Regenerative medicine remains a promising field for management of osteoarthritis. The rate of publication for regenerative medicine interventions continues to grow at an exponential rate. Within the last year or two there have been some landmark studies that support use of regenerative treatments and encourage further research given promising early results. Regenerative medicine remains early in its development as a specialty. Studying regenerative interventions in knee osteoarthritis remains the most predominant form of research as knee arthritis is the number one cause of limb debilitation in arthritis patients.
Hernigou et al. published very compelling research comparing total knee replacement vs intra-osseous bone marrow aspirate concentrated (BMAC) stem cells in one study, and intra-articular BMAC vs intra-osseous BMAC in another study. These were 15 year prospective studies which is very impressive in its own right, and they were able to perform a different intervention on each knee in the same patient. In other words, a patient’s left knee would get one treatment, and the patient’s other knee would get a different treatment. This is useful to eliminate interpatient variability. These studies demonstrated that Intraosseous BMAC resulted in similar improvements in pain, function, and similar need for subsequent surgery compared to TKA on contralateral knee. In other words, the rate of a TKA needing revision was the same as the rate of a BMAC case needing conversion to a TKA. The average patient age was 75 years old. This suggests viability of this intra-articular BMAC as an alternative in many cases to TKA.
There were also studies comparing BMAC vs platelet rich plasma vs hyaluronic acid published within the last year, for both hips and knees. Authors included Nouri, Dulic, and El-Kadiry. While studies were mixed in terms of whether intra-articular PRP vs BMAC were superior, there was consistency in demonstrating superiority of regenerative injections by PRP or BMAC as compared to hyaluronic acid.
Studies were performed evaluating the promise of regenerative injections to augment surgical interventions in shoulders and knees. Authors included Schoch and Forsythe. There is evidence that ligamentous and tendon grafts in both shoulder surgeries and knee surgeries benefit from intra-operative as well as postoperative supplementation with PRP or BMAC. Improvements include marked reduction in failure of the grafts, imaging evidence for stronger graft to bone healing, and improved pain at various points in time.
Finally, evidence for regenerative medicine in spine pain was published in 2022 that provides a practical guide for performing injections in complex degenerative spine disease. Degenerative spine disease is one of the leading causes of disability in the country. Studies that provide evidence for a protocol that is safe and easy to replicate from a practical standpoint are quite valuable. Aluri et al published such a study which compared BMAC injections in the SIJ, facets, epidural space, or intradiscal space (depending on physical exam findings) vs standard therapy including medications, opioids, physical therapy, and steroid injections. It found superiority in both pain and function with a single BMAC injection session compared to standard therapy at multiple time points up to one year.
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