Stem cells for avascular necrosis of femur : New horizons

Avascular necrosis of femoral head is a common disorder in Indian males. Chronic alcoholism and long term steroid intake are known risk factors but in 50% of cases we do not find any cause , these are termed “idiopathic: avascular necrosis of femur. Previously limited choices were available for treatment. These included taking drugs from the bisphosphonate family, getting a surgery called “core decompression” done or if the disease was fairly advanced to go for a total hip replacement.

This disorder typically affects males in the age group of 25 to 45 and hence replacing a joint so early was never an attractive option. Stem cells have emerged as a new interesting option for this disorder.

The first step is to find out whether the patient is a suitable candidate for this procedure. All patients with advanced arthritis are ruled out since they can benefit only form a hip replacement. The grading of avascualr necrosis is done by MRI,

Those who are suitable undergo a bone marrow aspiration under local anesthesia. About 10m of bone marrow is aspirated under local anesthesia from patient’s hip area (Iliac crests). This costs around 10000 INR>. The marrow cells are collected by a tissue laboratory and millions of cells are then grown in the laboratory. It takes around 6 weeks for the cells to grow. When the cells are ready to be implanted the patient is anaesthetized and an  8 mm drill hole is made in the necrosed area under X-ray control. The stem cells then are injected in the avascular area. Patient stays in the hospital for 48 hours and then can start walking with the help of crutches. Patients are not allowed to put any weight on the operated leg for 10 weeks. Sequential MRI scans are done to see the revascularization.

This is a relatively new procedure (available since 2 years). It is expensive ( around 1.75 lakhs to grow the cells). However the early results have been very encouraging. There are no ill effects because the cells belong to the patient and there is no foreign material inserted.