KNEE OSTEOARTHRITIS TREATED WITH MESENCHYMAL STEM CELLS ARTHROSCOPY AND PHYSIOTHERAPY: EVALUATION WITH WHOQOL
Keywords:
OA, MSC, Arthroscopy, WHOQOL-BREF, QoLAbstract
Introduction: Osteoarthritis (OA), a degenerative joint disease, affects the quality of life (QoL). Although there are various therapy options, no existing therapy fully restores cartilage tissue. Mesenchymal stem cells (MSC) arthroscopy has emerged as a promising treatment. Impact of MSC arthroscopy with physiotherapy on patients' QoL requires further study.
Aim: This study examined the effects of MSC arthroscopy, combined with an eight-week standard physiotherapy regimen, on QoL in knee OA patients, with a focus on gender- and age-related differences.
Material and methods: This mono-centric clinical study involved 35 knee OA patients (aged 45-65, both genders) treated with MSC arthroscopy and physiotherapy. QoL was assessed pre- and post-treatment using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), focusing on physical health, psychological health, social health and environmental health domains. Additionally, the influence of age and gender on treatment efficacy was analyzed to understand demographic impacts on therapeutic response.
Results: The average WHOQOL-BREF score after the treatment in male patients presented better condition compared to the female in individual domains and for WHOQOL-BREF total. The physical health domain showed the greatest improvement followed by the psychological health domain. Younger age was associated with better outcomes in QoL.
Conclusion: The results of the study show MSC arthroscopy therapy in combination with physiotherapy for managing knee OA a promising treatment approach showing significant improvement in QoL. However, further research is needed to understand long-term effects and optimize the treatment of patients with diverse demographic backgrounds.
References
Raposo F, Ramos M, Lúcia Cruz A. Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal Care 2021; 19(4): 399-435. doi: 10.1002/msc.1538.
Leifer VP, Katz JN, Losina E. The burden of OA-health services and economics. Osteoarthritis Cartilage 2022; 30(1): 10-16. doi: 10.1016/j.joca.2021.05.007.
Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med 2019; 53(15): 940-947. doi: 10.1136/bjsports-2017-098661.
Segal NA, Nilges JM, Oo WM. Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics. Osteoarthritis Cartilage 2024; 32(9): 1045-1053. doi: 10.1016/j.joca.2024.04.002.
Huang L, Guo B, Xu F, Zhao J. Effects of quadriceps functional exercise with isometric contraction in the treatment of knee osteoarthritis. Int J Rheum Dis 2018; 21(5): 952-959. doi: 10.1111/1756-185X.13082.
Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med 2016; 59(3): 134-138. doi: 10.1016/j.rehab.2016.01.006.
Jeong HS, Lee SC, Jee H, Song JB, Chang HS, Lee SY. Proprioceptive Training and Outcomes of Patients With Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. J Athl Train 2019; 54(4): 418-428. doi: 10.4085/1062-6050-329-17.
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol 2020; 72(2): 220-233. doi: 10.1002/art.41142.
Zampogna B, Papalia R, Papalia GF, Campi S, Vasta S, Vorini F, et al. The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9(4): 1167. doi: 10.3390/jcm9041167.
Sluka KA, Berkley KJ, O'Connor MI, Nicolella DP, Enoka RM, Boyan BD, et al. Neural and psychosocial contributions to sex differences in knee osteoarthritic pain. Biol Sex Differ 2012; 3(1): 26. doi: 10.1186/2042-6410-3-26.
Pan Q, O'Connor MI, Coutts RD, Hyzy SL, Olivares-Navarrete R, Schwartz Z, et al. Characterization of osteoarthritic human knees indicates potential sex differences. Biol Sex Differ 2016; 7: 27. doi: 10.1186/s13293-016-0080-z.
National Institute for Health and Care Excellence (NICE). Osteoarthritis: care and management [Internet]. London: NICE; 2020
Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2020; 54(5): 263-271. doi: 10.1136/bjsports-2018-099683.
Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, et al. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine (Baltimore) 2018; 97(52): e13823. doi: 10.1097/MD.0000000000013823.
Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clin Rehabil 2017; 31(5): 596-611. doi: 10.1177/ 0269215517691084.
Wei P, Bao R. Intra-Articular Mesenchymal Stem Cell Injection for Knee Osteoarthritis: Mechanisms and Clinical Evidence. Int J Mol Sci 2022; 24(1): 59. doi: 10.3390/ijms 24010059.
Xiang XN, Zhu SY, He HC, Yu X, Xu Y, He CQ. Mesenchymal stromal cell-based therapy for cartilage regeneration in knee osteoarthritis. Stem Cell Res Ther 2022; 13(1): 14. doi: 10.1186/s13287-021-02689-9.
Xia P, Wang X, Lin Q, Li X. Efficacy of mesenchymal stem cells injection for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop. 2015; 39(12): 2363-2372. doi: 10.1007/s00264-015-2785-8.
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998; 28(3): 551-558. doi: 10.1017/ s0033291798006667.
Shane Anderson A, Loeser RF. Why is osteoarthritis an age-related disease?. Best Pract Res Clin Rheumatol 2010; 24(1): 15-26. doi: 10.1016/j.berh.2009.08.006.
Zhu C, Wu W, Qu X. Mesenchymal stem cells in osteoarthritis therapy: a review. Am J Transl Res 2021; 13(2): 448-461. PMID: 33594303.
Freitag J, Bates D, Wickham J, Shah K, Huguenin L, Tenen A, et al. Adipose-derived mesenchymal stem cell therapy in the treatment of knee osteoarthritis: a randomized controlled trial. Regen Med 2019; 14(3): 213-230. doi: 10.2217/rme-2018-0161.
Partan RU, Putra KM, Kusuma NF, Darma S, Reagan M, Muthia P, et al. Umbilical Cord Mesenchymal Stem Cell Secretome Improves Clinical Outcomes and Changes Biomarkers in Knee Osteoarthritis. J Clin Med 2023; 12(22): 7138. doi: 10.3390/jcm12227138.
Song Y, Zhang J, Xu H, Lin Z, Chang H, Liu W, et al. Mesenchymal stem cells in knee osteoarthritis treatment: A systematic review and meta-analysis. J Orthop Translat 2020; 24: 121-130. doi: 10.1016/j.jot.2020.03.015.
Papakostidou I, Dailiana ZH, Papapolychroniou T, Liaropoulos L, Zintzaras E, Karachalioset ST, et al. Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord 2012; 13: 116. doi: 10.1186/1471-2474-13-116.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013; 111(1): 52-58. doi: 10.1093/bja/aet127.
Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, et al. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med 2012; 15(7): 422-428. PMID: 22724879.
Garay-Mendoza D, Villarreal-Martínez L, Garza-Bedolla A, Pérez-Garza DM, Acosta-Olivo C, Vilchez-Cavazos F, et al. The effect of intra-articular injection of autologous bone marrow stem cells on pain and knee function in patients with osteoarthritis. Int J Rheum Dis 2018; 21(1): 140-147. doi: 10.1111/1756-185X.13139.
Vega A, Martín-Ferrero MA, Del Canto F, Alberca M, García V, Munar A, et al. Treatment of knee osteoarthritis with allogeneic bone marrow mesenchymal stem cells: a randomized controlled trial. Transplantation 2015; 99(8): 1681-1690. doi: 10.1097/TP.0000000000000678.
Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, et al. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation 2013; 95(12): 1535-1541. doi: 10.1097/TP.0b013e318291a2da.
