Stem Cell Hip Treatment: An Alternative to Hip Replacement?

Hearing that you need a hip replacement can be terrifying, especially when you still feel young and active. You might be a runner, a contractor, or just someone who can’t afford to be sidelined for months by a major surgery. The idea of being “managed” with painkillers and physical therapy until your hip is “bad enough” for surgery is frustrating. Regenerative medicine offers a different approach.

Bone-on-Bone Hip? Is Avoiding Surgery an Option?

Over the years we have seen our fair share of people with a diagnosis of a bone-on-bone hips. The people we usually see have a lot of hip pain and instability which causes walking difficulties, balance difficulties and prevents these people from feeling stable on their feet. They also come in claiming that they have been told they only have one treatment option. Hip replacement and that they should get on the list to get one. Often they will ask, “Is hip replacement really my only option?”

At this point they will describe their medical history. They will tell me that their hip has been bothering them for a long time, sometimes 10 years, maybe even 15 years. That is also the same amount of time that they have been getting medical treatments for it. It is easy to see why people would be this way for 10-15 years. They were probably too young to be considered for replacement and have now grown old enough to be considered a good candidate for surgery.

Over these 10 – 15 years these people have tried many treatments, pain medications, acupuncture, physical therapy, cortisone and others and every time they get an MRI their hip looks worse.

Generally speaking, if you have a good range of motion in that hip and can bend your knee upwards and point your knee out to the side, then we would expect a realistic expectation that stem cell therapy could help you.

How Common is Hip Osteoarthritis?

If you’re dealing with hip pain, it can feel incredibly isolating, but you are far from alone. Hip osteoarthritis is a very common condition, affecting millions of people and often leading to significant pain and difficulty with simple movements. In fact, it’s estimated that about 30 million people in the United States are living with some form of osteoarthritis. This condition can seriously impact daily life, making it hard to walk, climb stairs, or even just get comfortable. The frustration you feel is shared by many who are looking for effective ways to manage their symptoms and regain their mobility.

For most people, the primary goal is to preserve their natural joint for as long as possible, hoping to delay or completely avoid a hip replacement. This is why exploring all your options is so important. The traditional path often involves treatments that offer only temporary relief before leading to the prospect of major surgery. Regenerative medicine, however, presents a different approach. By focusing on supporting the body’s own healing processes, treatments like stem cell therapy offer a path that may help you maintain your joint health and quality of life without immediately resorting to invasive procedures.

Why More Patients Are Choosing Against Hip Replacement

As I mentioned above, some people are told that hip replacement is their only option. For some people, it is their only option. Their hip maybe fused or stuck in place by bone spurs.

Some people come in with a diagnosis of avascular necrosis. Some of these people have been told that the only way they will ever get pain relief is from a hip replacement. There are cases where the bone is very damaged and it has collapsed completely. The hip joint is now fused and the person cannot move or lift their leg. This person will probably need a joint replacement. But most people I see with avascular necrosis of the hip, talus or shoulder don’t need a surgery. Sometimes they only need a little education to help them understand what is happening in their hip and that they can avoid the hip replacement. There are many doctors like myself, who are upset that patients are not given the full story on hip replacement options and alternatives. Below is the opening sentence of a study published recently in the Journal of medical Internet research.(1)

• “Despite the availability of evidence‐based guidelines for conservative treatment of osteoarthritis, management of degenerated joints is often confined to the use of painkillers and the wait for eventual total joint replacement. This suggests a gap in knowledge for those with osteoarthritis regarding the many different treatment options available to them.”

How wide a gap? A recent study published in the journal Osteoarthritis and cartilage says that when given time and educational materials to deliberate whether or not to proceed with hip replacement, more patients decide not to have surgery.(2)

These findings should not be a surprise to you. In fact, after all, you are reading my article because you are exploring the possibility of avoiding a hip replacement for yourself or a loved one.

What Patients Recommended for Hip Surgery Are Really Saying

The patient who has been recommended to hip replacement will tell us:

• The thought of a hip replacement surgery terrifies me because I do not know if I will be able to resume all the activities I love.
• I have to find another way. I own my own construction business, I cannot be take this time off to recover.
• I had hip replacement on the left side, it worked, but I do not want to go through all that again!

Sometimes someone will come into the office at the request of a loved one or spouse or family member who are concerned about the surgery and what the general anesthesia and the toll of a demanding recovery time may do to their loved one. Sometimes a person will come in because they are the caregiver for their spouse or older parent and cannot take the time off for the surgery and recovery. Sometimes they cannot take the time off from work.

Why Active People Are Turning to Stem Cell Hip Treatments

What I present here are not statistics but what people are telling us in the office. It is in agreement from what research tells us, people are being sent to hip replacement with no other choices offered. This is what these people said:

• I am a man who is 55 years old, I am in fantastic health. My orthopedists has diagnosed me with osteoarthritis in my right hip. He showed my my x-rays and he showed my an MRI and I get it. There is degenerative hip disease going on. I have lost some mobility and sometimes I have pain and discomfort. But I am just as active as I have always been. I’d like to avoid hip replacement if I can, because I am being managed until the hip gets bad enough to be replaced.I am looking for options
• I ran a marathon less than a year ago. Now I am a hip joint replacement candidate. I want to consider all my options.
• I have no cartilage in both hips, I need help, I am not on pain medications, but can’t work anymore. What are my options?

Can Stem Cell Therapy Help You Avoid Hip Replacement?

When a patient comes into our office with a more advanced arthritis and similar challenges as those demonstrated above, we perform a detailed examination and look at how much range of motion his/her hips have. If the hip can move left to right, back and forth that is a good indication that stem cell therapy can be effective. If the patient is as active as ever, that is usually a good sign that stem cells can help. If someone ran a marathon last year, that is a good indication that we can help.

The Stem Cell Procedure for Hips Explained

If you’re considering stem cell therapy, you’re probably wondering what the procedure actually involves. It’s a lot more straightforward than many people think. The entire process is minimally invasive and focuses on using your body’s own healing mechanisms to repair damage and reduce pain in your hip. Unlike a major surgery, this treatment is performed right in the office and is designed to get you back to your life with minimal downtime.

Who is a Candidate for Hip Stem Cell Therapy?

Stem cell therapy can be a good option for many people suffering from hip pain, but it’s not a one-size-fits-all solution. The ideal candidate is typically someone who is experiencing chronic pain and loss of function due to joint degeneration or injury but is not yet at a stage where the joint is completely destroyed. It’s for people who want to find a way to heal their body and get back to their active lifestyle without undergoing major surgery. If you still have a decent range of motion in your hip but are limited by pain, you might be a great candidate.

Conditions That May Benefit from Treatment

Stem cell therapy is versatile and can be used to treat a variety of conditions that cause hip pain. It’s particularly effective for issues related to tissue damage and inflammation, as the primary function of stem cells is to repair and regenerate. By addressing the underlying cause of the pain, this treatment may offer long-lasting relief and improved function. It’s a promising option for athletes looking to recover from an injury, as well as for individuals dealing with the daily grind of chronic degenerative conditions who are seeking an alternative to a lifetime of pain management or eventual surgery.

Hip Labral Tears and Cartilage Damage

Two of the most common causes of hip pain are labral tears and cartilage damage. The labrum is a ring of cartilage that helps stabilize the hip joint, and tears can cause significant pain and instability. Similarly, the articular cartilage that cushions the joint can wear down over time, leading to osteoarthritis. Stem cell therapy can help by stimulating the regeneration of this damaged cartilage and reducing the painful inflammation associated with these conditions. By promoting healing at the cellular level, this treatment can help restore the integrity of the joint and get you moving comfortably again.

When Stem Cell Therapy Might Not Be the Best Fit

While stem cell therapy offers hope to many, it’s important to have realistic expectations and understand its limitations. This treatment works by stimulating your body’s own repair mechanisms, but it can’t regrow a joint that has suffered from complete cartilage loss. Being honest about who is—and who isn’t—a good candidate is crucial for achieving successful outcomes. For this reason, a comprehensive evaluation is the first and most important step in the process. It ensures that you are choosing a path that offers a genuine chance for improvement and avoids disappointment down the line.

What “Bone on Bone” Really Means for Your Hip

Someone who is on the list for hip replacement and has a few weeks to go before the surgery will come into our office for a second opinion. This is a person who is not sure that hip replacement is right for them or for their lifestyle. They tell us that the agreed to the surgery because, “it is the only way.” Or, because “I am bone on bone.”

What Does the Research Say About Stem Cell Hip Treatments?

• In recent research doctors at Toronto Western Hospital suggested that stem cells injected into the joint can initiate the healing environment in a degenerated hip including the regrowth of bone in cases of osteocronosis (bone death).(3)
• Doctors at the Mayo Clinic write that in pre-clinical studies  the use of stem cells uniformly demonstrates improvements in osteogenesis (bone growth) and angiogenesis (blood vessel formation). In clinical studies, groups treated with stem cells show significant improvements in patient reported outcomes.) (4)
• Researchers in France led by Philippe Hernigou of the Department of Orthopaedic Surgery, University Paris East shows that despite advanced hip disease, bone marrow derived stem cell therapy can repair bone damage in hip osteonecrosis for the long-term. In one study, the researchers treated 189 hips in 116 patients with bone marrow concentrate and had a follow-up of 5 to 10 years. Satisfactory results were achieved in the majority of patients according to improvement of the (pain) hip score, radiographic assessment and the avoidance of hip replacement.(5)
• Doctors in Argentina and Seton Hall University in New Jersey combined to suggest that in their research in patients receiving bone marrow aspirate intra-articular injections for the treatment of early knee or hip osteoarthritis were found to be safe and demonstrated satisfactory results in 63.2% of patients. It should be pointed out that this was a single injection treatment. (6)

Can Stem Cells Treat Avascular Necrosis in the Hip?

A July 2020 (7) questioned whether core decompression of the femoral neck was necessary for all patients considering the procedures inconsistent results. It is interesting to note the suggestion of this and other research that this procedure can optimized by injecting autologous stem cells into the necrotic zone (the damaged area). Injecting autologous stem cells have demonstrated long-term results in the early stages of the disease, where the femoral head has not yet lost its sphericity. This study adds: “The now proven long-term efficacy as well as the safety of this technique (stem cell injections) make it the method of choice for treating young patients detected at the sub-radiological stage by MRI.”

What Causes Avascular Necrosis?

Avascular necrosis (AVN) happens when the blood supply to a part of your bone gets interrupted. Without that vital blood flow, the bone tissue can start to break down and die, which may eventually cause the bone to collapse. A common cause is a significant injury, like a joint dislocation or a bad fracture, that physically damages the blood vessels. As experts at Yale Medicine put it, this lack of blood can weaken the bone until it breaks down.Certain medical conditions, such as sickle cell disease, can also trigger AVN by creating blockages in the tiny blood vessels that feed your bones.

Beyond physical trauma and specific diseases, some lifestyle factors and medications are also known culprits. Long-term use of high-dose corticosteroids and excessive alcohol consumption are two of the most significant risk factors. According to the National Institutes of Health, these can interfere with your body’s ability to maintain healthy blood flow, leading to bone death and joint dysfunction. Other contributing factors can include radiation therapy and certain autoimmune disorders. Understanding the root cause of your AVN is a crucial first step in creating a treatment plan and exploring non-surgical options, like regenerative medicine, that aim to support the healing environment within the joint.

Can PRP Help with Steroid-Induced Hip Damage?

Let’s look at a study from August 2020.(8) In this paper. the researchers examined the problem of steroid-associated necrosis of the femoral head. This problem is one, they point out, of the most common and difficult to treat chronic diseases with increasing incidence.

• The typical pathological changes of steroid-associated necrosis of the femoral head include decreased osteogenic differentiation (the ability of native stem cells to initiate repair).
• This animal study conducted on Dewey rats investigated the effects and potential mechanisms of Platelet-rich plasma (PRP) on steroid-associated necrosis of the femoral head.
• PRP treatment significantly increased the hemorheological indexes and serum levels of bone gla-protein (BGP) and vascular endothelial growth factor (VEGF), while decreased the levels of triglyceride (TG) and total cholesterol (TC). (In other words, increased circulation to the hip brought more healing factors and removed harmful fat deposits that could impair healing).
• Testing indicated that bone trabecular microstructure and bone mineral density were significantly improved after PRP treatment.
• In summary, for the first time, PRP was demonstrated to prevent the development of steroid-associated necrosis of the femoral head through stimulating bone formation and vascularization as well as retarding adipogenesis.

Understanding the Potential Risks and Limitations

It’s important to go into any procedure with your eyes wide open. While regenerative medicine offers a promising path for many, it’s not a one-size-fits-all solution. The effectiveness of the treatment and any potential side effects depend heavily on your individual circumstances and the expertise of the practitioner performing the procedure. Being aware of the potential risks and limitations is a key part of the process and ensures you have realistic expectations for your healing journey.

Is Stem Cell Therapy Guaranteed to Work?

While the results are very encouraging, stem cell therapy is not a guaranteed cure. This is a constantly evolving field, and success can be influenced by your age, your overall health, and just how advanced your hip condition is. Think of it as giving your body a powerful toolkit to initiate repairs. For many, this leads to significant improvements in pain and function, but the final outcome is unique to each person. A thorough consultation is the best way to understand what you can realistically expect.

Possible Side Effects

One of the biggest advantages of using your own stem cells is that it dramatically reduces the risk of an immune reaction or rejection. The most common side effects are minor and temporary, such as increased soreness at the injection site for a few days. As with any injection, there’s a very small risk of infection or nerve irritation. Choosing a highly experienced physician, like Dr. Marc Darrow, who has specialized in regenerative medicine for over two decades, is crucial for minimizing these risks and ensuring the procedure is done correctly.

The Typical Recovery Timeline

Patience is a virtue, especially when it comes to healing. Unlike the immediate but invasive results of surgery, regenerative medicine works with your body’s natural healing cycle. You might start to notice a real decrease in pain about two to three months after your treatment. From there, the improvements are often gradual and can continue for up to a year as the cells do their work to repair and regenerate tissue. Your provider will give you a personalized recovery plan, which may include physical therapy or specific exercises to support the healing process.

Stem Cell Hip Treatment: Four Patient Case Studies Clinical medicine insights. Case reports.

In research from our Stem Cell Institute, we suggested that the use of mesenchymal (connective tissue) stem cells from bone marrow concentrate improved quality of life for patients with hip osteoarthritis. Here are our 4 case studies.(9)

Case 1
The first patient is a 75-year-old woman with a 10-year history of progressive right hip pain. She had consulted with two orthopedic surgeons, each of whom recommended total hip replacement as her only option. Magnetic resonance imaging (MRI) of the right hip showed severe osteoarthritis with extensive bone spurs and near-complete obliteration of the joint space. (Bone on bone). The patient experienced the most pain when sitting for extended periods of time. She had tried massage therapy and anti-inflammatory gel for pain relief; however, her resting and active pain were each 6 out of 10.

• The patient underwent 4 bone marrow concentrate stem cell treatments over a 49-day period, and her symptoms improved with treatment.
• After the second treatment, the patient reported a 40% improvement, with more joint flexibility.
• At the follow-up after the fourth treatment, the patient noted a 60% total overall improvement with active and resting pain levels of 2/10.
• Her functionality score also increased to 37/40. At the final follow-up, the patient reported that she was sleeping better and that she had avoided a total hip replacement.

Case 2
The second patient was a 61-year-old man who had chronic hip pain for two years. His pain was most pronounced while standing or with intensive exercise. The patient had undergone chiropractic adjustments, cupping, and physical therapy for pain relief, but his symptoms returned within 1 week of each treatment. Radiographic assessment of the right hip demonstrated severe osteoarthritis. At baseline, the patient reported a resting pain of 1/10 and an active pain of 7/10. His functionality score was 28/40.

• The patient underwent 4 bone marrow concentrate stem cell treatments during a 42-day period.
• After the first bone marrow concentrate stem cell treatment, he reported an 80% total overall improvement, with no resting pain.
• At the follow-up after the fourth treatment, the patient reported only infrequent, mild pain (0/10 at rest and 2/10 with activity).
• Following treatment, he was able to resume exercise and an active lifestyle.
• His functionality score was 37/40 and reported that he had 94% total overall improvement.

Case 3
The third patient was a 76-year-old man who had a 7-year history of chronic hip pain. He previously underwent a left hip replacement but reported that the recovery had been challenging. Furthermore, he did not want a second hip replacement that had been recommended by his surgeon. The MRI of the right hip showed moderate to severe osteoarthritis with articular surface irregularity. The patient had physical therapy and massage but his pain had progressed. He underwent 4 bone marrow concentrate stem cell treatments over a 54-day period. At baseline, his resting pain was 4/10, active pain was 5/10, and functionality score was 33/40.

• After the second treatment, the patient reported a 50% total overall improvement with increased hip flexibility and range of motion.
• At the follow-up after the fourth treatment, the patient reported a 65% total overall improvement with a resting pain of 1/10 and active pain of 2/10.
• Following treatment, his functionality score was 37/40, and he was able to walk long distances with no pain and enjoyed a significantly improved quality of life.

Case 4
The fourth patient was a 56-year-old man who had a 2-year history of chronic hip pain resulting from his physically demanding career as a contractor. The patient reported that his pain was worsening and limiting his everyday activity. He had an epidural injection with no pain relief. A radiograph of his right hip showed mild osteoarthritis. His resting pain was 2/10, active pain was 5/10, and functionality score was 17/40 at baseline.

• The patient underwent 4 bone marrow concentrate stem cell treatments over a 146-day period.
• The patient experienced minor, incremental improvements following each of the first 3 treatments (overall improvement, 30%). He reported improved ability to perform daily activities with less pain during the course of those 3 treatments. After 40 days of the fourth treatment, the patient reported a 70% total overall improvement. His resting and active pain were 1/10, and his functionality score increased to 30/40.

Based on these results we were able to demonstrate that receiving multiple bone marrow concentrate stem cell injections within a short time period may provide an effective hip cartilage repair. While this is a short-term outcome study, we have seen many patients with long-term results.

A study from December 2018 (9) examined Bone marrow aspirate concentrate in the treatment of early knee and hip osteoarthritis. In 19 patients (16 female and 3 male), totaling 25 joints (10 knees, 15 hips), treated with intra-articular Bone marrow aspirate concentrate for early osteoarthritis found a satisfaction rate of 63.2%. Two patients were converted to total hip replacement at 8 months after Bone marrow aspirate injection.

It is important that proper patient selection is involved. Not everyone will benefit and success rates would be higher with better candidate selection. Are you a good candidate? Ask me.

References

1. Umapathy H, Bennell K, Dickson C, Dobson F, Fransen M, Jones G, Hunter DJ. The web‐based osteoarthritis management resource my Joint pain improves quality of care: a quasi‐experimental study. J Med Internet Res.2015 Jul 7;17(7):e167. doi: 10.2196/jmir.4376.
2. Stacey D, Taljaard M, Dervin G, Tugwell P, O’Connor AM, Pomey MP, Boland L, Beach S, Meltzer D, Hawker G. Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage. 2016 Jan;24(1):99‐107. doi: 10.1016/j.joca.2015.07.024. Epub 2015 Aug 4.
3. Lau RL, Perruccio AV, Evans HM, Mahomed SR, Mahomed NN, Gandhi R. Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review. BMC Musculoskelet Disord. 2014 May 16;15:156. doi: 10.1186/1471-2474-15-156.
4. Houdek MT, Wyles CC, Martin JR, Sierra RJ. Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning. 2014 Apr 9;7:65-70. eCollection 2014.
   
5. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clinical Orthopaedics and Related Research®. 2002 Dec 1;405:14-23.
6. Rodriguez-Fontan F, Piuzzi NS, Kraeutler MJ, Pascual-Garrido C. Early Clinical Outcomes of Intraarticular Injections of Bone Marrow Aspirate Concentrate for the Treatment of Early Osteoarthritis of the Hip and Knee: A Cohort Study. PM&R. 2018 May 29.
7. Massin P. Treatments of avascular osteonecrosis of the hip: Current treatments [published online ahead of print, 2020 Jul 8]. Morphologie. 2020;S1286-0115(20)30051-5. doi:10.1016/j.morpho.2020.06.003
8. Xu HH, Li SM, Fang L, et al. Platelet-rich plasma promotes bone formation, restrains adipogenesis and accelerates vascularization to relieve steroids-induced osteonecrosis of the femoral head [published online ahead of print, 2020 Aug 24]. Platelets. 2020;1-10. doi:10.1080/09537104.2020.1810221
9. Darrow M, Shaw B, Darrow B, Wisz S. Short-Term Outcomes of Treatment of Hip Osteoarthritis With 4 Bone Marrow Concentrate Injections: A Case Series. Clinical Medicine Insights Case Reports. 2018;11:1179547618791574. doi:10.1177/1179547618791574.
10. Rodriguez-Fontan F, Piuzzi NS, Kraeutler MJ, Pascual-Garrido C. Early clinical outcomes of intra-articular injections of bone marrow aspirate concentrate for the treatment of early osteoarthritis of the hip and knee: a cohort study. PM&R. 2018 Dec 1;10(12):1353-9.