Knee avascular necrosis (AVN) is a difficult disorder, and the use of stem cells for the treatment of AVN now is now being more readily applied. The concept of using stem cells to treat avascular necrosis is not new. Less specific and concentrated approaches of using stem cells for AVN have been used for many years with the use of core decompression.
Knee AVN is associated with debility and pain. Long term outcomes for AVN with joint collapse is poor, and usually leads to knee joint replacement. Alternatives to knee joint replacement are desired, as other options such as living with the pain, and loss of function and mobility are not very appealing.
Knee AVN is caused by the disruption of blood flow (ischemia) to a region of bone resulting in necrosis or bone cell death. The amount of necrotic area can influence outcome, as well as if contact with the knee joint surface or collapse has occurred.
Knee joint collapse is associated with the development of rapid secondary degenerative arthritis.
Knee AVN treatment with concentrated stem cells from the patients own body, is actually a collection of many types of stem cells, progenitor cells, vascular cells and other cell types which may all collectively be beneficial. Improving blood flow can be initiated by signals from various cell types and is very complex.
Regeneration of bone cells can involve the differentiation of stem cells into new bone cells or the recruitment of progenitor cells (precursor cells).
Stabilization of secondary degenerative arthritis or halting the development, is important for knee joint stability and prevention of joint collapse.
The complexity of knee avascular necrosis due to the many possible risk factors and the variations in different individual patients, necessitates an individualized treatment plan for each patient. There is no automated formula for treating knee AVN. The most optimal plan includes assessing each patient individually.
Chronic knee pain is a frequent finding in those traumatically injured in sports or work. At as we age, the knee is the most common joint afflicted with arthritis. Knee osteoarthritis is the 6th leading cause of disability.
Trauma accelerates arthritis, and surgery is often performed for knee trauma. Knee surgery further accelerates knee joint arthritis. This leads to an ever increasing problem with time. Especially those that continue to have knee pain despite prior knee surgery.
This leads to further debility. Debility is the lack of functional level due to an injury or illness. A frequent secondary effect of debility is weight gain which may bring more medical problems further perpetuating the debility. Diabetes, heart disease, hypertension are all correlated with arthritis and obesity.
Disability is a more legal term rather than a medical description. It can take the meaning of lack of ability to continue working or maintain gainful employment as the result of debility. This can all result from an original knee injury, and become compounded by knee surgery, the development of arthritis, and weight gain related disease states.
The condition of disability can be met by the social security system in these types of situations. Unfortunate consequences to perhaps an unwanted and unwelcome knee injury.
Stem Cell Therapy for knees is gaining popularity. Athletes with sports injuries have been utilizing Knee Stem Cell Therapy. The role of stem cell treatments in sports medicine has both scientific and regenerative applications.
Trauma accelerates the degenerative arthritis cascade. This is a continuos domino like effect. The normal repair processes of joint cartilage are disrupted and an imbalance exists in which breakdown exceeds repair. This results in a net loss of knee joint cartilage.
Knee surgery is generally done in sports medicine for athletes who sustain sports injuries to their knees. Surgery is a form of trauma. Knee surgery done for knee trauma results in more cumulative progression towards eventual knee osteoarthritis or arthritis.
It is not unusual for athletes who have knee surgery to later have more knee problems or early arthritis. This has occurred during many elite professional athletes career, often shortening their longevity in sports. Professional football running backs do not play often into their mid 30’s. Quarterbacks can play till 40, if their shoulders and knees are good. However many famous Quarterbacks such as Joe Namath, had his career shortened due to knee arthritis and prior knee surgeries.
Now professional athletes are being treated with stem cells after their surgery. Some display rapid recovery. Whether they will still develop knee arthritis or will this arthritis be lessened as a result of their being treated with knee stem cells will remain to be seen. One possibility would be that these patients may have less knee arthritic effects, compared to if they did not receive the stem cells after surgery. However if they continue to play more years, perhaps the extended sports career will expose them to more knee trauma than they would have had if they retired.
An interesting academic question would be what would Joe Namath’s knee looked like towards the end of his career, if he had been treated with knee stem cells post surgery, and would it have lengthened his career? Of course these are just speculative interesting questions that no answer exists for.
What about professional athletes who have knee surgery fail to improve and are eventually released by their team?
Some have improved in this situation after treatment with stem cell treatments.
Dr. Dennis Lox has treated such professional athletes with persistent knee problems. These athletes failed to improve after knee surgery, and then they subsequently improved after knee stem cell treatments with Dr. Lox. Later the athletes we’re resigned to another professional sports franchise. Different situations do exist. Not all patients are alike and should not be treated as though they are all alike.
Optimal treatment requires optimal assessment and experience.
Knee osteonecrosis is another name for avascular necrosis (AVN)
There are several names for this medical condition:
Osteonecrosis and avascular necrosis (AVN) are the most common terms. Differences in regional preferences or authors may have a predilection for one term.
A loss of blood supply to a region of bone results in bone cell death. Bone refers to osteo, and necrosis refers to bone cell death. Avascular refers to the loss of blood supply.
Osteonecrosis of the knee may be present in any bone surrounding the knee. Most commonly the femur or tibia.
The extend of osteonecrosis can influence the course of the condition. Osteonecrosis of larger regions of bone in close proximity to the knee joint may collapse. If the necrotic bone collapses, a rapid secondary joint arthritis can follow often with recommendations for total knee joint replacement.
Alternatives to knee joint replacement are often sought. Younger patients and athletes are more impacted by the prospect of knee joint replacement, though all patients typically would like an alternative if reasonable to knee joint replacement. Younger patients have to deal with the lifespan of the knee implant, while athletes may not return to their chosen career after knee joint replacement.
Stem Cell Therapy has been included as an alternative to knee joint replacement for patients with knee osteonecrosis or avascular necrosis (AVN). This decision should be made with an experienced Regenerative Medicine physician who understands osteonecrosis and has treated this condition with Stem Cell Therapy.
Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. Dr. Lox has treated many patients with a variety of types of osteonecrosis or AVN, including the knee. Dr. Lox has also treated athletes with AVN successfully with Stem Cell Therapy, including soccer players, tennis players and even ballerinas with knee osteonecrosis.
Dr. Dennis Lox a Sports and Regenerative Medicine expert in the Washington, D.C. metro region consults on a variety of knee conditions to treat with Stem Cell Therapy.
The Washington DC area is home to many professional sports franchises and has an active athletic community. Knee avascular necrosis (AVN) is not as common in the leg as hip AVN, however like hip AVN, it is most frequently caused by trauma. Avascular necrosis (AVN) occurs when the blood supply to a region of bone becomes impaired leading to a region of bone cell death or necrosis. This area of AVN necrosis may ultimately collapse, resulting in a rapid knee joint secondary degenerative arthritis.
As is the case with knee osteoarthritis, it tends to progress with time, however knee AVN may have a much more rapid acceleration of the arthritis curve. This makes timely treatment essential. Traumatic induced AVN may not initially be considered serious, and therefore conservative measures such as rest are thought to bring about improvement. The lack of improvement may be the first signal of something really wrong such as AVN. Other causes or risk factors of knee AVN are spontaneous onset, steroid induced, excessive alcohol consumption, chemotherapy, radiation, coagulopathies and autoimmune disorders.
Stem cell treatments have been considered a possible viable option for some patients with AVN. Stem Cell Therapy may work on several pathways including immunomodulation, cell signaling, repair or regenerative responses.
Many patients desire alternatives to knee joint replacement. Younger patients and athletes diagnosed with AVN are especially concerned with knee joint replacement.
Athletes may have career ending injuries when diagnosed with AVN. Younger patients must weigh the lifespan of a knee joint implant with their young age.
For many patients with knee arthritis or knee AVN alternative strategies such as Stem Cell Therapy may be a viable option for some patients.
Patients with chronic knee pain, arthritis or AVN may consult Dr. Lox in the Washington, D.C. Metro area.
A patient from Dubai, with knee arthritis consulted Dr. Dennis Lox for knee stem cell injections. His knee arthritis had been present for several years with gradual worsening of symptoms. Pain, increased with prolonged walking was his main difficulties. He was told he needed a total knee replacement surgery, and desired to be treated with knee stem cell injections as an alternative strategy.
Dr. Lox treats many patients from around the world. Dr. Lox is an expert in Sports and Regenerative Medicine, specializing in the treatment stem cell injections.
Many patients visit his office in Florida to take advantage of a beach holiday, as well as a knee tuneup with stem cells.
Knee joint swelling may occur for a variety of reasons. Possible causes are injury to the knee joint, degenerative arthritis, infectious and inflammatory processes.
Knee injury resulting in knee swelling. may be a known traumatic injury, a prior injury or an underlying degenerative meniscal tear that was previous silent or symptomatic.
Degenerative or osteoarthritis may cause knee swelling often referred to as an effusion. Some patients may have so much swelling, the knee joint must be drained as it interferes with mobility and is quite painful.
Infections can present as knee swelling. The knee joint may be hot and swollen. Though heat and swelling is not limited to infections. Laboratory analysis, fever, or joint fluid analysis may determine this.
Arthritis processes are not limited to osteoarthritis. The autoimmune disorders rheumatoid arthritis, lupus, and psoriatic arthritis may present as knee swelling.
Joint crystals as in in gout or pseudo gout may also be present in knees resulting in swelling.
Knee Stem Cell Therapy for swelling related to injury, prior trauma, including surgery may be considered. Stem cell treatments for knee arthritis are more common, including as an alternative to knee joint replacement.
Knee problems are a common condition. Knee stem cell treatments are becoming more common. Obesity in the United States and other developed countries continues to escalate.
Most individuals who have knee pain are aware that being overweight is not good for their knees. Often despite this knowledge and even told they have knee arthritis, they still do not lose the weight.
Sometimes it is being told they need a knee replacement or worse two knee replacement surgeries, that is what finally gets their attention. In some cases their weight is so much that they fall into the obesity category and are told by the orthopedic surgeon that knee replacement cannot be done until they lose weight. This leaves these patients with knee pain and often debility.
A frequent complaint is that they hurt so much that they can’t exercise to lose the weight and their immobility may even result in more weight gain.
Dr. Dennis Lox a Sports and Regenerative Medicine expert is often consulted on these difficult cases. The proverbial catch 22 situation, sometimes has a solution.
At times stem cells can be placed into the knee of the overweight patient to reduce pain, improve mobility and function to jump start the weight loss effort. This is often more complicated than it seems. This is why an expert in Regenerative Medicine such as Dr. Lox is invaluable to the treatment as modifications to the treatment must be done to address factors which will hinder the effectiveness of knee stem cell treatment in overweight and obese patients.
Not all patients are alike, and not all overweight patients are alike. Individual factors which are important to treatment success is essential to achieve the best outcome.
Hypertension and coronary artery disease often are seen together. As our understanding of underlying causes of hypertension and coronary artery disease increase, key associated factors are integral to stem cell treatment.
Inflammation is a common denominator in joint arthritis, hypertension and coronary artery disease. Inflammation has been associated with obesity and the rise of inflammatory markers common in many diseases including diabetes and heart disease.
These inflammatory markers are also involved in Rheumatoid arthritis and degenerative osteoarthritis. Inflammation causes changes in blood vessels leading to plaque formation and atherosclerosis. This leads to less flexibility of blood vessels and high blood pressure ensues. These changes also lead to narrowing of the blood vessels to the heart resulting in coronary artery disease (CAD).
Stem cells may function in multiple ways, including regulating the inflammatory process. Studies are underway to use stem cells to treat heart attacks. However, this is after the fact. Prevention is still the obvious answer. Diet and obesity can all contribute to the progression of inflammation in blood vessels. These factors are important treatment as well as preventative measures.
Stem cells placed into patients who are obese or suffer from multiple systemic inflammatory disease processes, are always thrust into a harsher inflammatory environment than stem cells placed in your healthy patients.
This does not mean it is hopeless. In fact this is exactly why a highly skilled Regenerative Medicine physician is needed to deal with more complicated patients.
Treating knees with stem cells should not be a one size fits all patients practice.
Many factors control the fate and success of stem cells placed into a knee joint.
A key factor is the knowledge and experience of the physician treating your knee.
Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. Dr. Lox understands the complexity of different patients and the need for individualized care. This approach ensures the best possible outcome.
Dr. Lox lectures on the National and International level on various Stem Cell related issues.
Avascular Necrosis (AVN) may occur from a variety of sources. Trauma is the leading cause of avascular necrosis (AVN). Spontaneous or insidious onset AVN is another common factor.
When more than one joint is diagnosed as having spontaneous avascular necrosis, an exhaustive search for other potential causes should be undertaken. Some patients may be a candidate for Stem Cell Therapy of more than one joint. If a proper evaluation suggests they may be a good candidate for several joint stem cell treatments, a proper understanding of whether the AVN is truly insidious or not is important.
CAUSES OF AVN
Excessive corticosteroids (cortisone)
Caisson’s disease (decompression sickness)
Sickle cell disease
Spontaneous Avascular Necrosis
This term should be used when no other risk factor is present that may readily explain the condition. A times, remote corticosteroids during childhood for asthma, may be forgotten if the history is not very carefully structured.
Multiple trauma induced AVN, may also be diagnosed much later.
The effects of chemotherapy and radiation therapy may have many side effects as well, often confusing early diagnosis. With many possible risk associated factors, Spontaneous AVN should be used hesitantly in AVN occurring in multiple sites without exhausting other potential causes.
Treatment of AVN with Stem Cell Therapy
The treatment of avascular necrosis with Stem Cell Therapy should be with a Regenerative Medicine physician who has experience treating AVN. The complexities of treating AVN, as well as the issues of patient specific goals, needs, or sports participation is highly important for the patient, and in arriving at a treatment plan.
Factors which may progress Knee Osteoarthritis faster:
Prior knee surgery
Other diseases (Inflammatory related)
Coronary artery disease
Joint Mechanical problems (instability and ligamentous laxity)
Knock knees and bowlegs
Leg length differences
Abnormalities of adjacent joints hip, the other knee, or foot
These factors should be addressed if possible.
The effect of weight is significant. For each 10 pounds gained there is a 30-50 pound load increase on the knee. Women traditionally have smaller knee joints thus the available surface area to absorb these additional weigh related forces is reduced, there by accentuating the weight gain effects on the knee in women.
Inflammatory effects have not been shown to be altered long term with arthritis medications (NSAID’s) or cortisone injections.
Surgery and continued trauma accelerates the knee arthritis.
Inflammation may be modified by stem cells. The knee undergoes cartilage degeneration in osteoarthritis. This is a progressive disease state. Some progress at faster rates than others.
Stem cells may exert a positive anti-inflammatory effect on the knee cartilage resulting,in slower rates of degeneration, cessation of degeneration for a period of time (stopping Father Time) or may repair and regrow cartilage which reverses the degenerative effect of arthritis. Again this sets time back (like turning the clock back), however time will eventually begin ticking again but turning it back may add years of forestalling knee joint replacement, if stem cells are done early enough in the treatment of knee arthritis combined with modifying other risk factors like obesity and trauma, substantial changes may occur as a strategy to avoid knee replacement surgery.