The most common form of arthritis is osteoarthritis (OA) which is mainly due to the loss of cartilage or changed the shape of the head of the femur. OA in the hip can cause pain and affected movements in patients. The incidence of hip OA is 9.2% for men and women above 45 years in the United States. Genetics has been suggested as the incidence of higher hip OA is seen in Caucasians (3-6%) against 1% in Blacks, Native Americans, and Asians. The risk of symptomatic hip OA is 18.5% for men and 28.6% for women, according to the Centres for Disease Control and Prevention.
The current treatment involves surgery that however has several side effects including inefficient operation, infection, dislocation, and sometimes death. Post-surgery, chronic pain was seen in 7% to 23% of patients. This calls for looking at alternatives to surgically treating hip OA. An alternative treatment is using intra-articular corticosteroid (IACS) injections that show pain relief but, have a side effect of damage to the joint cartilage. Another option is non-steroidal anti-inflammatory drugs (NSAID) whose pain relief effect does not go beyond 2 weeks. Some patients also use manual physical therapy that has shown promise to decrease the pain and increase the functions of the hips.
An upcoming treatment approach is the use of bone marrow concentrate (BMC) injections. BMC mainly contains platelets and mesenchymal stem cells (MSCs) along with other factors. A study published in 2017 in the Journal of Hip Preservation Surgery showed that injecting autologous cultured MSCs from BMC in 10 hip OA patients had all the patients reporting a decrease in pain and increased hip functioning.
Another article published in 2018 by Darrow and team in the Clinical medicine insights: Case reports journal reported promising case studies of using 4 successive BMC treatments in hip OA patients with follow-up injections. In the first case, a 75-year-old woman progressive right hip pain for 10 years reported a 60% total overall improvement after 49 days of treatment. An 80% total overall improvement with no pain while resting was seen in a 61-year-old man with chronic hip pain since 2 years after the first injection itself. A 76-year-old man with 7years of chronic hip pain and has previously undergone a challenging a left hip replacement reported a 65% total overall improvement after the 4 injections. In the fourth case, a 70% total overall improvement was reported by a 56 -year old man with 2 years of hip pain. The overall decrease in resting and active pain was 69.7% and 69%, respectively showing the promise of using stem cells to heal the pain in hip OA and avoiding the requirement of surgery.
A bicentric, uncontrolled, open phase I clinical trial conducted in France and Germany involved the administration of adipose-derived stromal cells (ASCs) in 18 patients with knee OA. While no serious adverse events were recorded, the pain levels were improved showing the safety of stem cells in treating severe knee OA.
According to a review published in the Frontiers in bioengineering and biotechnology, (2019) the direct administration of MSCs in OA patients was shown to be safe, according to Phase I clinical trials. It was also suggested that MSCs cause the healing of OA via a hit-and-run mechanism. The possible mechanism of this relief is attributed to the ability of MSCs to form cartilage cells and replace the damaged cartilage in OA. The role of various factors secreted by the MSCs is also thought to play an important role in the healing process.
Darrow M, Shaw B, Darrow B, Wisz S. Short-Term Outcomes of Treatment of Hip Osteoarthritis With 4 Bone Marrow Concentrate Injections: A Case Series. Clin Med Insights Case Rep. 2018;11:1179547618791574. Published 2018 Aug 10. doi:10.1177/1179547618791574.
Mardones R, Jofré CM, Tobar L, MinguellJJ. Mesenchymal stem cell therapy in the treatment of hip osteoarthritis. J Hip Preserv Surg. 2017 Jul; 4(2):159-163.
Lespasio MJ, Sultan AA, Piuzzi NS, et al. Hip Osteoarthritis: A Primer. Perm J. 2018;22:17–084. doi:10.7812/TPP/17-084
Pers Y. M., Rackwitz L., Ferreira R., Pullig O., Delfour C., Barry F., et al. (2016). Adipose mesenchymal stromal cell-based therapy for severe osteoarthritis of the knee: a phase I dose-escalation trial. Stem Cells Transl. Med. 5, 847–856. 10.5966/sctm.2015-0245.
Mancuso, P., Raman, S., Glynn, A., Barry, F., & Murphy, J. M. (2019). Mesenchymal Stem Cell Therapy for Osteoarthritis: The Critical Role of the Cell Secretome. Frontiers in bioengineering and biotechnology, 7, 9. https://doi.org/10.3389/fbioe.2019.00009