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Avascular
Necrosis of the Hip:
Inevitable Hip
Replacement or Prolotherapy?
Robert Filice, M.D.
In June of 2006 I saw a 47 year old man who
had been diagnosed with avascular necrosis (AVN) of both hips in 2003.
His initial symptom was pain in the right hip. The destruction of the
bone at the end of both of his hip bones (femur) occurred because of
blockage or interference with the blood supply to the area.
Interestingly, this patient did not seem to have any of the predisposing
factors working against him. The most common of these is the use of high
dose steroid (prednisone) therapy for some other disease or condition.
In other words, the most common known cause of AVN is iatrogenic, i.e.,
caused by modern medicine's treatments!
This condition, therefore, is frequently seen in rheumatology clinics,
patients being treated for serious autoimmune disorders, and in organ
transplant recipients taking steroids for suppression of the immune
system's rejection response.
By standard critera based on symptoms and MRI findings, my patient had a
class III AVN. This is considered serious enough for surgery. People do
not die from AVN, but the rate of serious or complete disability is
extremely high.
To be quite honest, since I understood that the cause of AVN is the lack
of blood supply to the area, I had serious doubts as to whether
Prolotherapy could help this man. Prolotherapy's primary mode of action
is to bring blood, cells, and growth factors to the damaged areas,
thereby allowing the body to repair and heal. Without an adequate blood
supply to work with, Prolotherapy may not work. But I asked
Dr. Hauser for a second opinion, and based
on his experience he told us had seen some cases of AVN respond to
Prolotherapy, and that he would of course also inject growth hormone
directly into the hip joint. So that first day in our office, the
patient went from discouragement back to cautious hope, but in either
case he was determined to give Prolotherapy a chance, and so was I. He
definitely did not want a hip replacement, and that was all his
orthopedist had offered him. Being as young as he was, and given the
fact that the disease is progressive and many patients with AVN require
multiple surgical procedures, he needed and wanted an alternative that
would work for him.
He was treated that first day he came to see me. He received injections
into the supportive structures around the right hip joint (his left hip,
although affected by the disease, was not yet causing him any pain so we
decided to wait on treating that one), and I also injected
human growth
hormone (HGH) into the joint cavity. The rationale for the growth
hormone is that it can directly stimulate the growth and division of
cells with which it comes into contact. The plan here was that it would
stimulate osteoblasts (bone forming cells) and that there would be
enough blood and nutrients around to help the new cells take hold. This
is called "tissue engineering" in traditional medical circles, but to my
knowledge there are no orthopedists employing HGH for AVN or any of the
other conditions they usually treat surgically. I also recommended he
take supplements for nutritional support for the body's healing efforts.
At his second visit in August he told us he was better able to
sleep on
the right side, but rated his improvement overall at about 10%. Because
he did not have much of a noticeable inflammatory response to the first
treatment, I made his
Prolotherapy solution stronger for the second
treatment, but once again also injected HGH into the joint. When he
returned in October for treatment number 3, he was still about the
same...only 10% better. Once again he received Prolotherapy and HGH.
He did not return again until last month, January of 2007. At that time
he told us his "progress was amazing". His hip felt stronger and more
stable, his pain was almost gone, and he was able to tolerate cycling
and strength training. He rated his improvement overall to be at 90%!! I
gave him treatment number four.
There are several important lessons in this case. The first and most
important one is "Always give Prolotherapy the benefit of the doubt!"
There have been some other cases in which I was completely surprised at
the speed and completeness of the patient's response to Prolotherapy,
but this case really drove the lesson home to me. Because it is so safe,
I say don't make false promises, but give Prolotherapy a chance! The
other thing was that under the circumstances the patient might easily
have gotten discouraged by only a 10% improvement after his first two
treatments. But I always explain that the work of tissue engineering
that is performed by the HGH takes time, so patience is required. With
the more usual type of joint case, we often see steady improvement with
each visit. This patient plateaued at 10% for two treatments because I
believe the HGH therapy was doing some important base building. Then
when he had a foundation ready, that third treatment brought him the
results he was hoping for. If you have a painful musculoskeletal
condition, I urge you to heed the instructive lesson taught by this
case. Give Prolotherapy a chance. |
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