Patrick Henry in 1775? No, Dr Mitchell Sheinkop in 2012. Last Monday, I evaluated a new patient, a 32 year old woman with steroid related avascular necrosis of her humeral head. On Wednesday, I did a bone marrow aspirated stem cell concentrate procedure in an attempt to prevent the dead femoral of a 31 year old male from collapsing and going on to secondary arthritis. In the second scenario, steroids again were the culprit. The young woman had required steroids as part of a chemotheraputic protocol for ovarian cancer.
The young man had been using steroids long term for asthma. Alcohol abuse, trauma( fracture in proximity to a joint or dislocation of a joint), and high dose steroids are the most common reasons for loss of blood supply to a femoral head, humeral head or lower end of the femur. Until the advent of Regenerative Medicine, with little exception, management of avascular necrosis basically consisted of measures to provide comfort until progression of the disease leads to a joint replacement. Enter the possibilities of stem cell adjunct to stimulate new blood supply, prevent progression , and stimulate healing.
As in all of Regenerative Medicine, the statistical evidence for successful outcomes using stem cells to influence creeping substitution is not available to provide guidance. On the other hand, there is animal based evidence that it works. We know that stem cells affect bone healing after fracture nonunion and improve success following spinal fusion by promoting the Ingrowth of new blood supply. I think it is worth clinical investigation. Actually, there are published reports regarding core decompression and bone grafting in humans. What about core decompression and stem cells?
My approach in attempting to influence the natural history of avascular necrosis with adult mesenchymal bone marrow derived autogenous stem cells is based on appropriate patient selection. The X-ray and MRI must confirm the joint has maintained its geographic kconfiguration and the cartilage joint space must be maintained. Whereas in arthritis, the bone marrow concentrate first and foremost relieves pain by controlling the chronic inflammation. In avascular necrosis, we are attempting to influence angiogenesis ( new blood supply) and influence bony healing. As concluded in an article published in the Journal of Bone and Joint Surgery,implantation of autologous bone marrow derived mononuclear cells appears a safe and effective treatment for early stages of osteonecrosis of the femoral head.
Mitchell B. Sheinkop, M.D.
847 . 390.7666
1565 N. LaSalle Street . Chicago . Illinois . 60622