Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Reale, Davide; Feltri, Pietro; Franceschini, Marco; Girolamo, Laura de; Laver, Lior; Magalon, Jérémy; Sánchez, Mikel; Tischer, Thomas; Filardo, Giuseppe

doi:10.1007/s00167-023-07469-x

Cited by 6 publications

(1 citation statement)

References 110 publications

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“…In this light, it would be better to bring an increasing number of patients up to an age where their life expectancy matches the longevity of joint replacement [68]. To this end, several alternative less invasive approaches have been developed with promising results, ranging from the more documented treatments like intra‐articular injections and osteotomies [59], to new experimental options like subchondral bone injections, intra‐articular spacers, and implantable shock absorbers [35, 51, 71]. Still, the available strategies to postpone metal resurfacing do not seem able to contrast the increase in prosthetic replacements.…”

Section: Introductionmentioning

confidence: 99%

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

De Marziani,

Boffa,

Di Martino

et al. 2023

J. exp. orthop.

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Purpose The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA). Methods A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis-Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options. Results Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub-analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects. Conclusions This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.

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Section: Introductionmentioning

confidence: 99%

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

De Marziani,

Boffa,

Di Martino

et al. 2023

J. exp. orthop.

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Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

Solaro,

Andriolo,

Di Martino

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to prospectively evaluate the long‐term clinical results and failure rate of patients treated with complex salvage procedures using a combined mechanical and biological approach to address unicompartmental knee osteoarthritis (OA) and postpone the need for joint replacement.MethodsThirty‐nine patients (40.3 ± 10.9 years old) affected by unicompartmental OA (Kellgren–Lawrence 3) in stable joints underwent a personalized surgical treatment depending on the specific requirements of the affected compartment, including high tibial osteotomy, osteochondral scaffold, meniscal scaffold and meniscal allograft transplantation. Patients were evaluated with the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS) and Tegner scores before surgery, at 3 years and a minimum of 10 years of follow‐up.ResultsA significant improvement was observed over time in all scores but worsened at the final follow‐up. The IKDC subjective score improved from 46.9 ± 16.2 to 79.8 ± 16.4 at 3 years (p < 0.0005) and then decreased to 64.5 ± 21.4 (p = 0.001) at 12 years. A similar trend was confirmed for VAS and Tegner scores. Only two patients subsequently underwent knee arthroplasty, and nine more patients were considered clinical failure, for a cumulative surgical and clinical failure rate of 28.2% at the final follow‐up.ConclusionA personalized, joint‐preserving, combined mechanical and biological approach, addressing alignment as well as meniscal and cartilage lesions, is safe and effective, providing a clinical benefit and delaying the need for arthroplasty in young patients affected by unicompartmental knee OA. At the final evaluation, the clinical improvement decreased, but more than two‐thirds of the patients still benefited from this treatment at a long‐term follow‐up.Level of EvidenceLevel IV case series.

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Cell‐based therapies have disease‐modifying effects on osteoarthritis in animal models: A systematic review by the ESSKA Orthobiologic Initiative. Part 3: Umbilical cord, placenta, and other sources for cell‐based injectable therapies

Sourugeon,

Boffa,

Perucca Orfei

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis systematic review aimed to investigate in animal models the presence of disease‐modifying effects driven by non‐bone marrow‐derived and non‐adipose‐derived products, with a particular focus on umbilical cord and placenta‐derived cell‐based therapies for the intra‐articular injective treatment of osteoarthritis (OA).MethodsA systematic review was performed on three electronic databases (PubMed, Web of Science and Embase) according to PRISMA guidelines. The results were synthesised to investigate disease‐modifying effects in preclinical animal studies comparing injectable umbilical cord, placenta, and other sources‐derived products with OA controls. The risk of bias was assessed using the SYRCLE tool.ResultsA total of 80 studies were included (2314 animals). Cell therapies were most commonly obtained from the umbilical cord in 33 studies and placenta/amniotic tissue in 18. Cell products were xenogeneic in 61 studies and allogeneic in the remaining 19 studies. Overall, 25/27 (92.6%) of studies on umbilical cord‐derived products documented better results compared to OA controls in at least one of the following outcomes: macroscopic, histological and/or immunohistochemical findings, with 19/22 of studies (83.4%) show positive results at the cartilage level and 4/6 of studies (66.7%) at the synovial level. Placenta‐derived injectable products documented positive results in 13/16 (81.3%) of the studies, 12/15 (80.0%) at the cartilage level, and 2/4 (50.0%) at the synovial level, but 2/16 studies (12.5%) found overall worse results than OA controls. Other sources (embryonic, synovial, peripheral blood, dental pulp, cartilage, meniscus and muscle‐derived products) were investigated in fewer preclinical studies. The risk of bias was low in 42% of items, unclear in 49%, and high in 9% of items.ConclusionInterest in cell‐based injectable therapies for OA treatment is soaring, particularly for alternatives to bone marrow and adipose tissue. While expanded umbilical cord mesenchymal stem cells reported auspicious disease‐modifying effects in preventing OA progression in animal models, placenta/amniotic tissue also reported deleterious effects on OA joints. Lower evidence has been found for other cellular sources such as embryonic, synovial, peripheral blood, dental‐pulp, cartilage, meniscus, and muscle‐derived products.Level of EvidenceLevel II.

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Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Cited by 6 publications

References 110 publications

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

Cell‐based therapies have disease‐modifying effects on osteoarthritis in animal models: A systematic review by the ESSKA Orthobiologic Initiative. Part 3: Umbilical cord, placenta, and other sources for cell‐based injectable therapies

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