1. 2024;27;E1033-E1044Clinical Response to Joint Infiltration With Bone Marrow Aspirate in Hip Osteoarthritis: A Systematic Review and Single-arm Meta-analysis
   Systematic Review
   Michael Silveira Santiago, MD, Fernanda Valeriano Zamora, MD, Elcio Machinski, ., Andre Richard da Silva Oliveira Filho, ., Mariana Taina Oliveira de Freitas, ., Deivyd Vieira Silva Cavalcante, BPH, Felipe da Fonseca Delmondes, MD, and Rosana Cipolotti, MD, PhD.

BACKGROUND: Hip osteoarthritis is a joint disease that causes  worsening pain and inhibits activities of daily living. Due to poor pain control and the function of usual clinical treatment, joint infiltration with orthobiologics is a therapeutic alternative. Among these, bone marrow aspirate (BMA) represents a cellular therapy with promising clinical results.

OBJECTIVE: Our study aimed to assess the clinical response of joint infiltration with BMA for hip osteoarthritis.

STUDY DESIGN: We conducted a systematic review and meta-analysis of the main outcomes in hip osteoarthritis after infiltration with BMA and bone marrow concentrate (BMC).

METHODS: We systematically searched PubMed, Embase, Cochrane, and Science Direct for studies evaluating patients with hip osteoarthritis who received joint infiltration with BMA or BMC. In the absence of studies with a control group, we performed a pairwise meta-analysis comparing results of a single group at follow-up vs baseline.

RESULTS: We included 4 studies with improvement in Numeric Rating Scale pain scores associated with BMA or BMC therapy at 3 months (mean difference [MD], -3.48 points; 95% CI, -5.81 to -1.15), 6 months (MD, -3.25 points; 95% CI, -4.07 to -2.42), and 12 months (MD, -2.79 points; 95% CI, -3.83 to -1.74). There was also  a significant improvement in measurable quality of life through validated questionnaires at 3 months (standardized mean difference [SMD], -0.91; 95%, CI -1.59 to -0.23), 6 months (SMD, -1.38; 95% CI, -1.79 to -0.98), and 12 months (SMD, -1.30; 95% CI, -2.44 to -0.16).

LIMITATIONS: Among our study’s limitations is the lack of a randomized controlled trial in the meta-analysis.  Also, since there was no comparator, we could not conduct a pairwise meta-analysis. Finally, the small sample size  limits the generalization of the findings.

CONCLUSION: In this meta-analysis, joint infiltration with BMA or BMC was associated with an improvement in pain and quality of life in patients with hip osteoarthritis. Further randomized studies are needed to improve the quality of evidence.

KEY WORDS: Hip osteoarthritis, bone marrow aspirate, bone marrow concentrate