Thursday, July 7, 2016

Stem Cells for Treatment of Hip Osteonecrosis in Sickle Cell Patients

Stem cell treatment for a variety of conditions is becoming more and more mainstream.  More and more research is being done to evaluate the efficacy of stem cell treatments in a variety of diseases.  I became interested in this particular subject, as I recently had a patient with osteonecrosis of the femoral neck.  Hip necrosis can be found in a variety of patient types.  It is common in children, young athletes, and patients who suffer from sickle cell disease.  It can also be seen in patients who have used short term or long term steroids.  The typical treatment for this condition is a hip replacement.  This is generally not a good option for young people, as it will require more hip replacements down the line.

I found a physician in my area that is treating these young people with bone marrow stem cells.  I was fascinated with his new approach to this disease, as it seems to absolve the need for a hip replacement.  This treatment has not been around for very long, so long term outcomes are still pending.  However, short term outcomes are very promising.

Anyhow, I decided to get online and see if any longer term studies have been done on this subject. The only study that I could find evaluated the use of bone marrow stem cells in patients with sickle cell disease.  The study I found was a prospective, uncontrolled study.  This made it simple to put into a STAR™ block.



As you can see above, there was only a 17.4% improvement in the Harris Hip Score after the procedure.  However, after taking into consideration the risk of infection from the procedure, the overall treatment grade decreased slightly.  Once I added back some points for no longer needing surgery, decrease cost to the patient, and less time lost from work, the overall treatment grade remained the same, despite the number itself increasing.  

The Treatment Score may decrease further as we continue to implement guidelines for Treatment Scores. We are learning to compare the certainty of statistics from different types of studies. A randomized, blinded, placebo-controlled study might have a different outcome, and possibly a much lower improvement on the Harris Hip Score. The point we want to make with our early examples is that treatments can be quantified to create treatment transparency. (See the disclaimers above and below.)




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