hip bone, which is why its other name is Avascular Necrosis. That does happen, but mostly due to surgical injury to the blood vessels. More often, Hip Osteonecrosis happens due to damaged progenitor cells. These are cells that live in your bone and make new bone. These cells can be damaged by steroid medications, chronic alcohol abuse, chemical exposure, or other things.
If this disease is caught early, the hip can be saved. Traditionally, that’s been through the use of a surgery called Core Decompression. That’s when the surgeon drills a tunnel from the good bone to the bad bone. The idea was that since the dying bone is often surrounded by a hard shell, the surgeon needed to “decompress” this area. However, the procedure likely works because you’re dragging healthy bone marrow and its stem cells into the dying bone.
BMC Use in Treating Osteonecrosis
We’ve known since the 1990s that using Bone Marrow Concentrate (BMC) can help more patients recover from Osteonecrosis of the hip without needing a hip replacement. Philippe Hernigou, a French orthopedic surgeon in Paris published the first results on using the stem cells concentrated from Bone Marrow Aspirate (BMC) in addition to Core Decompression way back in 2002 (1). This showed that when the procedure was performed in pre-collapse hips (ARCO stage 1 and 2) there was a 94% success rate in avoiding hip replacement over 5-10 years. The results of 534 cases with an average 12-year follow-up were published by the same author in 2009 showing similar excellent results (2). Hence, this is NOT a new technique. We’ve had strong evidence that this procedure works for almost 30 years.
Our BMC Procedure for Treating Osteonecrosis of the Hip
Our Regenexx HQ site in Colorado began treating hips with Osteonecrosis more than a decade ago. We evolved the procedure from a surgical core decompression to a percutaneous one using a long trocar. That reduced the invasiveness from a surgery where a tunnel the size of a large ballpoint pen is bored through the bone to one the size of the much thinner internal ink refill (see above). As I always say, less invasive procedures mean a much quicker recovery and fewer complications. For example, our patients are able to get back to full weight-bearing (on average) in a few days while surgical core decompression patients need a much longer period on crutches taking weight off of the surgical hip.
Above is an example of one of those patients with early Osteonecrosis that showed complete healing due to this new percutaneous BMC injection technique. I posted this image back in 2014.
Yale Enters the Hip BMC Treatment Trend
Remember when you read here that major universities were adding PRP and BMC to their patient treatments at a rapid rate. That includes the likes of Harvard, Stanford, Emory, etc… This week Yale University entered the 21st century through a press release describing Phillipe Hernigou’s old technique from the 90s (3). While they added modern imaging, it’s really just the same old surgical technique perfected 30+ years ago.
Also, remember when I said that most major universities weren’t leading in Orthobiologics but following? Yale is a great example here. We had already evolved this technique away from surgery by 2014. Yale is now just getting around to adding the older and more invasive surgical technique.
Having said that, it’s great to see that Yale is modernizing their offerings and catching up to major universities that have already added bone marrow concentrate injections! The more the merrier here.
The upshot? Bone Marrow Concentrate can help Osteonecrosis patients heal and avoid hip replacement. The research on that has been clear for some time. By 2014 we had already evolved that surgical procedure away from surgery. However, it’s fantastic to see that a prestigious university like Yale is now adding BMC to its surgical treatment offerings!
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(1) Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002 Dec;(405):14-23. doi: 10.1097/00003086-200212000-00003. PMID: 12461352.
(2) Hernigou P, Poignard A, Zilber S, Rouard H. Cell therapy of hip osteonecrosis with autologous bone marrow grafting. Indian J Orthop. 2009 Jan;43(1):40-5. doi: 10.4103/0019-5413.45322. PMID: 19753178; PMCID: PMC2739495.
(3) Yale School of Medicine. Stem Cell Therapy Reduces Need for Nearly 10% of Hip Replacements. https://medicine.yale.edu/news-article/stem-cell-therapy-reduces-need-for-nearly-10-of-hip-replacements/
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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.
