• By Susan Buckles

Science Saturday: The regenerative alternative to hip replacement for baseball player

June 19, 2021
a young Black man, Mayo patient Mikaili Robertson, in his baseball uniform

Mikaili Robertson has a passion for playing college sports, so the second baseman was devastated when at age 18 he learned he needed a hip replacement. Worried his playing days might be over, he turned to Mayo Clinic and a surgery that — along with a cadaver tissue transplant — would tap the body’s power to assist healing. Mayo’s Center for Regenerative Medicine provided support for this procedure integral to its focus on bringing innovative regenerative treatments to patients.

“When people talked to me about hip replacement, I had visions of myself being like an old man with a walker, not able to do a whole lot. I started wondering what my quality of life would be like outside of baseball,” says Robertson. “My parents and I searched for alternatives to a hip replacement, and we found new options for hip surgery at Mayo.”

Robertson was a freshman playing baseball at Hood College in Maryland when his right hip started hurting after games. The diagnosis: sickle cell disease was choking off blood supply to the top of the hip joint known as the femoral head. Bone tissue began dying, causing a condition known as avascular necrosis, also called osteonecrosis of the hip.

a medical illustration of sickle cell anemia

June 19 is World Sickle Cell Day.
The day was established to increase awareness about sickle cell anemia, one of a group of disorders known as sickle cell disease. Sickle cell anemia is an inherited red blood cell disorder in which there aren't enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels. In sickle cell anemia, the red blood cells are shaped like sickles or crescent moons. These rigid, sticky cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. But treatments can relieve pain and help prevent complications associated with the disease.

Avascular necrosis also can be a rare side effect of heavy steroids used in some chemotherapies to treat cancer. It has been described as one of the unsolved mysteries of orthopedics. Once it starts, there is no known way of stopping the bone tissue from dying unless it is caught early. Without treatment 90% of patients with avascular necrosis will need a hip replacement.

Rafael J. Sierra M.D., and his colleague, Aaron Krych, M.D., are among a few orthopedic surgeons in the United States to perform a regenerative surgery called Fresh Osteochondral Allograft Transplantation Surgery (OATS) to the femoral head as an alternative for hip replacement in select patients with avascular necrosis. They are perfecting the surgery based in part on research in the Journal of Hip Preservation Surgery. Under a controlled dislocation of the hip, the dead bone can be removed and replaced with donor cartilage. Smaller lesions can be treated with transplants of the patient’s own cartilage. Larger areas of necrosis need cadaver cartilage-bone transplants. Bone marrow and stem cells spun from the patient’s own blood help the bone-cartilage transplant to fuse with the patient’s natural bone. Dr. Sierra describes it as a process similar to an organ or tissue transplant but without the need for immunosuppression to avoid rejection.

Read the rest of the article on the Center for Regenerative Medicine blog.

Related post: Mayo Clinic Q&A podcast: Regenerative medicine offers an alternative to hip replacement.

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