Category: Clinical Sciences/Health Conditions
Case Diagnosis: Mrs.Y, 58 years,housewife came on 14 January,2019 with the complaints of left hip pain for 6months. On hip joint examination, her VAS score was 7, tenderness gr-II, leg length discrepancy 0cm and restricted ROM in all direction. Her muscle power of hip girdle was 5/5 except hip abductor 4/5 and flexor 4/5, Hip Disability and Osteoarthritis Outcome Score (HOOS) was 43.8. In MRI shows, subcoritcal zone has trabecular loss leading to microfracture with good contour and in STIR image shows diffuse bone marrow edema in head extending into neck of femur and she was leveled Ficat stage III avascular necrosis (AVN) of left hip.
Case Description: She was planned to inject Bone Marrow Aspirate Concentrate (BMAC-MSCs) into head of femur followed by rehabilitation. With all aseptic precautions, Ultrasound (US) guided aspiration of 100cc BMAC from right posterior-superior iliac spine (PSIS).Then 6cc BMAC–MSCs was processed and application into head of femur was done by using US & C-arm machine in fracture table.After successful taking of BMAC-MSCs, patient had become less pain at 2 week VAS-4, after 4 weeks VAS-2 and after 8 weeks VAS-1. At 4th week all ROM was improved.Subsequently her functional improvement was markable and HOOS became 78.9. After 6 months of MRI shows dramatic reducing bone marrow edema in STIR image and reducing trabecular loss in head.
Discussions: In AVN, this intrinsic regeneration capacity have lost.Cultured MSCs shows good clinical outcome only in early stage before collapse.Hernigou et al, good clinical outcome in 116 patients (189 hip).When patients were operated before collapse, hip replacement was done in 9in 145 hips.
Tissue regeneration by BMAC-MSCs is excellent. Early approach of AVN hip by BMAC-MSCs can reduce disability and prevent hip replacement surgery in the long run. A large scale research is need to establish the effectiveness of stem cell induced bone regeneration.
mohammad moniruzzaman– Associate Professsor, Dhaka Medical College