Orthobiologics in the treatment of hip disorders

Table 1 Clinical studies regarding the use of orthobiologics for hip disorders

Ref.	Groups	Follow-up	Results
Battaglia et al[84]	IA–HA (n = 50) vs PRP (n = 50)	12 mo	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
Pogliacomi et al[85]	HA (n = 226), 2500 kDa	12 mo	Scores improvement, but Kellgren-Lawrence stage 2 patients exhibited most benefit. Nevertheless, the number of applications and molecular weight of the injected products are subject to debate
Clementi et al[86]	HA single high-molecular weight (n = 27), two-shot medium molecular weight (n = 23)	12 mo	A single dose of high molecular weight was as effective as two doses of medium molecular weight resulting in similar reductions in pain and disability
Dallari et al[87]	HA (n = 36), PRP (n = 44), HA + PRP (n = 31)	12 mo	IA PRP injections offer a significant clinical improvement in these patients, without side effects, verified by scores. The best results were achieved with PRP used as monotherapy and remained stable up to 12 mo. The addition of HA to PRP did not lead to a significant improvement in pain symptoms
Fitzpatrick et al[88]	LR-PRP (n = 40), corticosteroid injection (n = 40)	24 mo	Favorable results from baseline for 6 wk only for cortisone, whereas LR-PRP ultrasound-guided applications continued improvement for up to 15 mo.
Houdek et al[89]	PRP + BMAC with core decompression of the hip	24 mo	Improvement in pain and function with the injection of BMAC and PRP. During follow-up (2 years), more than 90% of hips were collapse-free. Successful results were more evident when nucleated cell count was high and modified Kerboul grade was low
Hernigou et al[58]	BMAC adjunct to core decompression (n = 189)	5 yr	Results showed that patients in early stages (Steinberg I-II) had excellent outcomes at 5 years, only 6.2% of the hips requiring total hip arthroplasty. On the other hand, patients in advanced stages (Steinberg III-IV) had poor outcomes, with 60% requiring total hip arthroplasty (THA). Positive relationship between the clinical outcomes and the number of progenitor cells
Einhorn et al[59]	BMAC adjunct to core decompression (n = 52)	24 mo	Minimization of pain, preservation of joint function, and obviation or at least a delay in the need for THA with 2 years of follow-up. In this study 62-75% of CD-BMAC recipients avoided the need for additional interventions, including THA
Freitag et al[83]	AD-MSC single injection (100 × 106 cells) (n = 10), AD-MSC two injections (100 × 106 cells) (n = 10), control-conservative treatment (n = 10)	12 mo	Both treatment groups receiving AD-MSCs showed clinically significant pain and functional improvement at completion of follow-up at 12 mo (Numeric Pain Rating Scale and WOMAC, as well as KOOS). Radiological analysis using MRI indicated modification of disease progression
Mardones et al[81]	BM-MSC a unique dose (40 × 106 cells), preceding core decompression (n = 5), hydroxyapatite or a calcium phosphate plug was placed immediately after cell instillation	19-54 mo	After the follow-up period all patients had significantly improved hip function and markedly reduced pain intensity. As a corollary, no patient required hip arthroplasty
Mardones et al[82]	BM-MSC 20 × 106 cells n = 7, mild OA	8-14 mo	All patients’ symptoms improved over the follow-up period of 10 mo (8–14 mo). Average Vail-10 and Modified Harris Hip Scores for all patients showed significant improvement at 3 and 6 mo. None of the patients required a total hip replacement at the time
Zhao et al[7]	BM-MSC 2 × 106 autologous cells (n = 50), CD (n = 50)	60 mo	In comparison with CD, the cell treated group showed a significant improvement in the Harris hip score, as well as a decrease in the volume of femoral head and no complications were observed in either group. The authors concluded that ex vivo expansion of autologous BM-MSC provides a greater number of cells; it is safe and effective in delaying and avoiding FH collapse

IA: Intra articular; HA: Hyaluronic acid; PRP: Platelet-rich plasma; OA: Osteoarthritis; LR-PRP: Leukocyte-rich platelet-rich plasma; BMAC: Bone marrow aspirate concentrate; CD: Core decompression; THA: Total hip arthroplasty; AD-MSC: Adipose-derived mesenchymal stem cell; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; BM-MSC: Bone marrow-derived mesenchymal stem cell; KOOS: Knee injury and Osteoarthritis Outcome Score.