Avascular Necrosis Procedure Outcomes Archives

Avascular Necrosis Procedure Outcomes

Managing an Arthritic Hip with Stem Cells over the Long Haul

Wednesday, May 23rd, 2012

Can we manage severe hip arthritis with stem cell injections?

CM is a 52 year old woman who presented to our clinic in 2008 with fairly severe hip arthritis (most of the hip cartilage gone, but not “bone on bone”). She was very active and noted a significant decrease in hip range of motion and new onset hip pain after trying to get back in shape with yoga. She was seen by our clinic in 2008. While she had clear hip arthritis, like many of our hip arthritis patients, she also had irritated nerves in her back that went undiagnosed, so these were treated as well. In 2008 she received a Regenexx-C procedure where we injected her own cultured stem cells. She came back last year for an update treatment where we again treated her low back and injected same day stem cells into her hip. This year she’s back for another update injection of same day cells as she’s very active and wants to continue to work out at a high level. So where is she at at this point? She reports about 70% overall improvement and is much more active. However, an important point is that she has not regained her lost hip range of motion (ROM). As I have blogged before, this lost hip ROM likely comes from the early and destructive phase of hip arthritis and even patients treated with stem cells rarely recover this function. So how did she do structurally over the past 4 years? I’ve placed her films above. Note that while the 2008 MRI is a slightly different front-back angle, the arthrograms (radiographic contrast in the joint) are remarkable for what they don’t show over the past 4 years. They don’t show any significant advancement in joint space collapse. Since they’re not 100% perfect matched images for angle of the x-ray beam, it’s tough to call any increase in joint space using these films. The upshot? This woman has regained much lost physical activity and has maintained significant reductions in pain over the past 4 years. Her hip arthritis (which usually progresses rapidly) is stable, but her hip range of motion hasn’t returned. It’s likely that she will continue to get update treatments once every year or two.

NOTE: Regenexx-C is a medical procedure and like all medical procedures has a success and a failure rate. Not all Regenexx-C patients will have the same result. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.

Note: Any case reports or patient results presented on this web-site are not indicative of all patient results. Like any medical procedure, all Regenexx procedures have a success and failure rate.

Tags: hip stem cell injection
Posted in Avascular Necrosis Procedure Outcomes, Hip, Hip Procedure Outcomes, Latest News, Recent Results, Regenexx-C, Regenexx-SD | Comments Off

Stem Cells for Hip Osteonecrosis-Mexican Style: Ole?

Thursday, March 8th, 2012

Why are we so finicky about candidacy grading? As you may know, we insist on giving every patient an honest assessment of their candidacy grading-Good, Fair, or Poor. Being a good candidate doesn’t guarantee the procedure will work just like being a poor candidate doesn’t guarantee it will fail. However, given all the patients we’ve treated through the years, the patient has a rough assessment of where they stand. They also know the possible headwinds they may experience. Recently my partner John Schultz performed an evaluation on a patient with ARCO grade 3-4 hip AVN with collapse of the bone. She was a poor candidate for hip stem cell treatment of any type because she had a “square peg in a round hole”. This is based not only on our clinical experience going back 6 years and treating more than a hundred severe hip patients, but also based on the published works by Gangji and Hernigou. Dr. Schultz told her she was a poor candidate for our treatment. Believing stem cells were magic (they are not), she called a Mexican outfit with little experience treating hip AVN and was told that their stem cells would likely work. She went to Mexico and had a very painful bone marrow aspiration from her tibia (not a great place to take a marrow aspirate because the bone is very thick and it’s painful). The cells were spun down in the same way that she could have gotten at many clinics in the United States using a bedside centrifuge. They then re-injected the cells into the hip joint without any guidance (blind), so we have no idea where they went. In addition, for AVN, since the main issue is in the bone, injecting cells into the hip joint after the bone has collapsed will do little good – like trying to fix the roof on a house where the structure of the roof has collapsed. However, this was done this way because the technical expertise needed to place cells into the bone is very high. She had intense pain, so the next day they carried her back from her resort hotel to the clinic for a second injection. After paying $8,500, she’s now signed up for a hip replacement after Dr. Schultz again refused to treat her with stem cells because it wouldn’t help her hip. The upshot? Buyer beware. There’s a good reason we’re brutally honest with patients about their prospects, as we’ve usually treated many patients just like them and know what works and what doesn’t. Again, while this doesn’t mean all good candidates get amazing results or all poor candidates get no results, it does mean that we try hard to not take money from patients we have little hope of helping. When we do agree to treat poor candidates, we continually emphasize that we are not optimistic about their prospects. In addition, the basis for the treatment needs to make sense, even if it ultimately fails. For example, not placing cells in the bone to treat a bone disease is a bad idea.

NOTE: All Regenexx procedures are medical procedures and like all medical procedures they have a success and failure rate.

Tags: hip avn stem cells
Posted in Avascular Necrosis Procedure Outcomes, AVN/Osteonecrosis, Hip, Hip Procedure Outcomes, Latest News, Recent Results | Comments Off

Our Patients Speak about their Stem Cell Experience

Wednesday, February 8th, 2012

On a recent discussion board, someone posted a question about whether the Regenexx stem cell procedure was for real. Well our patients seem to have jumped on to answer the question. What we do isn’t magic. Some patients respond and some don’t respond. However, we’re thrilled as physicians to see this group of patients tell their experiences. Comments like this make all the long hours and hard work worthwhile! These are their own experiences and opinions and are not necessarily typical of all patients’s experiences and opinions, but here are a few of their comments:

Jason Brown: I had a great experience with the staff at the Centeno Schultz Clinic. I was suffering from severe tendinitis in my elbow and Dr. Schultz and team were able to address this and I am completely pain free.

George Knish: In 2007 I suffered a severe tear to my medial meniscus. I hadn’t heard of the Regenexx procedure. I went to a sports medicine doctor. The doctor saw the tear was severe, and removed a large portion of my meniscus, telling me I should never run again. I went through PT and got back to where most of the pain was gone as long as I didn’t run on it. Over the next 2-3 years, I started to experience more and more pain all over my knee. That’s when I heard about Regenexx. I went to the Centeno-Schultz clinic in early 2010. Dr. Centeno looked at my MRI and saw 3 issues. 1. Most of my meniscus was missing. 2. Severe laxity in my ACL which was causing my tendons to work much harder, get inflamed, causing a lot of the additional discomfort. 3. I had cartilage worn off under my knee cap which caused pain that I was experiencing at the top of every revolution while I was biking. Dr. Centeno stated at the time that they could only repair tears to the meniscus with the stem cells, and that he couldn’t grow new tissue to replace what had been surgically removed. He stated that he strongly believed they could help me with the ACL laxity and repair the cartilage under my knee cap. I went through two different “same day” stem cell procedures (not restricted by the FDA) in their clinic in Broomfield, CO. I was absolutely blown away how quickly I experienced pain relief after these procedures. My ACL tightened up in what seemed like 1 month absolute max. The pain under my kneecap disappeared immediately after the procedure. I still couldn’t run from meniscus tear/surgery, but at least I was back biking again. Then, just this last Christmas eve, I tore what was left of my medial meniscus. This time I saw the third doctor, Ron Hanson, at the Centeno-Schultz clinic. I got the sense he’s considered their knee expert. He stated that the tear could be fixed with the stem cell procedure. Then he brought up that there had been a study in mammals (dogs and/or pigs I recall) that had shown measurable meniscus growth when fat was injected in the knee. He said they didn’t have before and after MRI data on people, but they had seen very good symptomatic success since they’ve started doing it. Two weeks ago I had the stem cell procedure and fat graft done. Again, after only two weeks, I’m completely stunned. I forgot what it felt like not to have pain in my knee. I’m not quite to the point yet in the recovery to go running, but I see light at the end of the tunnel. This is a total life changer. I didn’t expect to get this level of relief, let alone only 2 weeks after the procedure. I can’t say enough good things about these guys. I’m thrilled for my own recovery, and thrilled for my kids who are very active in sports….just knowing that there is this great alternative out there for them to fix injuries that they will inevitably encounter is very comforting.

Delbert Clark: I think it’s been about a year now since I had the procedure done on my left knee.
It’s amazing!. I have minimal pain, can do my work without pain. I can’t say I’m 100% better, but I am at least 75% better. I would do the procedure again if I needed to. It is very disappointing that insurance doesn’t pay for it. But you know what? I still have my knee, not some high dollar hunk of iron that has no guarantee that they’ll work either. The FDA needs to pull their heads out of their Butt and leave The Centeno / Schultz crew alone!!! They are on to something that works. I think that the doctors and insurance company’s don’t want them doing what their doing, because it will cut them out of their money for knee or joint replacement’s. I’m glad I did it and would do it again! Keep up the good work Centeno!!!

Deb Smith: I have had 2 “same day” and fat graft injections in both knees. One in April 2011, the other July 2011. I am thrilled with the results! I have had a 90% improvement in pain relief & function. I had been looking at getting a knee replacement for my rt. knee due to an old injury (torn ACL, MCL, med & lat. meniscus) that had caused a lot of degeneration in the joint. I heard about the Centeno-Schultz Clinic through my old family Dr. who recommended I try it. I was skeptical at first but I trusted his recommendation. I am so glad that I did. Dr. Hanson had rated my rt. knee as a fair to good candidate so I wasn’t expecting as good of results that I ended up with, what a surprise! My lt. knee had a meniscus tear and also degeneration behind the patella. The patellar pain has improved 90% as well, but I reinjured the meniscus tear after the 1st round of injections. I ended up having a 3rd injection for the meniscus tear about 4 weeks ago now. I now have no pain and am expecting it to heal this time. I am so glad that I went ahead with these injections, they have saved me from a major surgery. Thank you Dr. Hanson!!

John Steinhauer-My personal experience has been remarkable. My MRI confirmed a torn MCL and tears to my medial meniscus. Its been just over a year since my PRP & Stem Cell treatments and I am 100%, in fact after only 60 days I was back on the road bike and now I’m involved in Crossfit training and 100% pain free and completely satisfied with the treatment from Dr. Centeno and his team.

NOTE: All Regenexx procedures are medical procedures and like all medical procedures have a success and failure rate. Not all Regenexx patients experience the same results.

Tags: regenexx stem cell
Posted in Avascular Necrosis Procedure Outcomes, Knee Procedure Outcomes, Latest News, Recent Results | Comments Off

Treating Hip AVN/Osteonecrosis with Stem Cells

Thursday, January 5th, 2012

Hip AVN stem cell treatment has been science fiction for many patients but we here at the Centeno-Schultz clinic have been pioneering this advanced procedure for years. RA is a patient that has benefited from an injection of his own stem cells which helped him to dodge the hip replacement bullet. He is now 58 years old seen and was first seen by us in April of 2009. In 2003 he had a fall on his hip while playing volleyball and was eventually diagnosed with avascular necrosis of the hip. By the time he was seen in our clinic he was an ARCO grade III with a large area of osteonecrosis in the head of the femur and flattening of the femoral head. He was only a fair candidate for being able to avoid a hip replacement with a stem cell injection due to this advanced grade of osteonecrosis (grade III means that the femoral head had begun to collapse). The patient had tried various treatments before being evaluated by our clinic and these had included chiropractic adjustments, acupuncture, and arthritis medication. Being an otherwise active man in his late fifties, he wasn’t thrilled about the prospect of undergoing a hip replacement. As a result we agreed to place his own cultured stem cells (Regenexx-C procedure) into the femoral bone lesion under x-ray guidance. Note that rather than an injection of the cells in his joint (an easier injection) that our advanced AVN procedure involved placing a needle into the bone lesion to deliver the stem cells. Now 2 1/2 years out from his procedure, he reports that he’s 70% improved and has yet to pull the trigger on a hip replacement. Even just delaying hip replacement by just a few years in these AVN patients (possibly longer term) may mean the difference between needing just one hip replacement versus needing to replace the worn-out prosthesis at a later and much more invasive second surgery. In addition, research has already shown that less advanced stem cell injection procedures can delay the need for a hip replacement as much as ten years. While we generally have more success with ARCO grade I and II osteonecrosis patients, we’re happy to hear this success story from a more severe grade III patient!

NOTE: Regenexx-C is a medical procedure and like all medical procedures it has a success and failure rate. Not all Regenexx-C patients can expect the same results. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.

Tags: hip avn stem cells
Posted in Avascular Necrosis Procedure Outcomes, AVN/Osteonecrosis, Hip, Hip Procedure Outcomes, Latest News, Recent Results, Regenexx-C, Uncategorized | Comments Off

A Two Year plus Report of Knee Stem Cells in an Avid Skier

Tuesday, January 3rd, 2012

PD is a 57 year old woman first seen by our clinic in February of 2009 for a one year history of knee pain on both sides. She had a right knee arthroscopic surgery in the 1980′s and her recent MRI showed almost complete loss of cartilage under the knee cap. The outside meniscus of that right knee was degenerated with the left knee MRI having similar, but less severe problems. In essence, the right knee was a mess. In 2009 she had her own cultured stem cells (Regenexx-C) placed via injection into both of her knees on multiple occasions. She did well, returning to skiing. However, I always get asked by patients how long does the effect of placing stem cells in a knee last? Here is her 2 year plus report on how her knees have held up:

“Both of my knees have behaved exceptionally well since the last injections I received at your clinic…I had come to you because everyday was a painful experience. I had swelling and when I snow skied (on ‘black diamond’ Western slopes for several hours) I usually took 6 Advil prior and post the ski, also I iced the knees down afterwards. Wore compression and stabilizing braces, usually they still swelled! Was never sure when my knee/s might simply buckle…After the injections and following protocol the prescribed of easing back into the activities I desired, I have had: no pain, no swelling, no range of movement limitations. Functionally, I noticed I no longer avoid stairs, I no longer consider stair railings a ‘must’ hold on to, I no longer take pain killers and my knees do not feel ‘tight’. Personal practical items which improved: comfortable to stand up from a chair (toilet) without use of arms/hands support, walk and run without pain or swelling, consider knees ‘trustworthy’ to walk carrying grandchildren, breakables, etc., I no longer have the noise of ‘clicking’ knees as I ascend stairs.”

We’re happy to see PD’s ongoing success due to her own stem cells injected in her knees. Certainly, before we began that process in 2009, her right knee was a candidate for knee replacement surgery and instead, all she had was a series of injections with minimal downtime. We wish PD many more happy miles spent skiing the slopes!

NOTE: Regenexx-C is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-C patients experience the same results. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.

Posted in Avascular Necrosis Procedure Outcomes, Knee, Knee Procedure Outcomes, Latest News, Recent Results, Regenexx-C | Comments Off

Hip Pain after a Hip Replacement: Helping a Patient with Blood Platelets and Stem Cells

Thursday, November 17th, 2011

Hip replacement pain after one year? ML is a 69 year old woman who we first evaluated in June and who now claims we have performed a “miracle”. I don’t know if I would use the same terms other than we were able to get to an accurate diagnosis of what was wrong. Prior to having a hip replacement, the patient had a long history of low back problems and had a failed back surgery. Her physical therapist thought her hip pain was coming from her SI joint, while her orthopedist thought it was her hip. The surgeon won and she eventually had a metal on metal hip replacement, which seemed to help her hip pain for a few months, but then it returned with a vengeance. So she had hip replacement pain after one year of trying to recover. Based on her lack of recovery, she was then told by another surgeon that she may need a low back fusion. At that point she ditched the whole concept of more surgery and began looking for answers. On her initial exam it seemed clear that either her hip pain was from the metal on metal wear particles caused by her prosthesis or was being caused by her low back and SI joint. We investigated all of this by first numbing up what was left of her hip joint under x-ray guidance. When this numbing block didn’t help we then tried her SI joint and SI joint ligaments, which helped her hip pain. We now had a diagnosis, her hip pain was coming not from her hip, but the SI joint. The SI joint is the area between the tailbone and the back of the hip. How can the SI joint cause hip pain? This is discussed in our practice’s book (Orthopedics 2.0) but briefly, most patients with SI joint pain have pain that they describe as the back of the hip and sometimes the groin. However most patients with hip joint pain describe it as in the groin area. Many times there’s no accurate way to tell which joint is causing the hip pain (the SI or hip joint) outside of taking a good history (she had a fall off a horse at a young age and landed on her SI joint and sacrum) and performing a numbing block of the hip and the SI joint to see which injection helps more. Because either joint could be causing hip pain, just looking at an x-ray of the hip and concluding that since it looks like it has arthritis it’s causing pain is a bad idea. So how did we help this patient? We injected her own blood platelets and stem cells into the SI joint and associated ligaments three times under x-ray guidance (Regenexx-SCP). Today she reports long-term pain relief for the first time in years. She’s reduced her pain medications significantly and is finely getting more active. She states that it’s a miracle. It is not; it’s really just taking the time to tease through a correct diagnosis of the cause of her hip pain. The upshot? Even though you feel hip pain doesn’t mean it’s really coming from the hip joint! It could be your SI joint or even a pinched nerve in your back. Insist that a doctor numbs your hip under x-ray or ultrasound guidance to prove that your hip is causing most of the pain before they surgically remove the hip joint. If all of your pain doesn’t go away, then your pain isn’t coming from the hip joint!

NOTE: Regenexx-SCP is a medical procedure and like all medical procedures has a success and failure rate. Not all Regnexx-SCP patients experience the same results.

Tags: hip replacement alternatives, hip replacement surgery alternative
Posted in Avascular Necrosis Procedure Outcomes, Hip, Hip Procedure Outcomes, Latest News, Recent Results, Regenexx-SCP | Comments Off

Severe Hip Arthritis treated with Stem cells: Two Year Update

Saturday, August 20th, 2011

We pride ourselves in discussing all aspects of the results of our hip stem cell therapy, so rather than an astounding success today I’d like to discuss a patient that had a time limited result. CS is a middle aged woman who has post-polio syndrome with severe hip arthritis. In fact, there wasn’t much left of the hip when she was first seen in clinic several years ago. She ultimately underwent several Regenexx-C stem cell procedures to treat her hip arthritis and she did well, reporting about 80% relief of her pain for about 2 years. She recently contacted us that because the pain was beginning to return. It’s likely she’ll need another treatment. So let’s explore what may have happened in this patient with a very weak lower body due to her illness and very severe hip arthritis. Did the stem cells magically grow her a new hip? No. We have seen MRI evidence in select patients with severe hip arthritis that using the Regenexx-C stem cell procedure did seem to establish a joint space where none existed before, but this was far from growing the patient a brand new hip. Why did the effects of the Regenexx-C stem cell procedure only last about two years? We’ve seen duration of effects lasting up to 4-5 years, but have no data beyond that at this point. There may be several reasons why this patient may have been a shorter term responder. One is that the hip arthritis is very severe. For the most part continued analysis of Regenexx-C patient outcomes show that knee and hip arthritis patients respond independent of severity-meaning patients with more severe arthritis seem to do as well as those less severe arthritis. However, this amount of severe arthritis due to the polio was more than we would usually encounter. Another reason for the shorter term response may be that the hip was severely unstable due to the weakness in the hip girdle muscles, so this is a hip with substantially more ongoing wear and tear than other hips. The upshot? Again, we pride ourselves in being frank with patients about what stem cells as a tool can or can’t deliver. In this case, while it’s great that we were able to give this patient two years of dramatic relief when she had few other hip surgery alternatives, it looks like she’ll need re-treatment of the hip.

NOTE: Regenexx-C is a medical procedure and like all medical procedures has a success and failure rate. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.

Tags: hip stem cell therapy, hip stem cells
Posted in Avascular Necrosis Procedure Outcomes, Hip, Hip Procedure Outcomes, Latest News, Recent Results, Regenexx-C | Comments Off