Bone marrow concentrate therapy improves short-term outcomes in patients with symptomatic hip osteoarthritis

Abstract

Purpose: Millions of people are affected with hip osteoarthritis (OA) in the United States, and anticipated to double by 2030. Pain management strategies mainly focus on providing an analgesic affect to improve joint function and reduce pain. Autologous bone marrow concentrate (BMC) is a promising alternative therapy that has the potential to mediate inflammation and improve joint function. There is a paucity of clinical and fundamental evidence available to support its therapeutic efficacy for the treatment of hip OA. Therefore, the present study investigated short-term changes in patient pain and outcome scores following a single BMC injection for symptomatic hip OA. Methods: Under an IRB approved protocol (2016-06), patients who had elected to undergo an autologous BMC procedure for symptomatic hip OA were prospectively enrolled. Patients were diagnosed with hip OA based on clinical examination and radiographs. Joint space and Tonnis osteoarthritis grade scores were recorded on the pre-injection anteroposterior (AP) pelvis x-ray. Patients were excluded if they reported less than 6/10 on the VAS pain score prior to the injection, had a previous intra-articular injection in the treated hip within 6 months or refused to participate. Patient-reported outcomes were collected at baseline, 6 weeks, 3 months and 6 months following the BMC injection. Data collected were patient age, gender and body mass index (BMI). Outcome variables used for patient assessment include VAS pain score, stiffness and motion. A paired t-test was used for comparison of the pre-injection and follow-up outcome measurements. Results: This sample analysis examined 19 hips in 17 patients (8 males and 9 females) who had completed all patient-reported outcome surveys and were a minimum of 3 months from their autologous BMC injection. Patients had an average age of 57.3±11 and average BMI of 26.2±3.6. On pre-injection radiographs, one patient had hip OA Tonnis grade 1, six patients had Tonnis grade 2, and ten patients had Tonnis grade 3. No serious adverse events were reported from the BMC procedures. Significant improvement from pre-injection was seen as indicated (*) for specific outcome measures (P<0.05). At 6 months, patients maintained improvement and did not return to pre-procedure status. Conclusions: Patients with symptomatic hip OA who underwent a single intra-articular hip BMC injection reported significantly less pain with and without activity at 6 weeks, 3 months and 6 months. Patients saw a significant decrease in pain and increase in motion as well as a significant improvement in WOMAC, mHHS, and HOS ADL at 3 and 6 months. These results suggest that BMC therapy for the treatment of hip OA can improve hip function and reduce pain over 6 months. Clinical studies that track long-term outcome measures are necessary to determine if this autologous biological treatment maintains symptom improvement and allows hip OA patients, who do not wish to have a total hip arthroplasty, to return to normal function.Table 1Outcomes data.Pre-injection Mean±SD6 weeks Mean±SD3 months Mean±SD6 months Mean±SDPain today (0 to 10)5.3±2.32.4±2.4*1.9±1.6*1.9±1.9*Pain at its worst8±1.54.7±2.3*4.8±2.5*4±2.7*Pain with activity6.7±2.84.1±2.2*3.3±2.1*4±2.3*Pain with walking distances (0 to 40)19.7±9.026.4±9.5*31±11*28.7±11*Stiffness (0 to 10)4.6±1.92.9±1.7*2.1±1.6*2.5±2.1*Motion (0 to 10)4.7±2.53±2.3*1.6±2.4*2.3±2.2*SF12 PCS43±943±945±947±9SF MCS49±956±754±1054±8WOMAC33±1825±1220±14*17±15*mHHS61±1672±14*78±16*79±16*HOS-ADL67±2177±1483±13*85±13* Open table in a new tab