Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP

Abstract

Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton–Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months (p < 0.0001) and 2 (IQR 5) after two years (p < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months (p = 0.004) and to 35 (IQR 34) after two years (p < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.

Liparthroplasty for Thumb Carpometacarpal Joint Osteoarthritis: A Case Series with Median 5 Years of Follow-Up

“…For the present study, we called in patients who were assessed in our previous study, including the 2 year postinterventional results [ 10 ], for another follow-up appointment. Between February 2017 and August 2018, patients with symptomatic, Eaton-Littler stage II to III thumb CMC joint OA were included in this study and treated with liparthroplasty.…”

“…Our liparthroplasty technique was described in detail in our former publication [ 10 ]: After infiltrating 50 milliliters of tumescent solution, lipoaspirate was harvested in regional anesthesia from the lower abdominal region using a single umbilical incision. After the fat tissue was separated from fluids and oils using the decanting method, it was mechanically homogenized with two syringes.…”

“…In this regard, novel therapies, including intra-articular injection of platelet-rich plasma (PRP) [ 8 ] as well as adipose-derived mesenchymal stem cells in autologous lipoaspirated fat transplantation (AFT) [ 9 ], aim to avail the endogenous, immunosuppressive, and regenerative capability of autologous agents. In our previous study reporting our outcomes of AFT, i.e., liparthroplasty, we found a cumulative symptom remission rate of 58% after 2 years [ 10 ]. To investigate the mid-term performance and the sustainability of this novel therapy, our former study cohort was followed up for this study.…”

Intra Articular Injection of Autologous Microfat and Platelets-Rich Plasma in the Treatment of Wrist Osteoarthritis: A Pilot Study

“…This is consistent with the good tolerance observed after injection of MF-PRP mixture into the joints of racehorses [ 28 ]. More generally, no infectious or neoplastic complications related to intra-articular injection of any orthobiological product (PRP, ADSCs, SVF or unfractionated adipose tissue) have been reported in the literature [ 40 , 41 , 42 , 43 ] whereas the most common complications reported were early pain and swelling of the injected joint [ 36 , 40 , 44 , 45 , 46 , 47 , 48 ]. The latter side effect is usually observed after joint injection, regardless of the product injected.…”

“…The procedure requires the use of a dedicated cannula to select small (600 µm) fat lobules followed by a purification step using the Puregraft ® bag membrane required to remove oily substances and blood residues [ 26 ]. Although the manufacturing slightly differs with microfragmented fat (MFAT) [ 36 , 38 , 41 , 56 , 57 , 58 , 59 ], both techniques generally select small fat lobules that retain intact MSCs in the vascular niche of the adipose stroma during the preparation process [ 59 ].…”