Successful Treatment of AVN of Femoral Head with Stem Cell Therapy

Avascular necrosis of the femoral head is bone death thought to arise from interruption of the blood supply.

Progression of the disease is characterized by flattening of the femoral head with eventual collapse of the hip joint.

Stem cell therapy is a non surgical option in the treatment of AVN of the femoral head.

MFH is a 50y/o active female initially evaluated at the Centeno-Schultz Clinic with ARCO stage 2 AVN of the femoral head.

On 4.2009 she underwent core decompression where bone marrow derived stem cells were injected directly into the area of necrosis.

Clinically patient has done extremely well as reflected in her 5 year follow up questionnaire which she permitted us to share.

Her hip x-rays demonstrate successful treatment of AVN with Regenexx treatment.  Note that the contour of the femoral head has not changed, flattened or collapsed.

ITB: Iliotibial Band Dysfunction and Treatment Options

At the Centeno-Schultz Clinic we approach pain and dysfunction in a systematic fashion which is outlined in Ortho 2.0.

We employ the acronym SANS:  symmetry, articulation, neurologic and stability.

This approach can be utilized for any joint.

The iliotibial band (ITB) is a fibrous band that extends from the hip (ilium) to the knee (tibia).

It is a critical in the stability of the hip and pelvis.

There are both anterior and posterior forces on the ITB.

Posteriorly it connects with the gluteus medius  muscle which when contracted pulls the ITB posteriorly.

Anteriorly the ITB connects with the tensor fasciae latae muscle which when contracted pulls the ITB anteriorly.

Biomechanics of ITB:  Supports and stabilizes the hip and pelvis when the opposite foot is suspended and off the floor such as when we are walking.

Lumbar spinal nerves provide essential information to the gluteus medius, tensor fasciae latae and other muscles that support the ITB.

Irritation or compression of lumbar nerves can result in a reduction in the nerve signal to the muscles and ensuing weakness.

This weakness can be witnessed on physical examination when the patient is asked to stand on one leg and the pelvis shifts.  Weakness in the ITB compromises the stability of the pelvis and hip with resultant shift of the pelvis as illustrated below.

 

 

 

An excellent analysis and summary of the iliotibial band is presented below by Dr. Centeno.

 

 

 

 

 

 

 

 

Groin Pain: Consider Iliopsoas Tendinitis

At the Centeno-Schultz Clinic we acknowledge the pain and restriction in motion associated with groin pain.

Inflammation of the iliopsoas tendon can be a cause of groin and anterior hip pain.  Treatment options include prolotherapy and platelet rich plasma injections.

The psoas and iliacus muscle originate from the lumbar spine, converges to form the iliopsoas muscle and its tendon  attaches onto the lesser trochanter of the femur.

The musculotendinous junction can be found in a groove between the anterior inferior iliac spine and the iliopenctineal eminence.

Major causes of iliopsoas tendinitis are  trauma and overuse resulting from repetitive hip flexion.

In adolescents the combination of inflexible hip flexors and tightness of the iliopsoas muscle and tendon can lead to anterior pelvic tilt and increased stress on the lower lumbar discs and facets.

Groin or anterior thigh pain is a common presentation as illustrated below in red.

Physical examination may be significant for anterior pelvic tilt, tenderness of the iliopsoas tendon and a snapping hip sign.

At the Centeno-Schultz Clinic  a diagnostic ultrasound is utilized to confirm the diagnosis.  Below is an ultrasound image identifying the iliopsoas tendon and adjacent femoral artery.

Effect of Amide Local Anesthetics on Stem Cell Viability: Patient BEWARE !

At the Centeno-Schultz Clinic ongoing research and publication is a cornerstone of the practice.

Multiple articles have been published in peer-reviewed journals.

A new article just published examined the effect of amide type local anesthetics on human mesenchymal stem cell viability and adhesion.

Why?

Local anesthetic are commonly utilized in joint and injections.  Local anesthetics combined with high dose steroids are commonly injected into the joint.  The local anesthetic provides numbing which gives the patient several hours of pain relief.

Do the injected local anesthetics affect stem cells?

Four amide local anesthetics were examined in varying concentrations:  ropivacaine, lidocaine, bupivacaine and mepivacine.

Each anesthetic in different concentrations was incubated with human mesenchymal stem cells for 40 minutes, 120 minutes and 360 minutes and 24 hours.  Cell viability was assessed at each time point.

Conclusions

Extended treatment with local anesthetics for 24 hours or more had signficant impact on both stem cell viability and adhesion.

Stem cells treated with lidocaine, bupivacaine and mepivacine resulted in cell death via apopotosis after brief exposures.

Amide local anesthetics induce stem cells apoptosis(cell death) in a time and dose dependent manner.

Bottom Line

Patient beware!  Know that injected local anesthetics can negatively impact your repair cells.  If you medical provider wants to inject your joint ask why and with what acknowledging that your repair cells and cartilage are at risk of damage.

Lateral Hip Pain: Think Gluteus Minimus Tendon Dyfunction

At the Centeno-Schultz Clinic we understand how frustrating and debilitating lateral thigh can be.

There are many causes of lateral thigh pain so an accurate diagnosis is essential.

Irritation or inflammation of the  gluteal muscles, tendons and trochanteric bursa can create pain.

Treatment options include MSK ultrasound guided injections of prolotherapy, platelet lysate and concentrated stem cell plasma.

There are three major tendons that attach onto the greater trochanter (the large boney prominence on the lateral aspect of the thigh): gluteus maximus, medius and minimus.

The gluteus minimus tendon can be a cause of lateral thigh pain.

The gluteus minimus muscle originates from outer surface of the ilium and attache onto the anterior facet of the greater trochanter .

The greater trochanter has four principal facets onto which the  various tendons attach.  The gluteus minimus attaches to the anterior facet.

The gluteus minimus muscle and tendon are visible on MRI.

The gluteus minimus muscle and tendon are also visible on MSK Ultrasound.

Accurate diagnosis is essential for maximal clinical results.  At the Centeno-Schultz Clinic MSK ultrasound is used to diagnosis and accurately guide treatment of lateral thigh pain.

Anterior Hip Pain: Illiopsoas Tendinitis

At the Centeno-Schultz Clinic we acknowledge that hip pain can be disabling.

It may arise from osteoarthritis, avascular necrosis of the femoral head and femoral acetabular impingement syndrome.  Stem cell therapy is an alternative to traditional hip surgery.

Iliopsoas tendonitis can also cause hip pain which typically is anterior in location.  Tendinitis is inflammation of the tendon:  the rope-like tissue that connects muscle to bone.  Tendinitis is typically associated with an acute injury whereas tendinosis is chronic and associated with degeneration of the tendon.

Major causes include acute trauma and overuse from repetitive hip flexion.

The psoas and iliacus muscles originate from the lumbar spine and pelvis.  The muscles converge to form the iliopsoas muscle and insert onto the lesser trochanter.  The iliopsoas muscle functions as a hip flexor and external rotator of the femur.

Patients commonly present with anterior hip or groin pain.

Presentation may include shorten stride and anterior pelvic tilt.

Tenderness at the musculotendinous junction and insertion on tendon on the lesser trochanter is common.

The snapping hip sign or extension test is suggestive of iliopsoas injury.

At the Centeno-Schultz Clinic in-office ultrasound is an important diagnostic tool.  The noninvasive test typically demonstrates thickening of the tendon which is illustrated below.

Treatment options include prolotherapy, IMS, platelet derived growth factors and percutaneous needle tenotomy.

Lateral Hip Pain: Beyond Trochanteric Bursitis

At the Centeno-Schultz Clinic we understand that hip pain can be debilitating.  Hip pain can arise from osteoarthritis, avascular necrosis of the femoral head(AVN),  labral tears and fractures.  Stem cell treatments are an alternative to traditional hip surgery.

Trochanterteric bursitis is an inflammation of the bursa on the outside aspect of the hip bone (greater trochanter).  The bursa, a fluid filled sac lies between the insertion of the gluteus medius and gluteus minimus  muscles into the  greater trochanter.

Other causes of lateral hip pain include inflammation(tendinitis) and degeneration(tendonosis) of the tendons.  MSK ultrasound is an office based evaulation at the Centeno-Schultz Clinic that allows for accurate diagnosis and treatment.  Trochanteric bursitis can be distinguied by diagnostic ultrasound so that appropriate therapy can be understaken.  Therapies include prolotherapy, PRP and Regenexx platelet derived therapies.

Below is a illustration of the 4 surfaces on the greater trochanter and the insertions of the gluteus medius and mimimus tendons.

Stem Cell Therapy for Hip and Knee Osteoarthritis: Presentation to Florida Academy of Pain Medicine

On August 20, 2011 Dr. Schultz presented a Stem Cell Therapy Lecture to the Florida Academy of Pain Medicine.

The lecture highlighted the clinical results of a recent study conducted at the Centeno-Schultz Clinic that examined the effectiveness of culture expanded stem cell treatments in patients with hip and knee osteoarthritis.

 148 knee patient and 54 hip patients participated in the study.  These patients sought  alternatives to knee and hip replacements.  Many of the patients were frightened by the complications associated with joint replacement surgery.

The study demonstrated that culture expanded stem cells injected into either the knee or hip-joint were associated with better improvement in pain and function when compared to untreated controls.

The different outcomes between hip and knee patients have been previously discussed on the Regenexx blog.

Culture

Hip Osteoarthritis: Successful Stem Cell Treatment

Osteoarthritis is the most common type of joint disease, affecting over 20 million individuals in the United States.  Osteoarthritis of the hip commonly results in pain, restriction in range of motion and diminished participation in activities.

CH is an active 51y/o patient with a longstanding history of  hip osteoarthritis who came to the Centeno-Schultz Clinic searching for an alternative to hip replacement.  He underwent stem cell treatments and notes agreater thanb 75% improvement.  He chose stem cell treatments as he wanted to avoid the complications associated with total hip replacement.

He underwent stem cell treatments in July 2010(Regenexx C) and Regenexx SD in  August and November 2010.

Hip outcomes have been previsouly discussed in Dr. Centeno’s blog.

CH has returned to backpacking and recently sent this e-mail:

“I am happy to report on my progress following Regenexx C/SD on my hip.  Prior to treatment, my last backpacking trip was January, 2009.  Since then, I went through the stages of semi-immobility with osteoarthritis.  Last weekend I went on my first  Post-Regenexx backpacking trip of 32 miles in two days in Great Smoky Mountain National Park.  This represents long daily mileage for advanced hikers in this terrain.  Although I was apprehensive about trying such a long distance on my first trip out, I did fine.  Just a few small blisters on my toes and sore muscles the day after I got back.  I had a great time!

Steroids and Cell Death: Apoptosis

 

Apoptosis is the process of programmed cell death.  The process is controlled by a variety of factors both within and outside of  cells.  High dose steroids have been demonstrated to create cell death in muscles, bones, cartilage and ligaments.  High dose steroids are commonly used to treat a variety of painful conditions which include rotator cuff tears, lateral epicondylitis, patellar and Achilles tendonitis, pes anersine bursitis,  lumbar facet dysfunction and sciatica.

At the Centeno-Schultz Clinic we acknowledge the negative effect of  high dose steroids.  Our aim is to identify the source of a patient’s pain and provide a therapy which will attempt to repair the damaged tissue.  Our treatments are not aimed at advancing the degenerative process or triggering apoptosis.  Accordingly we use only very small doses of steroids when necesary and have a large number of regenerative therapies which promote healing: prolotherapy, platelet rich plasma (PRP), Regenexx SCP, Regenexx AD and Regenexx SD.