The role of orthobiologics in hip preservation surgery

Abstract

The potential regenerative role of different orthobiologics is becoming more recognized for the treatment of chronic and degenerative musculoskeletal conditions. Over the last few years there has been an increasing number of publications on cell therapy and other orthobiologics for the treatment of avascular necrosis of the femoral head and other hip conditions with promising short–term clinical results. In this article, we have used a systematic search of the literature to identify potentially relevant topics on orthobiologics and then selected those most applicable to hip preservation surgery. We identified several innovative strategies and present a summary of the currently available evidence on their potential role in hip preservation surgery. For many of these treatment strategies there was a lack of clinical evidence and therefore we suggest that there is a need for comparative studies in this field.

The role of cell therapies and hip arthroscopy in the management of osteonecrosis: an update

“…that no appropriately powered randomized trials comparing different surgical techniques exist. Another difficulty to allow safe conclusions to be drawn is that patients are evaluated using different classifications systems [ 3 , 31 ] preoperatively and evaluation outcomes postintervention.…”

“…These studies for the treatment group report variations in the source of cells, method of cell processing, cell characterization, quantitative and qualitative assessment of the cells used, surgical method of implantation, adjuvant therapies (i.e. use of structural graft), patient cohorts (age, etiology of ON), ONFH classification and the outcome measures used [ 3 , 12 , 31 , 55 ].…”

Patient Perspectives on Use of Stem Cells to Treat Osteoporosis

“…Therapeutic approaches using Mesenchymal Stem Cells (MSCs) are currently under investigation for several conditions including stroke, multiple sclerosis and diabetes amongst many others [12,13]. In recent years, exploration in the use of MSCs for orthopaedic applications has increased dramatically [14].…”

“…Orthobiologic therapy is a rapidly advancing field, which utilises cell-based therapies and biomaterials to promote bone healing and offers exciting alternatives to traditional treatment options for improving the long-term health of patients suffering from disabling musculoskeletal disorders [14,15]. Although human MSCs in bone marrow are known to decrease with age, MSCs can be expanded under culture conditions and expanded MSCs from older patients can retain effective osteogenic differentiation capacity [16].…”

So it is time

“…Our journal seems only to get better. Have a look at the review by Alshameeri and McCaskie on the role of orthobiologics in hip preservation surgery [ 3 ], which I am certain is an area destined for massive development. As for the reliability of evidence at the Annual Scientific Meeting of the International Society for Hip Arthroscopy (ISHA), a society that is very close to your Editor-in-Chief’s heart, this has been looked at by Kay et al [ 4 ] in this issue and I am delighted to see that the level of evidence has steadily improved over the years.…”