Paper #31 - ISHA Annual Scientific Meeting 2016

Cell Therapy For Cartilage Defects Of The Hip

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

Clinica Las Condes, Santiago, RM, CHILE

FDA Status Not Applicable

Summary: intra-articular infiltration of autologous expanded bone marrow mesenchymal stem cells 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 hip arthroplasty.

Abstract:
Focal chondral injuries or larger cartilage defects of the hip are commonly related to relatively poorer clinical outcome after hip arthroscopy. Treatment of articular cartilage defects remains still a challenge in clinical practice, and a gold standard treatment have still to be found. 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 (Tönnis 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, previous joint infections and patients with symptomatic lumbar spine disorders. Patients who left the follow protocol or with a follow-up shorter than one year have also been excluded. 80 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.
The modified Harris Hip score (mHHP) were administered to all patients before surgery and final follow-up. 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.