Randomized blinded comparative analysis of autologous mononuclear medullary fraction and viscosupplementation in grade 0 and grade 1 radiographic scale of knee osteoarthritis

Abstract

Introduction: Bone marrow aspirate concentrate (BMAC) has been demonstrated to induce unfathomable healing activity in various forms of arthritis. On the other hand, viscosupplementation is widely used as one of the modalities to palliate the symptoms of knee osteoarthritis (OA). To the best of our knowledge, no research involving a comparison of the two interventions has been done. We evaluated and critically analyzed the comparative efficacy of an intra-articular injection of BMAC or sodium hyaluronate injection (Halonix; Cadila) in terms of pain relief or functional improvement using validated scoring instruments. Materials and Methods: Fifty patients of either sex, aged more than 18 years with grade 0 and grade 1 primary knee OA were randomized to receive intra-articular injection of either the mononuclear marrow concentrate or Halonix, and they were followed for 6 months. The patients treated received single injection either of mononuclear marrow concentrate or Halonix during the course of study. An independent, blinded evaluator assessed the patient with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the visual analog pain scale. Results: Both the cohorts treated with mononuclear marrow concentrate and with Halonix showed improvements from the baseline parameters at the end of 1-month follow-up. Group treated with BMAC showed significant difference (p<0.05) with respect to WOMAC, or visual analog scale results at the end of 6 months of follow-up. Men demonstrated significant improvement (p<0.05) in both the groups. Conclusion: Statistical significant differences were detected between patients treated with intra-articular injections of monocular marrow concentrate and those treated with the Halonix with respect to pain relief or function at 6 months of follow-up. Clinical Relevance: Direct delivery of bone marrow mononuclear concentrate to radiographic symptomatic grade 0 and grade 1 knee OA has the clinical potential to improve functional activity/ functional aspect of knee OA, providing a cost-effective approach for grade 0 and grade 1 knee OA.