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Stem Cell Therapy in AVN

In India, approximately 70,000-90,000 patients get affected by Avascular Necrosis (AVN) every year4. However, what’s worse is that this number is increasing sharply. One important question is why.

The second wave of COVID-19 wreaked havoc in India and claimed countless lives. While the healthcare system was on the brink of collapse in the country, corticosteroids proved life-saving. But little did we know that the worst was yet to come.

Although life-saving, steroids are one of the major causes of AVN. Avascular Necrosis (AVN) or Osteonecrosis is the death of bone tissue caused by temporary or permanent loss of blood supply to the bone. About 40% of AVN cases are caused by long-term or high dosages of steroids.

Fig.1. Healthy Hip Joint vs Avascular Necrosis (AVN) of Hip joint

The exact mechanism of steroid-induced AVN is not known, but it is believed to cause blockage of blood vessels by fat globules (fat embolism), increased tendency to develop blood clots (hypercoagulable condition), and other blood vessel abnormalities.

Apart from steroids, various other factors such as trauma, excessive alcohol consumption, smoking, pregnancy, radiation, systemic lupus erythematosus, Sickle cell anemia can cause AVN.

Current Treatment Options for AVN:
A.Pharmacological Treatment
Treatment Mechanism of Action Advantages Disadvantage
Bisphosphonates Inhibit the resorption of bone by osteoclasts Used along with anticancer treatments to prevent skeletal complications and relieve bone pain.
  • Bisphosphonate-associated AVN of the jaw is widely reported complication.
  • Renal dysfunction can also occur.
Vasodilators Dilate or prevent constriction of the blood vessels Decrease intraosseous pressure, allowing increased blood flow
  • Rapid Heartbeat (Tachycardia)
  • Heart Palpitations
  • Fluid retention (Edema)

B.Surgical Treatment
Treatment Mechanism of Action Advantages Disadvantage
Core Decompression Surgical drilling into the area of dead bone near the joint Prevents complications of collapse of the femoral head. Delays the need for total hip replacement. 
  • Temporary pain relief
  • No new bone formation
  • Leads to joint collapse
Osteotomy Cutting the bone and then reshaping it It may delay the need for a joint replacement for several years.
  • Highly morbid surgery
  • < 1 % doctors practice osteotomy
  • Limb shortening affects gait and normal daily activities
Total Hip Replacement Surgical removal of damaged hip joint and replace with artifical joint (prosthesis) Reduction in pain
  • High chance of infection
  • Need for revision or additional hip surgery
  • Blood clots in the legs or lungs
  • Dislocation

Stem Cell treatment for AVN

Although the above procedures sometimes provide satisfactory results, they are not always ideal. There’s a need for another alternative treatment to tackle the challenges.

Thus, experts are exploring the use of stem cells in AVN treatment. Stem cells are a group of cells that can develop into many different types of cells in the body. Adult stem cells, which include mesenchymal stem cells (MSCs), have been widely used for the regeneration of various tissues.

Several types of MSCs such as bone marrow-derived MSCs (BMMSCs), adipose-derived MSCs (ADMSCs), allogeneic human umbilical cord-derived MSCs (hUCMSCs), and peripheral blood MSCs (PBMSCs) are used in the treatment of AVN. However, Bone Marrow-derived MSCs (BMMSCs) are more commonly used.

Stem cell therapy is a minimally invasive procedure, and it involves the following steps:

The advantages of stem cell therapy include:

Fig.3. Pre-operative and Post-operative MRI1
  • No surgical complications
  • Naturally regenerative approach
  • No side-effects
  • Quick and safe
  • Rapid recovery post-treatment

Thus, stem therapy has significant potential in the treatment of AVN. Depending on the stage of the disease, stem cell therapy can also be combined with a surgical procedure such as bone decompression to achieve better results.

Fig.3. Pre-operative and Post-operative MRI1
(A) Patient with an Avascular Necrosis lesion at the femoral head (star).
(B) 2 years after core decompression and bone marrow stem cell injection.

Studies have proved that core decompression when combined with bone marrow stem cells, can significantly reduce pain, improve joint function, and halt the progression of AVN.

AVN mostly affects young adults. Hence, stem cell therapy can help them retain their original bone by avoiding the need for total hip replacement surgery and help them return to normal activities.

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