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.

Keywords: bone marrow aspirate (BMA); bone marrow concentrate (BMC); hip; osteoarthritis (OA); patient-reported outcomes (PROs).

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.H., M.J.P., and T.A.E. have received research support from Arthrex, Canon, Ossur, Siemens, and Smith & Nephew; and financial support from ProofPoint Biologics. M.J.P. has received educational support from Linvatec; speaking fees and consulting fees from Smith & Nephew; royalties from Arthrosurface, Biedsoe, ConMed Linvatec, DJO, DonJoy, Elsevier, Linvatec, SLACK, and Smith & Nephew; and hospitality payments from Siemens Medical Solutions, Pfizer, and Sanofi-Aventis; is a shareholder/owner in Arthrosurface, MJP Innovations, MIS, Vail Valley Surgery Center, Vail MSO Holdings, and EFFRx; and is a board member for Vail Health Services and co-chairman for the Steadman Philippon Research Institute. J.H. receives royalties from Cook Myosite Inc. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.