Regeneration of human bones in hip osteonecrosis and human cartilage in knee osteoarthritis with autologous adipose-tissue-derived stem cells: a case series

Jaewoo Pak, Jaewoo Pak

Abstract

Introduction: This is a series of clinical case reports demonstrating that a combination of percutaneously injected autologous adipose-tissue-derived stem cells, hyaluronic acid, platelet rich plasma and calcium chloride may be able to regenerate bones in human osteonecrosis, and with addition of a very low dose of dexamethasone, cartilage in human knee osteoarthritis.

Case reports: Stem cells were obtained from adipose tissue of abdominal origin by digesting lipoaspirate tissue with collagenase. These stem cells, along with hyaluronic acid, platelet rich plasma and calcium chloride, were injected into the right hip of a 29-year-old Korean woman and a 47-year-old Korean man. They both had a history of right hip osteonecrosis of the femoral head. For cartilage regeneration, a 70-year-old Korean woman and a 79-year-old Korean woman, both with a long history of knee pain due to osteoarthritis, were injected with stem cells along with hyaluronic acid, platelet rich plasma, calcium chloride and a nanogram dose of dexamethasone. Pre-treatment and post-treatment MRI scans, physical therapy, and pain score data were then analyzed.

Conclusions: The MRI data for all the patients in this series showed significant positive changes. Probable bone formation was clear in the patients with osteonecrosis, and cartilage regeneration in the patients with osteoarthritis. Along with MRI evidence, the measured physical therapy outcomes, subjective pain, and functional status all improved. Autologous mesenchymal stem cell injection, in conjunction with hyaluronic acid, platelet rich plasma and calcium chloride, is a promising minimally invasive therapy for osteonecrosis of femoral head and, with low-dose dexamethasone, for osteoarthritis of human knees.

Figures

Figure 1
Figure 1
MRI of the right hip; T1 sequential coronal views. The cavity surrounded by the three green arrows has decreased in size in post-treatment MRIs due to probable bone regeneration.
Figure 2
Figure 2
MRI of the right hip; T1 sequential coronal views. The blue arrow shows the pattern of probable bone regeneration. The green arrow shows probable bone consolidation.
Figure 3
Figure 3
MRI sagittal T2 view of the knee. Pre-treatment and post-treatment MRI shows increased height of medial meniscus cartilage and articular cartilage (arrow).
Figure 4
Figure 4
MRI coronal T2 view of the knee. Pre-treatment and post-treatment MRI shows increased height of medial meniscus (arrow).
Figure 5
Figure 5
MRI sagittal T2 view of the knee. Pre-treatment and post-treatment MRI shows increased height of medial meniscus cartilage. The articular cartilage also has a clearer marking, representing probable cartilage regeneration.
Figure 6
Figure 6
MRI coronal T2 view of the knee. The anterior medial meniscus has increased in height.

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