Avascular necrosis of the hip is a frequently seen condition in young patients. It is of diverse origin and its treatment is controversial. Surgical treatment remains the key stone in late cases with hip replacement as the proved and tested method. Surgeons at the Madras Joint replacement center are proud to announce a novel form of biological treatment with stem cells. It can be performed for patients with the early stages of the disease.
When the disease is detected early by MRI scans, it is possible in India now to perform a biological treatment.

In fact a biological treatment option of early disease is a medical necessity and must be the treatment of choice whenever possible.

A novel approach to this condition is being mooted by a leading Orthopedic surgeon in Chennai, India. This is by means of stem cells. Stem cells have the potential to regenerate any tissue. In this case, bone forming stem cells are utilized to synthesize new bone over the dead bone. Stem cells are harvested from the pelvis of the patient.

There are two techniques being promoted. One is a three stage procedure and the other is a single stage procedure. Both procedures are done in India, implying that you will save thousands of dollars in treatment costs.

The first method is by stem cell culture in the lab to multiply the number of cells several million fold. These cultured stem cells are reinjected into a previous core decompression site.

In the second method, bone marrow obtained from the pelvis is centrifuged in the operating room to yield a Bone marrow concentrate rich in stem cells. These are injected into a core decompression site.

A paper presented at the recent American academy of surgeons meet in New Orleans highlighted the success story of stem cells.

http://www.prweb.com/releases/adultstemcellAVNsurgery/thomaseinhornmd/prweb3813974.htm

To know more about the stem cell option and to determine whether your case is suitable for this unique form of treatment, send an e mail to

Dr.A.K.Venkatachalam at drvenkat@kneeindia.com

Visit http://www.hipsurgery.in/blog

To get more information please e mail us

drvenkat@kneeindia.com

Web site- http://www.hipsurgery.in

Stem cell treatment of avascular necrosis.

A novel form of treatment is now available in India for patients with early stage avascular necrosis of the hip. This treatment is based on regenerative medicine.

Avascular necrosis of the hip is a condition of unknown origin affecting many young and middle aged patients. Steroid intake, alcoholism, Sickle cell diseas, hypertension, decompression sickness are some known causes. Moderate to severe disease is treated by hip resurfacing whereas core decompression is offered to the first stage of the disease. Grade II A disease is an intermediary stage between the two extremes and has no definite treatment options. There is controversy on the appropriate treatment. Hip replacement is perhaps too drastic an operation for this early stage of the disease. Core decompression has limited success rate. Left to progress it leads to deterioration and hip arthritis.

For this stage, a biolgoical option is now available. This is based on the potential of stem cells to heal the avascular bone. Stem cells are drawn from the patient and cultured in the lab. A few weeks later, they are injected back into the affected portion of the femoral head along with a core decompression. In a core decompression the surgeon will drill a tunnel in the hip bone leading into the affected area. The regenerative bone cells are injected into the affected area. The bone forming cells called Osteoblasts synthesize new bone in the dead area. This leads to healing and hence a biological cure. The technique is called Ossron

This process is avaiable in India for a reasonable cost.

To get a quote please e mail us at drvenkat@kneeindia.com

Avascular necrosis or Osteonecrosis is a fairly common hip condition.

Young patients are affected. Some of the causes leading to osteonecrosis are steroid intake, alcoholism, connective tissue disorders like SLE, Sickle cell disease, hypertension, decompression sickness, thrombosis, In a large number of individuals the cause is unknown or Idiopathic. Young and middle aged patients are affected. Involvement of both hips is fairly common.

Hip AVN

Hip showing advanced changes of avascular necrosis

Diagnosis- It takes a long time for the bony changes to be visible on plain x rays.

MRI scans and nuclear bone scans reveal the diagnosis early on when the condition is suspected. Both hips need to be imaged simultaneously. CT scans help to identify the extent of the bony involvement.

Treatment

The treatment depends on the stage of the disease. Most often conservative or non operative measures fail. Surgical treatment ranges from core drilling to total hip replacements. In the early stages core drilling can lead to a positive result in a good proportion of cases.

When this has failed, or the stage is more advanced, hip resurfacing is advised. However the surgeon should do so after a diligent assessment of the extent of disease. Hip resurfacing can be done when the extent of the femoral head involvement is less than 30 percent. In early cases partial hip resurfacing can be done in a few selected centers

Hip resurfacing operation

The presence of cysts makes hip resurfacing more difficult to perform with confidence. In these cases there are two options.

One is the Proxima hip replacement

where the bone is amputated at the base of the head similar to the BMHR. Then a short stem is impacted into the top portion or Proximal part of the neck and metaphysis of the femur. This has a large ball of the same diameter as the natural femoral head. The socket is also lined with a metal cup. Thus a trunnion of large diameter metal on metal results. The advantages are stability and less bone loss. The Proxima hip has a ten year follow up in the hands of its designer surgeon.

The other option is the Mid head resection Birmingham hip or BMHR.

Birmingham Mid head resection prosthesis

This operation involves amputating almost the entire head of the femur containing the cysts, impacting a conical stem into the neck portion of the femur and attaching a Birmingham hip like prosthesis. The cup also gets a metal liner.

All the options mentioned are bone sparing options.

There is not much difference in the extent of the bony resection in the Proxima hip replacement and the Birmingham Mid head resection prosthesis. The former has a longer follow up.

A total hip replacements with a variety of non metallic bearings is the only advisable replacement in patients with blood dyscrasias like sickle cell disease, thallesemia etc. Ceramic on Ceramic, Ceramic on polyetheylene, metal on poly are the available choices.

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