Dr. Wiznia explains what avascular necrosis is and how stem cells can treat this condition.
Stem cells are really important because they give us the ability to regenerate. We have cells in our bone marrow that are stem cells that then can become new blood vessels, new muscle, new bone.
Orthopedics is very interested in the field of stem cells because of the regenerative potential. If we’re able to regenerate with your own body, replacing injured bone with fresh bone, then you may not require a more invasive procedure like a joint replacement. Avascular necrosis is when the blood supply has been injured to the hip joint.
If you ever see a China plate, over time the glaze forms cracks in it. Then over time, that plate breaks.
Well, bone is the same way. Our blood provides nourishment to the bone so that the cells in the bone can repair those cracks every day. But with avascular necrosis, the bone doesn’t have that blood supply, so it can’t regenerate and fix the fractures.
The bone in the hip doesn’t have enough nourishment and it actually starts to die. It can be very painful. The worst case scenario is the hip joint collapses and then you need to have a joint replacement.
At Yale, I’ve developed a procedure that’s unique for each patient and it’s a custom surgery. Stem cells can enter that space where the crack or fracture is, remove some of the damaged material and then replace the cracked region and then replace the cracked region with fresh bone and this prevents further fracture.
It’s one procedure with about three or four very small, one centimeter incisions. I have found that patients typically return back to their activities by one to two weeks. So the first thing that I do is I harvest some bone marrow from the pelvis and isolate the stem cells.
The second thing that I do is I take a scan of the hip joints and I create a 3D model of the hip joint. I can then in the 3D model, isolate the specific regions in the hip joint where the avascular necrosis has occurred.
Then I target those specific lesions in 3D and remove some of the dead bone in those lesions and then inject the stem cells and bone graft into those regions. I was able to develop this technique at Yale because of the 3D modeling surgical collaborative that we have in Yale Medicine. This treatment is a game changer because we are targeting specifically where your avascular necrosis lesion is and prevent the need to have a hip replacement.
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