2017 ISAKOS Biennial Congress ePoster #502

 

Cell Therapy for Cartilage Defects of the Hip

Rodrigo M. Mardones, MD, Santiago CHILE
Daniel R. Camacho, MD, Santiago, RM CHILE
Alessio Giai Via, MD, Santiago CHILE
Claudio Rodriguez, MD, Santiago CHILE
Alexander Tomic, MD, Santiago CHILE
Alvaro Rivera, MD, Santiago CHILE
Matias Salineros, MD, Santiago CHILE
Carlos Musa, MD, Santiago CHILE
Marcelo Somarriva, MD, Santiago CHILE
Mauricio Wainer, MD, Santiago CHILE
Claudio Jofre, PhD, Santiago CHILE
Jose Minguell, PhD, Santiago CHILE

Clinica Las Condes, Santiago, RM, CHILE

FDA Status Cleared

Summary

BM-MSCs injections in in combination with hip arthroscopy treatment may improve the quality of life and functional score in patient with FAI and mild to moderate OA, which are still not candidate to a THA

Abstract

Background

Focal chondral injuries or larger cartilage defects of the hip are commonly related to relatively poorer clinical outcome after hip arthroscopy, and severe oateoathrosis (OA) has been considered a contraindication by many authors. However, recent data showed some improvements in outcome scores and pain in patients with moderate to severe articular cartilage degeneration at 12 months follow-up. Treatment of articular cartilage defects remains still a challenge in clinical practice, and a gold standard treatment have still to be found. To date, no serious adverse effects to the application of expanded MSCs have been reported, beyond transient pain and inflammation. Hip arthroscopy followed by autologous mesenchymal stem cells (MSCs) infusion for patients with FAI and OA may produce better outcome. The aim of this study is to evaluate the functional outcome and postoperative complications of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and intra-articular infiltration of autologous expanded bone marrow –MSCs (BM-MSCs) at mid-term follow-up.

Materials And Methods

The inclusion criteria were patients with symptomatic FAI and mild to moderate OA (Tonnis scale II-III) and age older than 40. The exclusion criteria were intra-articular space less than 2 mm on the standard weight bearing X-ray of the pelvis, OA secondary to hip developmental diseases, previous intra-articular fractures, autoimmune OA, joint infections. Patients who left the follow protocol or with a follow-up shorter than one year have also been excluded. Hip arthroscopy was performed with a standard anterolateral portal and a second modified anterior portal. Eighty mL of bone marrow were aspirated from the iliac crest and mononuclear cells (MNC) were isolated by Lymphoprep density gradient. BM-MSCs were than expanded, and 3 intra-articular injections of 20 x 106 cells were injected from 4 to 6 weeks post-operative, one per week.
All patients took standard weight-bearing anterior–posterior radiographs of the pelvis, AP and cross-table view of the hips. The modified Harris Hip score (mHHP) was administered to all patients before surgery (T0) and final follow-up (T1). The VAS score was also administered preoperatively and at each control. A failure of a treatment failure was considered the need of Total hip arthroplasty (THA).

Results

Sixty-three patients received hip arthroscopy and intra-articular BM-MSCs infusion, from 2012 to 2015, but only 38 met the inclusion criteria. Ten patients were treated bilaterally, for a total of 48 hips. The mean age of the patients (20 women and 18 men) was 51.8 years (range 40-68; SD 7.4), and the mean follow-up was 30 months (range 12-60 months; SD 10.3). The median preoperative mHHS score was 63.25 (range 38.2-82.5; SD 13.9). At final follow-up, the median mHHS score significantly improved to 71.5 (range 51.7-97; SD 51.8) (P<0.01).
According to VAS score, a statistical significant improvement was also found from the preoperative to final follow-up, from a median of 4 (range 2-7; SD 1,3) to 2 (range 0-4; SD 1,09) (p<0.01).
There were no infections or major complications with after the any of the 3 injections. Four patients had important pain 1-5 days after the second or third injection all relieve by oral pain medication.
Two patients shown relative improved joint space after one year follow up. There were two failures (THA) after at two year and five years from the initial treatment.

Conclusion

BM-MSCs injections in in combination with hip arthroscopy treatment may improve the quality of life and functional score in patient with FAI and mild to moderate OA, which are still not candidate to a THA.