New data on fat cells as a treatment of early stage hip osteoarthritis
Osteoarthritis will become more and more common in the future since the average life span is growing, and it is already one of the main causes of disability in the elderly and ageing population. After the knee, the hip is the second most affected joint of this condition. The cartilage in the hip joint gradually wears away over time and as it becomes frayed and rough, the protective joint space between the bones decreases. This leads to the excruciating pain of bone rubbing away on bone. It can also lead to the damaged bones growing outwards and forming bone spurs.
The lifetime risk to develop osteoarthritis in people who live to 85 years of age is 25% (1 in 3 people), and factors also include age, sex, and genetic make up. The most common reason for OA, however, is caused through wear and tear and stress on the joint.
Lower limb joints are subjected to repeated stress through use and heavy load and weight bearing of an individual. Daily activities such as walking, running, jumping, lifting, can cause classic and common wear and tear damage to the cartilage and joint itself. This is more apparent in those who carry more weight, or who are involved in high intensity sporting activities or prolonged heavy manual labour. All of these can lead to microtraumas and structural damage of the joint.
Articular cartilage (the smooth white tissue that covers the ends of bones where they come together to form joints. It allows bones to glide over each other reducing friction) does not easily regenerate once damaged due to lack of blood vessels, and the inflammation of the synovial leads to joint pain,tenderness and swelling.
The first line treatment for hip pain has always included a course of traditional anti-inflammatory such as NSAIDS with a combination of different physical therapies to help strengthen the surrounding muscles and create better support. Intra-articular hip joint corticosteroids or hialuronic acid injections are also used but they have actually proved to slow progression. These injections are a combination of steroid and local anaesthetic injected directly into the hip joint to reduce inflammation of tissue and reduce swelling and pain but are not always effective. Operative treatments such as Chondroplasty (surgical procedure to remove damaged cartilage in a joint. It is very often performed during an arthroscopic ,examination through a microscope, procedure to examine a painful joint), or micro fracturing (a surgical technique that has been developed to treat chondral defects, which are damaged areas of articular cartilage of the knee) are ineffective and hip arthroplasty and replacement can be premature in early onset osteoarthritis and should only be used as a last resort.
Lipogems® – the knee already a success!
Lipogems® adipose tissue stem cell therapy is when small amounts of fatty (adipose) tissue are taken from areas of the body,such as the stomach or the thighs. Using a special process, cells are extracted from this tissue and injected into the area of the body that has become damaged through wear and tear, injury or disease, such as the knee.Adipose tissue therapy can be used as an additional treatment alongside orthopaedic procedures to help bone and tissue healing.
Fat plays a number of roles in our body, including how we heal. The cells that are stored in body fat (or adipose tissue) are able to respond to problems in other areas of the body that are causing pain or dysfunction, proving to be natural tools to help with healing and regeneration.
The Lipogems® process enables MSCs (mesenchymal stem cells) taken from the patient’s own fatty tissue to be injected directly into sites of tissue damage, boosting their local presence and aiding recovery. In this method adipose tissue is proven to have anti inflammatory qualities and the MSCs to have the capacity to self renew by dividing and developing into multiple specialised cell types present in a specific tissue.
In the last few years this technique with MSCs, harvested from abdominal adipose (fat) tissue has been used and developed to halt the progression from osteoarthritis (OA).
The use of Lipogems® has already been proven successful in knee with mild and moderate OA thanks to its feasibility and adipose tissue manipulation and the ability for self renewal by the MSCs.
Decreased pain was reported in multiple studies associated with improved clinical functional scores and at the mid term follow up. No adverse effects from the procedure have been reported and 28 articles have since been published with reference to 584 patients undergoing treatment. It concludes that MSC therapy and Lipogems® is not only safe but has clear positive clinical outcomes.
New modern techniques have been developed with advanced cell based therapies and are already proving to be effective in knee treatment- can it do the same for hip?
Between June 2017 and June 2018, 6 patients affected by hip OA were treated with an intra- articular injection of autologous adipose-derived mescenchymal stem cells. The average age was 52 years old( patient age ranged from 37-60 years old) and were comprised of 5 male patients and 1 female patient.
All operations were performed by the same surgeon and the selection criteria was clear:
- The patient had to be experiencing constant hip pain that was proving resistant to all NSAIDs in the last 6 months or more.
- Functional movement should be limited and there should have been failure of conventional treatments.
- Patients with recent hip trauma or high graded OA were excluded.
Before treatment all patients underwent a thorough clinical examination including a standard X ray and pain questionnaire and pre operative scores were taken.
Patients were placed in the supine (lying horizontally with the face and torso facing up) position on a standard fracture table with traction applied to the lower limbs. The abdomen was chosen as the donor site for the adipose tissue harvesting. 7-10 minutes were awaited before the adipose tissue was aspirated and 60cc of harvested fat was obtained and used in the Lipogems® process. Around 5-10 ml of the final adipose tissue was injected into the affected hip area.
All procedures were performed in the same surgical state and all patients were discharged and home on the first post operative day. There would be no weight bearing for 7-10 days until normal walking could resume and each patient was granted immediate flexion and extension of the hip itself. Painkillers could be taken as needed and icing for 20 minutes, 4 times a day. An abdominal compression binder was worn for 20 days and the suture was removed 15 days post op.
In order to fathom the results, Pre and Post operative scoring took place and were collected. These pertained to pain, the function, and the range of motion.
The scoring was as below:
<70 = poor 70-80= fair 80-90= good 90+= excellent The collective Pre operative average score was 67.2 in 5 patients and 70-90 in 1.
The hip injections significantly improved clinical scoring.
The Post operative scores were 70-79 in 2 patients (fair) 80-89 in 3 patients (good) and >90 in 1 patient (excellent).
No patients worsened at all and all patients improved post op. One patient had an organised hematoma on the abdomen after harvesting the adipose tissue , but no patient underwent any complications or side effects.
There are three distinct advantages in the Lipogems® process for the hip – it acts as a natural inflammatory, it has an early mechanical easing effect due to its large lubricating capacity and the MSC can target specific tissue and regenerate. The MSC restores balance in the affected joint and less material is actually needed to inject into the hip as the volume of the hip joint is smaller than that of the knee.
The results from this trial shows that the injection of autologous and Microfragmented adipose tissue is a safe and effective treatment for the early phases and treatment of hip osteoarthritis, there are no adverse side effects and there are positive clinical outcomes.
Osteoarthritis is a chronic, progressive, and debilitating condition. Any treatment should be looking to reduce pain, increase motion and improve the quality of life for a patient. Lipogems® and the use of MSC injections not only improved clinical scores for these patients but it will prove to be an effective future tool to combat early onset OA. The procedure is simple, economic, quick, minimally invasive, and the future.