Whitney Kaitlyn E, Briggs Karen K, Chamness Carolyn, Bolia Ioanna K, Huard Johnny, Philippon Marc J, Evans Thos A
The Steadman Clinic, Vail, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Orthop J Sports Med. 2020 Dec 9;8(12):2325967120966162. doi: 10.1177/2325967120966162. eCollection 2020 Dec.
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.
To investigate the effectiveness of a single intra-articular BMC injection for patients with symptomatic hip OA.
Case series; Level of evidence, 4.
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.
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/m) were used in the final analysis. Significant improvements were observed in NRS pain with activity (from 8 to 4.5; < .001) and without activity (from 5 to 1; < .001), WOMAC (from 31 to 16; = .006), mHHS (from 63 to 80; = .004), and HOS-ADL (from 71 to 85; = .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 ( = .012) and inversely correlated with 6-month SF-12 Physical Component Summary ( = .038). Tönnis grades 2 and 3 were inversely correlated with 6-week SF-12 Mental Component Summary ( = .008) and 3-month pain with activity ( = .032). No serious adverse events were reported from the BMC harvest or injection procedure.
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.
骨关节炎（OA）是美国导致残疾的主要原因之一，髋关节是第二大最易受影响的负重关节。自体骨髓浓缩物（BMC）是传统治疗方法的一种有前景的替代疗法，具有减轻炎症和改善关节功能的潜力。
研究单次关节腔内注射BMC对有症状的髋关节OA患者的有效性。
病例系列；证据等级，4级。
共有24例诊断为有症状的髋关节OA且选择接受单次BMC注射的患者前瞻性纳入本研究。如果患者报告注射前活动时疼痛的数字评定量表（NRS）评分低于10分中的6分，则将其排除。在手术前后（6周、3个月和6个月）收集西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、改良Harris髋关节评分（mHHS）、髋关节功能评分-日常生活活动（HOS-ADL）、12项简短健康调查问卷（SF-12）以及NRS疼痛评分。在注射前的骨盆前后位X线片上记录关节间隙和Tönnis OA分级评分。
最终分析纳入了16例患者（7例男性和9例女性）的18个髋关节（平均年龄，57.6±1岁；平均体重指数，25.9±3.6kg/m²）。在6个月内，观察到活动时NRS疼痛评分（从8分降至4.5分；P<.001）、静息时NRS疼痛评分（从5分降至1分；P<.001）、WOMAC评分（从31分降至16分；P=.006）、mHHS评分（从63分升至80分；P=.004）以及HOS-ADL评分（从71分升至85分；P=.014）有显著改善。在6个月时，所有患者均维持改善效果，未恢复到术前状态。体重指数与基线WOMAC评分显著相关（P=.012），与6个月时的SF-12身体成分汇总评分呈负相关（P=.038）。Tönnis 2级和3级与6周时的SF-12心理成分汇总评分呈负相关（P=.008），与3个月时的活动时疼痛评分呈负相关（P=.032）。未报告BMC采集或注射过程中的严重不良事件。
单次BMC注射可使有症状的髋关节OA患者的主观疼痛和功能评分在长达6个月的时间内得到显著改善。有必要进行进一步研究，以在更大样本量中评估BMC治疗与其他疗法的效果，并比较可能导致治疗效果的生物学特征谱。
