Bone Marrow Concentrate Injection Treatment Improves Short-term Outcomes in Symptomatic Hip Osteoarthritis Patients: A Pilot Study

Abstract

Background: Osteoarthritis (OA) is one of the leading causes of disability in the United States, the hip being the second most affected weightbearing joint. Autologous bone marrow concentrate (BMC) is a promising alternative therapy to conventional treatments, with the potential to mitigate inflammation and improve joint function. Purpose: To investigate the effectiveness of a single intra-articular BMC injection for patients with symptomatic hip OA. Study Design: Case series; Level of evidence, 4. Methods: A total of 24 patients diagnosed with symptomatic hip OA who elected to undergo a single BMC injection were prospectively enrolled in the study. Patients were excluded if they reported a preinjection Numeric Rating Scale (NRS) score for pain with activity of <6 points out of 10. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), 12-Item Short Form Health Survey (SF-12), and NRS pain scores were collected before and after the procedure (6 weeks, 3 months, and 6 months). Joint space and Tönnis OA grade scores were recorded on preinjection anteroposterior pelvis radiographs. Results: A total of 18 hips from 16 patients (7 male and 9 female) (mean age, 57.6 ± 11; mean body mass index, 25.9 ± 3.6 kg/m2) were used in the final analysis. Significant improvements were observed in NRS pain with activity (from 8 to 4.5; P < .001) and without activity (from 5 to 1; P < .001), WOMAC (from 31 to 16; P = .006), mHHS (from 63 to 80; P = .004), and HOS-ADL (from 71 to 85; P = .014) over 6 months. At 6 months, all patients maintained their improvements and did not return to preprocedure status. BMI significantly correlated with baseline WOMAC scores ( P = .012) and inversely correlated with 6-month SF-12 Physical Component Summary ( P = .038). Tönnis grades 2 and 3 were inversely correlated with 6-week SF-12 Mental Component Summary ( P = .008) and 3-month pain with activity ( P = .032). No serious adverse events were reported from the BMC harvest or injection procedure. Conclusion: A single BMC injection can significantly improve subjective pain and function scores up to 6 months in patients with symptomatic hip OA. Further studies are warranted to evaluate BMC treatment against other therapeutics in a larger sample size and compare the biological signature profiles that may be responsible for the therapeutic effect.

Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review

“…Fifteen studies were excluded after full-text evaluation: 11 congress abstracts, two case series that considered less than five patients, one case report, and one study that combined intra-articular and intra-osseous injections. Thus, a total of 20 clinical studies focusing on orthobiologic approaches for the management of hip OA were included in this systematic review [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

“…The most common injection protocol was a single injection administration (seven studies), while three injections of BMSCs were used in one study, with an interval of one week between the injections. The expression of surface markers and microbial contamination were investigated in the two studies on BMSC injections [34,35], while the hematology analysis to obtain a complete blood cell count of BMAC was investigated in only one study [38]. Further details on the characteristics of the different cell-based therapies used are reported in Table 3.…”

“…One study analyzed two different PRPs in a comparative matchpaired analysis, demonstrating no significant differences between autologous PRP and cordonal PRP injections, although the results were influenced by OA severity, with cordonal PRP showing more benefits when advanced OA cases were excluded [33]. The role of OA severity was also underlined in six studies (five on PRP and one on BMAC), all showing better clinical results after injections in patients with early or moderate OA compared with those with severe OA [23,24,26,27,30,38]. One study analyzed the number of patients who responded to the treatment in relation to the platelet concentration of the injected PRP, reporting that responders had higher platelet concentrations compared with nonresponders [30].…”

Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Hip Osteoarthritis

“…BMAC has been the most widely utilized, primarily due to the fact that it meets the criteria of 'minimal manipulation' as proposed by the Food and Drug Administration (FDA) and similar regulatory bodies worldwide 6 . Presently, there are two small case series available on the efficacy of BMAC in the treatment of hip OA 29,34 . Rodriguez-Fontan et al utilized BMAC for the treatment of 15 hips with Tönnis grade I-II and 10 knees with Kellgren-Lawrence grade I-II OA 29 .…”

“…Only 2 of 15 hips (13.3%) required conversion to total hip arthroplasty, however the follow-up is likely inadequate to accurately report for this outcome. Similarly, Whitney et al reported on the use of a single BMAC injection for the treatment of symptomatic hip OA in 16 patients (18 hips) 34 . They, too, reported significant improvements in outcome scores out to 6 months, including a numeric rating scale for pain, WOMAC score, modified Harris Hip Score (mHHS), and Hip Outcome Score-Activities of Daily Living (HOS-ADL) subscale, as well as the 12-item Short-Form (SF-12) Health Survey.…”