Avoidance of Total Knee Arthroplasty in Early Osteoarthritis of the Knee with Intra-Articular Implantation of Autologous Activated Peripheral Blood Stem Cells versus Hyaluronic Acid: A Randomized Controlled Trial with Differential Effects of Growth Factor Addition

Abstract

In this randomized controlled trial, in early osteoarthritis (OA) that failed conservative intervention, the need for total knee arthroplasty (TKA) and WOMAC scores were evaluated, following a combination of arthroscopic microdrilling mesenchymal cell stimulation (MCS) and repeated intra-articular (IA) autologous activated peripheral blood stem cells (AAPBSCs) with growth factor addition (GFA) and hyaluronic acid (HA) versus IA-HA alone. Leukapheresis-harvested AAPBSCs were administered as three weekly IA injections combined with HA and GFA (platelet-rich plasma [PRP] and granulocyte colony-stimulating factor [hG-CSF]) and MCS in group 1 and in group 2 but without hG-CSF while group 3 received IA-HA alone. Each group of 20 patients was evaluated at baseline and at 1, 6, and, 12 months. At 12 months, all patients in the AAPBSC groups were surgical intervention free compared to three patients needing TKA in group 3 (p < 0.033). Total WOMAC scores showed statistically significant improvements at 6 and 12 months for the AAPBSC groups versus controls. There were no notable adverse events. We have shown avoidance of TKA in the AAPBSC groups at 12 months and potent, early, and sustained symptom alleviation through GFA versus HA alone. Differential effects of hG-CSF were noted with an earlier onset of symptom alleviation throughout.

Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II)

“…Mesenchymal stromal cells are a promising option to treat knee osteoarthritis (OA) where, to date, knee arthroplasty is the only therapeutic option [3]. In the short term, the safety and usefulness of single injection of expanded autologous MSCs have been reported with positive results [4–6]. However, long-term results on the efficacy of MSCs in patients with osteoarthritis have been scarcely reported.…”

Injectable Systems for Intra-Articular Delivery of Mesenchymal Stromal Cells for Cartilage Treatment: A Systematic Review of Preclinical and Clinical Evidence

“…Finally, four papers described the results of cell/HA/PRP combination for the treatment of OA, including one RCT [ 70 ] and three case series [ 71 , 72 , 73 ]. Recently in 2017, Turajane et al [ 70 ] described the use of autologous peripheral blood stem cells (AAPBSCs) in combination with PRP, hGCSF (human granulocyte colony-stimulating factor) and HA for the treatment of knee OA. Sixty patients were randomized into three groups: microfracture followed by injection of AAPBSCs, HA, and a mix of PRP+hGCSF or AAPBSCs, HA, and PRP versus HA injection alone.…”

Commentary: Autologous Peripheral Blood Stem Cells (PBSC) are Safe and Effective in Knee Osteoarthritis

“…We believe that our RCT in 60 early osteoarthritis patients (of which 40 were actively treated with autologous hG-CSF activated PBSC and 20 received conventional hyaluronic acid treatment) (Turajane et al, 2017) should have been included. Our RCT showed statistically significant avoidance of total knee arthroplasty, and potent, early, and sustained symptom alleviation.…”