The case for stem cells for non-surgical repair of degenerative hip

Hip joint pain and injury is one of the more difficult conditions to treat if a patient has let the condition progress for many years without treatment or mobility. One criterion that determines if a pain patient will do well with stem cells is good range of motion in that particular joint.

It is a relatively common occurrence in a stem cell / Prolotherapy practices to see patients under the age of 50 with premature osteoarthritis. Patients typically complain of significant hip and groin pain, especially with exercise.

There are many causes of premature osteoarthritis of the hip.

  • Coxa Profunda (a condition of a deep hip socket – however it is also seen in many patients on MRI and scans who exhibit no symptoms)
  • Femoroacetabular Impingement
  • Avascular Necrosis
  • Hip Instability From Hip Ligament Injury
  • Labral Tear
  • Joint Dislocation

As hip degeneration increases, normal mechanical load will cause worsening joint instability. Eventually articular cartilage breakdown and bony overgrowths called bone spurs, which are another common occurrence with osteoarthritis or degenerative arthritis will occur.Eventually the pain and hip range of motion will both deteriorate to the point where the patient ‘s activities are severely limited or stopped.

Prior to Hip Replacement – a patient may be recommended to the following procedures:

  • Labral Debridement and Repair: Debridement refers to the removal of tissue via an arthroscopic blade, shaver, or ablator.  The goal of debridement is to relieve pain by removing any torn or frayed labral tissue from the labrum.

In a recent study from Australian researchers published in the medical journal Knee surgery, sports traumatology, arthroscopy hip range of motion and  adduction strength (the lateral movement of the hip joint)  were associated with weakened and damaged hip labral tears and considered to be important quality-of-life in patients with labral problems.1 This clearly indicates that patients want repair not tissue removal.

  • Chondroplasty: The removal of damaged cartilage during surgery via shaving, cutting, scraping, laser, or burring away.  The idea is that after the damaged cartilage is removed via chondroplasy, the body may recover the area with new cartilage.
  • Microfracture: A surgical procedure whereby a “pick” is used to spike holes in damaged cartilage to promote bleeding and the migration of bone marrow cells to the joint surface.  The idea is that the blood cells/bone marrow will heal the damaged cartilage.  As aforementioned, microfracture is the only technique performed during this patient’s surgery that may be considered regenerative, in that the technique is applied in attempt grow new tissue.  However, a much simpler, less risky and more cost effective treatment would be PRP and stem cells to stimulate the growth of new cartilage.
  • Osteoplasty:  The surgical alteration of bone.
  • Synovectomy:  The surgical removal of the entire or partial synovial membrane of a joint.

The case for stem cells as non-surgical repair of degenerative hip

In a heavily cited 2015, Iranian doctors announced their findings for long-term safety follow up in patients who received stem cell therapy in the knee, stem cell therapy in the ankle, or hip for treatments of osteoarthritis.

  • Seventeen patients were followed through the end of the study.
  • The patients received ONE bone-marrow stem cell injection to the affected joint.
  • Patients were followed with clinical examinations, MRI and laboratory tests at 2, 6, 12, and 30 months post-transplantation.

The doctors concluded their findings as having observed no severe adverse events . . .

  • All patients exhibited therapeutic benefits such:
    • as increased walking distance,
    • increased function,
    • and reduced pain.

The research concludes: “Our study has shown that injection of MSCs (stem cells) in different osteoarthritis affected joints is safe and therapeutically beneficial.”2

In the medical journal Clinical medicine insights. Arthritis and musculoskeletal disorders, findings showed improvements in seven patients who had hip, knee or ankle osteoarthritis and who received two to seven stem cell therapy treatments  over a period of two to twelve months. Following treatments the seven patients all reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptom relief, and two additional patients achieved resumption of vigorous exercise.3

In study from the medical journal Arthritis & rheumatology doctors found that the repair of subchondral bone (the bone on bone phenomena) lesions and damage, with stem cells, should be considered as the native stem cells in the hip positively respond to the repair stimulus during stem cell therapy.(4The stem cells already in the hip jump started the repair process.

Hip Osteoarthritis

The patient’s X-rays and physical exam confirmed severe osteoarthritis in both hips. In many cases  dextrose Prolotherapy will eliminate all or most of the pain associated with this disease, however, severe cases are more difficult.

  • One of the determining factors that points to the severity of the arthritis is the range-of-motion that remains in the joint. This patient had zero degrees of internal rotation and 25-30 degrees of external rotation, which is very limited.

In research entitled: “How Much Arthritis Is Too Much for Hip Arthroscopy” doctors try to grade at what point hip damage is too severe for hip arthroscopy and when the patient should be sent to full hip replacement.

  • The researchers concluded: “Current evidence is insufficient to define a cutoff for how much arthritis is too much for hip arthroscopy.” 
  • They did suggest however that the lesser the amount of joint space the more likely that total hip replacement would be the recommended choice.5

When some health care providers see an advanced case of osteoarthritis or a patient after dextrose Prolotherapy treatments have not met the goals of treatment, they may suggest stem cell treatment for hip osteoarthritis.

This is a procedure where the patient’s own bone marrow or adipose fat cells are extracted via a simple procedures. Bone marrow and adipose  cells contain stem cells, cells that differentiate, or change, into any other types of cells in the body, according to what is needed.

  • Following stem cell therapy from bone marrow, the patient reported 20% improvement after the first treatment, 70-80% improvement after the second, and has been cycling ten miles per day nearly every day.

The promising results with these studies and the clinical evidence gives hope to those suffering with degenerative hip disease.

Questions about this article can be submitted below – you may also want to consider reaching out to a doctor to get information about a consultation.

1. Kemp JL, Makdissi M, Schache AG, Finch CF, Pritchard MG, Crossley KM. Is quality of life following hip arthroscopy in patients with chondrolabral pathology associated with impairments in hip strength or range of motion? Knee Surg Sports Traumatol Arthrosc. 2015 Jul 3.

2. Roghayeh Fazeli MD, Fatemeh Mohseni MD, Maryam Niknejadi MD, Fatemeh Moeininia MD, Fanni AA, Narges Labibzadeh MD. Long-term follow-up of intra-articular injection of autologous mesenchymal stem cells in patients with knee, ankle, or hip osteoarthritis. Archives of Iranian medicine. 2015 Jun;18(6):336.

3. Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013.

4. Campbell TM, Churchman SM, Gomez A, McGonagle D, Conaghan PG, Ponchel F, Jones E. Mesenchymal stem cell alterations in bone marrow lesions in hip osteoarthritisArthritis Rheumatol. 2016 Feb 11. doi: 10.1002/art.39622

5. Domb BG, Gui C, Lodhia P. How Much Arthritis Is Too Much for Hip Arthroscopy: A Systematic Review. Arthroscopy. 2014 Dec 25. pii: S0749-8063(14)00900-1. doi: 10.1016/j.arthro.2014.11.008.

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