The Osteoarthritis Epidemic
By Dr. Brian Shiple
Osteoarthritis is the number one joint disorder in adults and will affect the majority of the population in some way, shape, or form. According to the CDC 49.7% of adults 65 years or older reported being diagnosed by a physician with arthritis. Common treatment options for osteoarthritis include anti-inflammatory drugs, narcotics, high dose steroid injections, and surgery. These all come with their own host of side effects, risks, and complications including, but not limited to heart attacks, kidney failure, bleeding ulcers, dependency, addiction, worsening of arthritis or osteoporosis, tendon rupture, and increased pain.
The new field of Interventional Regenerative Orthopedic Medicine (IROM) uses patients’ own tissues to perform minimally invasive ultrasound or x-ray guided injections to help either repair or slow down the degenerative process involved in many forms of arthritis, which can postpone or completely eliminate the need for joint replacement surgery in the future.
Some patients with severe inflammation in their joints develop a condition called avascular necrosis (AVN). This occurs when the blood supply to an area of bone is interrupted and that bone begins to necrose or die. This can cause small fractures in the bone and lead to eventual structural collapse and failure of the joint. While AVN occurs in many joints in the body, we will highlight avascular necrosis of the hip, specifically.
This is a fairly common condition that affects a decent amount of our patients due to loss of the delicate blood supply to the femoral head in this ball and socket joint. Common causes for this vascular supply to be lost is excess or chronic steroid use, alcohol abuse, certain diseases that affect how the liver functions and trauma. Once lost, the bone in the femur head starts to die and this shows up on MRI as an increased image intensity making it quite obvious for diagnostic purposes. AVN can be extremely painful, especially once the blood supply is completely shut off. It is usually painful not only while trying to bear weight, but also while at rest.
The standard of care in orthopedic surgery for treatment of avascular necrosis is called core decompression. This involves drilling a large tunnel from the femur to the femoral head to decompress the congested, dying bone in the hopes that once the hole is drilled, the bone will fill back in with new blood vessels and bone, re-establishing a healthy blood supply, saving the bone from death, future collapse, and the need for joint replacement. If caught early, this treatment is only effective about 60-70% of the time.
A safer, less invasive, more effective treatment option that we have offered in our practice since 2010 includes injecting adult, concentrated bone marrow stem cells into the dying bone. Bone marrow stem cells have a very potent revascularization effect and can establish new blood flow in the dying bone, allowing it to recover. A French orthopedic surgeon, Dr. Phillip Hernigou, has performed over 4,000 bone marrow concentrate injections into the head of the femur with a much higher degree of success than core decompression. After long term follow up of these thousands of cases, Hernigou’s work has shown that he is able to help these patients avoid total joint replacement in 80-90% of cases.
While withdrawing bone marrow from the iliac crest to obtain stem cells and inject them back into your area of dying bone may sound painful, rest assured that extensive nerve blocks and local anesthetic are used to ensure patients are as comfortable as possible during both aspects of the treatment process. Over 90% of patients rate the pain of the treatment at a low level, say they would do it again, and would recommend it to friends and family. Additionally, we have added Pro-Nox nitrous oxide (laughing gas) to help our patients get through the treatment as comfortably as possible.
Fluoroscopic x-ray guidance is used to inject the stem cells into the precise area of avascular necrosis of the bone. This treatment has been used in bones of our patients’ hips, shoulders, knees, hands, and feet. It has also been used in our practice to treat delayed healing and non-union fractures with high success rates, without surgery. In addition, it is being used in areas of bone marrow edema seen on MRI as osteoarthritis advances. New research has discovered that osteoarthritis starts in the same area as the AVN does, in the bone underneath the thinning cartilage. Some researchers are advocating that our stem cell treatments need to be delivered in the subchondral bone as well as the intra-articular joint to help prevent advancement of osteoarthritis. Rest assured we have been offering this technique for advanced arthritis cases in our practice for over 5 years.
Credentials:
Dr. Brian Shiple is a highly accomplished sports medicine board certified physician. Dr. Shiple is one of the leading interventional regenerative medicine physicians on the east coast and uses platelet rich plasma and adult stem cells for the healing of musculoskeletal conditions. He has been practicing age management wellness and aesthetic medicine for over 8 years. He has been in practice for 23 years and is a highly sought after speaker, educator, and author.
