Avascular Necrosis of the Hip: Inevitable Hip Replacement or Prolotherapy?
In June of 2006 I saw a 47 year old black 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) occured 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, ie 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. It can also occur in Sickle Cell disease which is much more common in blacks, but this patient had no history of the diease or even the genetic trait.
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 Prolomax and Prolo Support Pack 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 ave gotten discouraged by only a 10% improvement after his first two treatments. But I always explain that the work of tissue engineering that is peformed 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.
Robert Filice, MD
708-307-8717
