The Yale Avascular Necrosis & Osteonecrosis program focuses on maintaining joint function in patients with avascular necrosis (AVN), a condition in which bone tissue dies as a result of a temporary or permanent loss of blood supply to the bone.
Our patients receive coordinated care across a spectrum of treatments, including 3D surgical planning, regenerative medicine, osteoinductive adjuvants, hyperbaric oxygen treatments, and stem cell therapies. The goal is to provide the best opportunity for patients to maintain their native joints, as well as continuity, if they eventually require total joint replacement. As a leader in AVN treatments, our innovative program merges evidence-based regenerative medicine with novel surgical techniques.
How Stem Cells Can Treat Avascular Necrosis - Yale Medicine Explains
A Yale Medicine orthopaedic surgeon has developed an innovative procedure that uses a patient’s own stem cells to treat a condition that can cause painful hip fractures. The condition, called avascular necrosis, is when the flow of blood to the bones is cut off or reduced. It can be caused by a trauma, such as a broken joint or certain kinds of cancer therapy; certain conditions, such as sickle cell disease; and/or fat deposits in blood vessels. Avascular necrosis can lead to fractures. Daniel Wiznia, MD, the Yale surgeon who has developed this surgery, compares the fracture to a delicate dinner plate. “Over time, the glaze of a plate will form cracks. And eventually, it will break. Bones work in the same way. Our blood provides nourishment to our bones, so that the cells within them can repair those cracks,” Dr. Wiznia explains. “But if the bones don’t have that blood supply, they can’t regenerate and fix the fractures.” And that’s where stem cells come into play. Stem cells in our bone marrow can regenerate new blood vessels, muscle, and bone. “Because we're able to replace injured bone with fresh bone, you may not need a more invasive procedure, such as a joint replacement,” Dr. Wiznia says. For the procedure, Dr. Wiznia takes bone marrow from a patient’s pelvis and isolates the stem cells. He creates a 3-D model of the patient’s hip joint so that he can precisely target the areas where bone is dead. He then removes some of the dead bone and injects stem cells—and places a bone graft—into those regions. “The treatment is a game-changer because we are targeting an avascular necrosis lesion, which prevents the need for a hip replacement,” Dr. Wiznia says.
AVN and osteonecrosis can be medically complex. Coordination of services is necessary to understand the cause of the disease, evaluate the extent of the necrosis, and prevent further occurrences. Our program directly works with Yale School of Medicine’s Hematology, Oncology, Infectious Disease, Pathology, Radiology, and Alcohol Cessation services to help streamline care for patients and their families.
We offer the following treatments for AVN- and osteonecrosis-related conditions:
Hip and knee Lesion treatment: We offer a minimally invasive 3D personalized surgery to address AVN of the hip joint. This procedure, developed at Yale School of Medicine by a team of biomedical engineers, aims to improve patient outcomes and reduce the need for total joint replacement.
Shoulder lesion treatment: We treat AVN-related shoulder conditions, with the goal of preserving the shoulder joint whenever possible. Our physicians are experts at both traditional and reverse total shoulder replacement surgery as well as minimally invasive techniques to allow patients to return to their normal activities as soon as possible.
Foot and Ankle lesion treatment: Our specialists have developed treatment options for AVN of the foot and ankle joints that range from traditional, conservative approaches, such as generic or custom braces, to surgical management, including joint-preserving or -sacrificing procedures. The treatment options are tailored to each patient, depending on the stage and extent of their necrosis.
Hand and Elbow lesion treatment: Our Hand & Upper Extremity experts offer treatment for Keinbock’s disease, Hegemann's disease, and Panner's disease. These include custom braces, joint-preserving procedures, and surgical treatments. Our specialists design treatment plans based on each patient’s stage of necrosis to improve functionality and quality of life.
Hyperbaric oxygen treatment: Our specialists are recognized experts in the use of hyberbaric oxygen for the treatment of AVN with the femoral head. Our team is able to create individualized treatment plans for patients seeking this procedure.
Stem cell treatment: During the procedure, a patient’s bone marrow is harvested, and stem cells are concentrated and isolated. Using 3D computer-navigated targeting techniques, these stem cells and growth factors are placed within the center of the avascular region to help regenerate the blood supply to the femoral head and prevent collapse.
Joint replacement: Patients who have experienced the collapse of their joint may benefit from a partial or total joint replacement. Our Joint Reconstruction team has surgeons with extensive experience who care for patients with end-stage AVN to improve their function and pain control. In addition, all patients undergoing a joint replacement procedure for AVN will be screened for low-grade or early-stage AVN lesions in their other major joints.
How To Contact Us
Call 1-877-925-3637 to request an appointment or refer a patient to the AVN Program.
Patients may fill out this form and will be contacted by our team to schedule a consultation.