Osteonecrosis or Avascular Necrosis of the Hip & Knee: Core Decompression and Cell Therapy

Osteonecrosis (ON) is a serious medical condition in which there are areas of bone death. The condition is also known as avascular necrosis (AVN). Bone death occurs as a result of disruption in the blood flow to the area of bone due to a variety of reasons. One of the commonest cause of ON or AVN in young patients is the ingestion of corticosteroids (which are drugs used to treat such conditions as psoriasis, SLE or rheumatoid arthritis). Other patients suffering from this disease may have a history of alcohol abuse or are under large doses of immunosuppresants (for instance cancer patients). In severe cases the overlying cartilage  over the dead bone may collapse, resulting in severe damage and arthritis to the affected joint.

The problems associated with treating these patients include:

  1. They are usually young
  2. The lesions of the tissue are usually bilateral (both limbs)
  3. The lesions are usually multifocal- eg affecting both hips and knees at same time
  4. Usually fairly extensive involvement
Osteonecrosis

MRI of the knee showing extensive areas
of bone death (in both the thigh and shin bone)

Osteonecrosis in Hips

Xray of both hips showing extensive areas
of bone death (whitish areas in the femoral heads)

The ideal treatment method is one that is minimally invasive, have a low complication rate and does not make future surgeries (if needed) to the affected area more difficult.

Dr Kevin Lee has published 2 papers (“Treatment Of Secondary Osteonecrosis Using An Injectable Bone Graft Substitute”. J. Orthopaedics 2011;8(4)e15 and “Cell Therapy For Secondary Osteonecrosis of the Femoral Condyles Using the Cellect DBMTM System – A Preliminary Report”. Lee K, SB Goodman. J Arthroplasty. 2008)  on using a novel technique to treat this difficult condition.

Our procedure involves the creation of a small incision in the affected area to remove the dead bone from the knee or hip. This procedure is also known as core decompression. Afterwards, bone marrow is obtained via a tiny incision near the hip bone. Bone marrow is rich in growth factors and stem cells (special cells that can turn into bone, fat or muscle cells under the right conditions). The marrow collected is then mixed with a bone graft material (called HEALOS FX). Using a syringe pump, this mixture which contains stem cells, growth factors and bone graft material is injected into the area where the dead bone was removed. New bone then grows and replaces the dead bone that was removed. Results are promising for patients with at least a 2 year period of follow up and early stages of ON/AVN. The technique has been successfully used for the treatment of osteonecrosis of both the hip and the knee.

 

Osteonecrosis Treatment

Picture of core decompression (removing dead bone)
of the knee via a small incision

Osteonecrosis Treatment

Picture of bone marrow aspiration via a tiny incision

Osteonecrosis Treatment

Picture of the injectable HEALOS FX graft mixed with bone marrow





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