The debit side of stem-cell joint injections: a prospective cohort study

Abstract

Background: There is little long-term information and no prior report that used independently collected data describing the effectiveness and complications of intraarticular injections of stem cells. Methods: This study reviewed the records of 2964 patients who received stem-cell injections in the hip, knee, or shoulder and 2971 patients who had injections of steroids or viscosupplementation (comparison group). Results: Pain improved initially in 2104 (71%) of patients who received stem cells. At a mean follow-up of 5.6 yr, 563 (15%) patients continued to report less pain, and the mean time of pain reduction was 17 mo (range, 1 to 84 mo). The mean cost of stem-cell care was $6000 (range, $1200 to $13,000). There were 115 (8%) complications using autologous stem cells, 113 (8%) with donor cells, and 13 (9%) when both were used. Stem-cell complications included six tumors, 14 infections, 48 syncopal, arrhythmia, seizure, or vasovagal reactions, 42 chronic culture-negative effusions, 18 injection site rashes, 44 instances of systemic viral like syndrome or herpes zoster-like reactions, 31 new allergies, and 39 instances of acute and severe worsening of pain and function. There were 82 hospitalizations. For the comparison group, there were 61 (2%) complications and eight hospitalizations. Conclusions: The frequency (8%) and severity of complications with stem cell-injections is higher than for steroid or viscosupplementation injections (2%). Stem-cell joint injections are a costly and speculative treatment and should only be used with a deep understanding of the risk. Practitioners providing stem cell joint injections must include long-term follow-up as part of their care. Additional validated scientific studies are needed. Level of Evidence: Level II.