The femoral head, carpals, humerus are the most commonly affected bones. Once the collapse of the affected bone occurs, pain ensues and results in limitation of daily activities. Spontaneous regression of the condition is rare.
The risk of developing AVN of the femoral head is 0.3% with an incidence of one per one thousand patients per year. The commonly reported causes of AVN are use of steroid medication and traumatic injury.
The use of progenitor cells has shown promise in halting the progression of AVN of the femoral head, and subsequently preventing patients from undergoing total hip arthroplasty. These cells have the ability to survive and expand in the avascular environment/necrotic area. The use of platelet concentrate aids in supply of growth factors to the necrotic region thereby acting synergistically with the progenitor cells.
Our protocol involves harvesting cells from the patients own body (autologous stem cells). After activation the cells are transplanted into the appropriate site. The degree of improvement achieved will depend on the stage of the condition, presence of other influencing factors and patient compliance with respect to following diet and allied therapies (physiotherapy, yoga).
A 28 year old male patient who is a known case of Avascular necrosis of the femoral head (both hip joints) since 2013 reported to Hospital. His initial complaint was pain in the left hip joint which gradually increased in intensity. Over a period of 6 months he felt pain in right hip joint as well with restricted movements and inability to squat. The patient consulted an orthopedic surgeon who advised conventional treatment with medicines. However, the patient had no relief and his condition worsened. He was advised to undergo total hip replacement surgery in the year 2014. The patient was also on steroid medication 5-6 months ago for a skin condition. On the patients first visit to Hospital, complete clinical, hematological and radiological investigations were done. The MRI findings were suggestive of grade 2 avascular necrosis of both the femoral heads. Based on the assessment, a treatment protocol comprising of 2-3 sessions of stem cell therapy over a period of 6-8 months was advised (tentative plan, sessions may be modified based on patients response to therapy). The treatment plan was as follows: - Injection of Neupogen (subcutaneous injection) for mobilization of cells from the bone marrow two consecutive days prior to the procedure, - On the day of the procedure: Harvesting of cells from the bone marrow, adipose tissue, peripheral blood (from the patients own body autologous stem cells), Isolation and activation of cells at Hospital in-house laboratory, Transplantation of cells into the appropriate site (intraarticular, intravenous). - Post treatment non interventional observational period of 48 hours was advised to monitor the general condition of the patient and homing of cells. - Allied modalities of physiotherapy, yoga, diet plan and nutraceutical medications were also advised. The patient has undergone 3 sessions of stem cell therapy following clinical and radiological assessment at each follow-up. Results: The first follow-up was 1 month following the first stem cell therapy. The severity of pain decreased within one week of 1st session. However, the patient had difficulty in walking for more than 15 minutes, climbing stairs and pain on bending. The clinical assessment revealed improvement in condition as compared to pretreatment status and previous session of treatment. However complete relief was not achieved. The advice for 2nd and 3rd session of stem cell therapy was given at the 3rd and 6th month follow-up. The present status of the patient (following 3rd session/ 1 year after 1st session) is as follows: mild pain, ability to bend and walk for longer distance and duration (upto 1 hour) without much discomfort, and improvement in range of motion. He has been advised to continue physiotherapy exercises, yoga, diet and nutraceuticals. This is a case report of avascular necrosis of the femoral head effectively treated by stem cell therapy at Hospital. Hospital adopts a well researched and personalized treatment protocol for every patient/condition to achieve the best possible outcome.