Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Article Selection
2.2. Data Extraction, Outcome Measurement, and Quality Assessment
3. Results
3.1. Article Selection and Characteristics
3.2. Orthobiologic Products
3.3. Safety
3.4. Clinical Efficacy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Studies Using Kellgren–Lawrence Scale | Grade I | Grade II | Grade III | Grade IV |
Battaglia M. et al., 2011 [22] | − | 4 | 8 | 8 |
Singh JR. et al., 2019 [24] | 7 | 11 | 9 | 9 |
Battaglia M. et al., 2013 [26] | − | 39 | 44 | 17 |
Di Sante L. et al., 2016 [28] | − | 12 | 31 | − |
Doria C. et al., 2017 [29] | + | + | + | − |
Villanova-López MM. et al., 2020 [30] | 27 | 37 | 10 | |
Kraeutler MJ. et al., 2021 [31] | − | 9 | 14 | − |
Palco M. et al., 2021 [32] | − | 24 | 28 | − |
Emadedin M. et al., 2015 [34] | − | − | + | + |
Burnham R. et al., 2021 [39] | + | + | + | + |
Heidari N. et al., 2022 [41] | 25 | 28 | 33 | 61 |
Studies Using Tönnis Scale | Grade 0 | Grade 1 | Grade 2 | Grade 3 |
Sánchez M. et al., 2012 [23] | − | − | 12 | 28 |
Ortiz-Declet V. et al., 2020 [25] | 3 | 6 | 2 | − |
Mazzotta A. et al., 2022 [33] | − | 11 | 42 | 43 |
Mardones R. et al., 2017 [35] | − | 2 | 9 | 2 |
Rodriguez-Fontan F. et al., 2018 [36] | − | + | + | − |
Dall’Oca C. et al., 2019 [37] | + | + | + | − |
Whitney KE. et al., 2020 [38] | − | − | 6 | 12 |
Meadows MC. et al., 2021 [40] | − | 3 | 6 | − |
Author Year | Study Design | Injective Product | Product Manufacturing and Characteristics | Injection Schedule and Amount | Patients (Sex) Age Mean + SD | Final F-up | mCMS | Results |
---|---|---|---|---|---|---|---|---|
Battaglia M. 2011 [22] | Prospective Case Series | PRP | NR | 3 injections 2 weeks intervals 5 mL US guidance | 20 (13 M/7 F) 52 ± 13 | 12 m | 41 | PRP injections are safe and effective in reducing pain and improving articular function and quality of life in patients affected by hip OA. |
Sánchez M. 2012 [23] | Prospective Case Series | PRP | LP-PRP (PRGF) Activation: Ca chloride (10%) | 3 injections 1–2 weeks intervals 8 mL US guidance | 40 (27 M/12 F) 56 ± 11.9 | 6 m | 49 | PRP injections improved pain and function in a limited number of patients with severe hip OA. |
Battaglia M. 2013 [26] | RCT | PRP | LR-PRP Activation: Ca chloride (10%) Plts: Increased 600% vs. WB each unit contained 6 to 8 mln plts Leukocytes: 8.3 × 103/μL | 3 injections 2 weeks intervals 5 mL US guidance | 52 (20 M/30 F) 51 ± 12 | 12 m | 73 | IA injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month F-up. |
HA | HMW-HA (1500 kDa) (Hyalubrix 30 mg/2 mL) | 3 injections 2 weeks intervals 2 mL US guidance | 52 (17M/33F) 56 ± 12 | |||||
Dallari D. 2016 [27] | RCT | PRP | LR-PRP Activation: Ca chloride (10%) | 3 injections 1-week interval 5 mL US guidance | 44 (20 M/24 F) NR | 12 m | 80 | IA PRP injections offer a significant clinical improvement in patients with hip OA without relevant side effects. The addition of PRP+HA did not lead to a significant improvement in pain symptoms. |
HA | HMW-HA (1500 kDa) (Hyalubrix 30 mg/2 mL) | 3 injections 1-week interval 2 mL US guidance | 36 (26 M/10 F) NR | |||||
PRP+HA | LR-PRP + HA | 3 injections 1-week interval 7 mL (5 mL PRP + 2 mL HA) US guidance | 31 (12 M/19 F) NR | |||||
Di Sante L. 2016 [28] | RCT | PRP | LP-PRP Plts: 100–150% vs. WB | 3 injections 1-week interval 3 mL US guidance | 21 (11 M/10 F) 71.37 ± 6.03 | 4 m | 66 | IA PRP had an immediate effect on pain that was not maintained at longer term F-up when, on the contrary, the effects of IA HA were evident. |
HA | Na-HA (30 mg/2 mL of HA with HMW 1000 to 2900 kDa) | 3 injections 1-week interval 2 mL US guidance | 22 (9 M/13 F) 73.62 ± 7.87 | |||||
Doria C. 2017 [29] | RCT | PRP | NR | 3 injections 1-week interval 5 mL US guidance | 40 (NR) 67.3 ± 5.8 | 12 m | 68 | PRP did not offer significantly better results compared with HA in patients with moderate signs of OA. |
HA | HA (Hyalubrix 15 mg/mL) | 3 injections 1-week interval NR US guidance | 40 (NR) 68 ± 4.6 | |||||
Singh JR. 2019 [24] | Retrospective Case Series | PRP | LP-PRP No activation | Single injection 6 mL IA + 1 mL extracapsular US or fluoroscopy guidance | 36 (12 M/24 F) 66.0 ± 12.1 | 6 m | 51 | In patients with mild/moderate hip OA, PRP may provide pain relief and functional improvement for up to 6 months. |
Ortiz-Declet V. 2020 [25] | Prospective Case Series | PRP | LP-PRP Plts: 2–3 times the level of WB | 3 injections 1-week interval 4–7 mL US guidance | 9 (4 M/5 F) 51.3 ± 9.4 | 12 m | 61 | Patients with early hip OA had significant improvements up to 12 months after PRP injections. |
Villanova- López MM. 2020 [30] | RCT | PRP | LR-PRP Plts: 2.22 times the level of WB Leukocytes: 3.87 ± 2.11 × 103/μL | Single injection 6 mL US guidance | 38 (14 M/24 F) 61.2 ± 9.72 | 12 m | 70 | PRP is as effective and safe as those of HA for the treatment of hip OA in its initial stages. |
HA | HA (Synvisc-One® 60 mg/6 mL) | Single injection 6 mL US guidance | 36 (19 M/17 F) 61.1 ± 12.3; | |||||
Kraeutler MJ. 2021 [31] | RCT | PRP | LP-PRP Activation: Ca chloride. Plts: 2–3 times the level of WB No leukocytes | 3 injections 1-week interval 4–8 mL PRP No guidance | 19 (8 M/10 F) 53.3 ± 8.4 | 24 m | 79 | LP-PRP resulted in an improvement in WOMAC scores and hip internal rotation at 6 months and delayed the need for THA compared with treatment with LMW-HA. |
HA | Na-HA (Supartz; 10 mg/2.5 mL) | 3 injections 1-week interval 2.5 mL PRP No guidance | 15 (10 M/3 F) 53.6 ± 7.6 | |||||
Palco M. 2021 [32] | Retrospective Comparative Study | LR-PRP | LR-PRP Plts: 370,000/μL Leukocytes: 4 × 103/μL | 2 injections 2 weeks interval 5 mL US guidance | 26 (16 M/10 F) 50.62 ± 16.14 | 12 m | 57 | Both treatments are effective at reducing pain in the short to medium term. LR-PRP could be the treatment of choice due to a more marked effect over time. |
PRP +HA | Cellular Matrix A-CP-HA centrifugation | 2 injections 2 weeks interval 5 mL (3 mL PRP + 2 mL HA) US guidance | 26 (12 M/14 F) 64.81 ± 10.81 | |||||
Mazzotta A. 2022 [33] | Prospective Comparative Study | C-PRP | LR-PRP Activation: Ca-gluconate (10%) Plts increased by 4–5 times vs. the baseline mean plts concentration of 1000 × 109/L ± 20% | 3 injections 1-week interval 5 mL US guidance | 50 (26 M/20 F) 47 ± 11.9 | 12 m | 63 | C-PRP is a safe approach for the treatment of patients with hip OA, with a low rate of adverse events and failures, although it provided only a mild clinical improvement comparable with A-PRP. |
A-PRP | LR-PRP Activation: Ca-gluconate (10%) Plts increased by 4–5 times vs. the baseline mean plts concentration of 1000 × 109/L ± 20% | 3 injections 1-week interval 5 mL US guidance | 50 (34 M/16 F) 49.5 ± 12.2 |
Author Year | Study Design | Injective Product | Product Manufacturing and Characteristics | Injection Schedule and Amount | Patients (Sex) Age Mean + SD | Final F-up | mCMS | Results |
---|---|---|---|---|---|---|---|---|
Emadedin M. 2015 [34] | Prospective Case Series | BM-MSC | Autologous Harvest from both iliac crests Expanded Characterized for membrane markers Tested for possible microbial contamination | Single injection 10 mL Fluoroscopy guidance | 6 (NR) NR | 30 m | 51 | BM-MSC injection is safe and therapeutically beneficial in patients with hip OA. |
Mardones R. 2017 [35] | Prospective Case Series | BM-MSC | Autologous Harvest form posterior iliac crest Expanded Characterized for membrane markers Tested for possible microbial contamination | 3 injections 1-week interval NR No guidance | 10 (5 M/5 F) 54.7 | 40 m | 54 | The IA injection of 3 consecutive weekly doses of expanded autologous BM-MSC proved to be a safe and clinically effective in patients with hip OA. |
Rodriguez- Fontan F. 2018 [36] | Prospective Case Series | BMAC | Autologous Harvest from the anterior iliac crest Not expanded BioCUE Platelet Concentration System | Single injection 12 mL US or RX guidance | 13 (NR); 58 ± 12.7 (also knee) | 24 m | 54 | IA injections of BMAC were safe and demonstrated satisfactory results for the treatment of early hip OA. |
Dall’Oca C. 2019 [37] | Retrospective Case Series | MF-AT | Autologous Harvest from abdominal wall adipose tissue Not expanded Lipogems® system | Single injection 5–10 mL Fluoroscopy guidance Traction | 6 (5 M/1 F) 52 (37–60) | 6 m | 42 | MF-AT injection provided a significant clinical improvement in patients with early hip OA. |
Whitney KE. 2020 [38] | Prospective Case Series | BMAC | Autologous Harvest from the posterior iliac crest Not expanded Hematology analysis | Single injection 6–12 mL US guidance | 21 (7 M/9 F) 57.6 ± 11 | 6 m | 57 | A single BMAC injection can significantly improve subjective pain and function scores up to 6 months in patients with symptomatic hip OA. |
Burnham R. 2021 [39] | Prospective Case Series | BMAC | Autologous Harvest from the posterior iliac crest Not expanded | Single injection 8–10 mL US guidance | 30 (64 M/48 F) 64.1 ± 9.1 | 12 m | 60 | Hip OA treated with a single BMAC injection resulted in significant improvements in pain, disability, and quality of life with a low complication rate. |
Meadows MC. 2021 [40] | Prospective Case Series | ASA | Homologous Not expanded | Single injection 4 mL US guidance | 10 (5 M/4 F) 54.2 ± 6.0 | 12 m | 53 | Promising results for relief of pain and improvement in patient-reported outcomes with IA ASA in patients affected by hip OA. |
Heidari N. 2022 [41] | Prospective Comparative Study | MF-AT | Autologous Harvest from abdominal wall adipose tissue Lipogems® system | Single injection 6 mL US guidance | 57 (21 M/36 F) 60 | 12 m | 59 | Positive role for IA injection of MF-AT + PRP as a treatment for hip OA which may be important particularly in low BMI patients where the difficulty in obtaining sufficient MF-AT. |
MF-AT + PRP | LP-PRP Activation: Ca-chloride Rich in plts | Single injection 6ml (4 mL MF-AT + 2 mL PRP) US guidance | 90 (53 M/37 F) 60 |
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Zaffagnini, M.; Boffa, A.; Andriolo, L.; Raggi, F.; Zaffagnini, S.; Filardo, G. Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review. J. Clin. Med. 2022, 11, 6663. https://doi.org/10.3390/jcm11226663
Zaffagnini M, Boffa A, Andriolo L, Raggi F, Zaffagnini S, Filardo G. Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review. Journal of Clinical Medicine. 2022; 11(22):6663. https://doi.org/10.3390/jcm11226663
Chicago/Turabian StyleZaffagnini, Marco, Angelo Boffa, Luca Andriolo, Federico Raggi, Stefano Zaffagnini, and Giuseppe Filardo. 2022. "Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review" Journal of Clinical Medicine 11, no. 22: 6663. https://doi.org/10.3390/jcm11226663
APA StyleZaffagnini, M., Boffa, A., Andriolo, L., Raggi, F., Zaffagnini, S., & Filardo, G. (2022). Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review. Journal of Clinical Medicine, 11(22), 6663. https://doi.org/10.3390/jcm11226663