Over the years we have seen our fair share of people with a diagnosis of a bone on bone hip or bone on bone hips. The people we see have pain, they have instability which causes walking difficulties and balance difficulties and they are not stable on their feet. They also come in claiming that they have been told they only have one treatment option. Hip replacement

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about degenerative hip disease using the contact form below. 

What if you don’t want the hip replacement surgery? Are there options? Some doctors say no.

Some doctors 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)

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. In truth, many are looking for an alternative, if one exists. Sometimes he or she will come in because the idea of surgery is making him or her nervous. 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.

Active, sports minded people being sent to hip replacement without suggestion of non-surgical options are finding options on their own. Stem cells are one option

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 be effective in treating hip osteoarthritis and in helping you avoid a hip replacement surgery?

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 research in support of stem cell therapy for hip osteoarthritis

  • 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)

What does Darrow Stem Cell Institute research say about hip osteoarthritis and treatment with bone marrow derived stem cells? Here are four patient cases we published in 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.(7)

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.

The treatment in this study is explained in the video below.

Stem cells: Umbilical Cord Blood

Above, you read about our clinical observations surrounding the use of bone marrow derived stem cells in the treatment of degenerative joint and spine disease. In late 2018, our clinical and research team, satisfied with preliminary observations of treatment success, decided to offer umbilical cord blood stem cell therapy to our patients as another option. Part of our decision was based on research like this, published in October 2018 in the journal Regenerative Medicine. (1)

“Stem cell-based therapy for the treatment of orthopedic diseases is arguably one of the most remarkable developments in the field of regenerative medicine. A better understanding of Mesenchymal stem cell biology and identification of Mesenchymal stem cells in (umbilical) cord blood have added umbilical cord blood to the sources of stem cells used for treatment of nonhematopoietic diseases.”

In that same study, the researchers noted: “the data conclusively establish that (umbilical cord blood) is enriched in cytokines (proteins that communicate commands to stem cells) and growth factors that play an important role in bone regeneration and repair.”

Bone regeneration and repair is certainly an appealing treatment for degenerative joint disease.

Less Invasive Procedure

The harvesting of bone marrow stem cells requires an aspiration of the bone marrow from the bone of the iliac crest of the pelvis. In other words, we drill into the pelvis. It is not as bad and painful as it sounds. We numb the area of the pelvis that we will be drilling into, we use a small drill device, we do not drill in that deeply, and the whole procedure is complete within a few moments. We have done thousands of these procedures with very comfortable patients.

However, even though we take great effort to make this procedure as painless as we can, some patients still did not like the process. Some decline a treatment that would be a great benefit to them because they cannot overcome the drilling aspect of the bone marrow treatment. The stem cell procedure with the donated stem cells is a much less invasive procedure because there is no drilling. Human umbilical cord stem cell therapy requires no harvesting from the patient. Indeed, umbilical cord stem cell therapy offers “a painless collection procedure.”

Are you facing hip replacement? Ask Dr. Darrow about your hip pain

 

STEM CELL INSTITUTE

A leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300

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.
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 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.