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PM R. 2018 Dec;10(12):1353-1359. doi: 10.1016/j.pmrj.2018.05.016. Epub 2018 May 29.

Early Clinical Outcomes of Intra-Articular Injections of Bone Marrow Aspirate Concentrate for the Treatment of Early Osteoarthritis of the Hip and Knee: A Cohort Study.

Author information

1
Regenerative Orthopedics Laboratory, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO; and Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina(∗).
2
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; and Instituto Universitario del Hospital Italiano de Buenos Aires, Argentina(†).
3
Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ(‡).
4
Adult Reconstruction and Young Adult Hip Service, Orthopedics Department, Washington University, 660 S. Euclid, Campus Box 8233, St Louis, MO 63110(§). Electronic address: pascualgarridoc@wudosis.wustl.edu.

Abstract

BACKGROUND:

Bone marrow aspirate concentrate (BMC) is one of the few cell-based therapies available as a possible biological treatment for early osteoarthritis (OA). Its efficacy, safety, and benefit compared with other treatments are still to be determined.

OBJECTIVE:

To assess the clinical outcomes of patients undergoing intra-articular injection of BMC for the treatment of early knee and hip OA.

DESIGN:

Prospective, cohort study.

SETTING:

Single institution, quaternary level of care.

PATIENTS:

Nineteen patients (16 female and 3 male), totaling 25 joints (10 knees, 15 hips), treated with intra-articular BMC for early OA between 2014 and 2016. The mean age at time of the procedure was 58 ± 12.7 years (range, 30-80 years). The mean follow-up was 13.2 ± 6.3 months (range, 6-24 months). Inclusion criteria included ≥18 years; knee OA, Kellgren-Lawrence grade I-II; hip OA, Tönnis grade I-II; first-time intra-articular BMC therapy, after unsuccessful symptomatic and conservative treatments (ie, physical therapy, analgesics and anti-inflammatory drugs) for 6 months. Exclusion criteria included pregnancy; malignancy; rheumatologic diseases; infection; Kellgren-Lawrence grade III-IV; Tönnis grade III; and previous intra-articular injections or surgery.

INTERVENTIONS:

All patients had autologous bone marrow aspirate harvested from the iliac crest and centrifuged to achieve BMC, for intra-articular injection.

MAIN OUTCOME MEASUREMENTS:

The hypothesis was formulated before the study. Patient-reported outcomes measures were assessed preoperatively and at last follow-up using the Western Ontario and McMaster Universities Arthritis Index.

RESULTS:

Western Ontario and McMaster Universities Arthritis Index improved from a baseline of 40.8 ± 18.3% to 20.6 ± 17% (P < .001) at final follow-up. The satisfaction rate was 63.2%. The minimal clinically important difference threshold of 9.15 points was reached by 64% of the patients. Two patients were converted to total hip arthroplasty at 8 months after BMC injection.

CONCLUSIONS:

Intra-articular injections of BMC for the treatment of early knee or hip OA were safe and demonstrated satisfactory results in 63.2% of patients. Future studies are necessary to determine the efficacy of this technique and its safety profile.

LEVEL OF EVIDENCE:

II.

Comment in

PMID:
29857166
DOI:
10.1016/j.pmrj.2018.05.016
[Indexed for MEDLINE]

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