Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Abstract

Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We hypothesized that injection of autologous adipose tissue, BMA, and PRP would provide significant benefit for patients with moderate knee OA resulting in avoidance of total knee arthroplasty (TKA) in most, with discontinuance of NSAIDs and other drugs. Methods: 42 TKA candidate patients (47 knees) with moderate (Kellgren-Lawrence 2 and 3) knee OA who had failed conservative treatment had autologous adipose tissue, BMA, and PRP injection as an alternative to TKA in office using only local anesthetic. Patients had discontinuance of all nonsteroidal anti-inflammatory medicines (NSAIDs) and other analgesics, except acetaminophen, prior to treatment. Patients were evaluated with Knee injury and Osteoarthritis Outcome Score Physical Shortform (KOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Single Assessment Numeric Evaluation (SANE) prior to treatment, and at 6 months, 1, and 2 years after treatment. Results: Follow up exceeded 80% at all time points. There were no significant adverse events. TKA was avoided in 97% at one and 86% at two years after treatment. Mean SANE, KOOS-PS, and WOMAC scores significantly improved at 6 months, 1, and 2 years post-treatment. WOMAC and SANE scores were higher at two versus one year post-treatment. Conclusions: Combined fat, BMA, and PRP injection is a safe and effective treatment for moderate knee OA, with reliable avoidance of TKA and possible continued improvement at two year follow-up.

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

“…This study demonstrates that a single treatment of AMSCI can produce significant clinical improvement that can last at least 2 years. Other results from our center showed significantly improved results out to 2 years with a trend toward further improvement from the one year to the two year follow-up, after a single treatment with fat, bone marrow and PRP [71]. Our hypothesis was thus validated regarding comparison to placebo.…”

Impact of being underweight on peri-operative and post-operative outcomes of total knee or hip arthroplasty: A meta-analysis

“…Nowadays, autologous platelet concentrates[ 49 - 51 ] have been proved to be beneficial in the management of bone-related disorders[ 52 - 55 ]. They have also been used as an adjunct to arthroplasty[ 56 , 57 ]. Many studies have opted for this as an alternative to arthroplasty[ 58 , 59 ].…”

Estudio comparativo del tratamiento de células madre en el tratamiento de la osteoartritis y la artroplastia de rodilla.

“…Evitar la artroplastia de rodilla sería ideal para los pacientes, debido a que cualquier tipo de operación lleva un riego, además de las complicaciones; el tratamiento de células madre, en combinación con ácido hialurónico, dieron como resultado que se puede evitar una artroplastia total de rodilla en pacientes en etapas tempranas de osteoartritis (Turajane et al, 2017). Incluso en pacientes con una moderada osteoartrosis, se evidenció mejoría y también se logró posponer una operación a la rodilla (Prodromos & Finkle, 2020).…”