The Operating Theatre Journal April 2022

60% OSTEOARTHRITIS SUFFERERS SHOW IMPROVEMENT IN PAIN
First of a kind study evidences effectiveness of MFAT on pain and improved joint function 2 years after treatment
In a significant discovery for the management of osteoarthritis, a team of
surgeons led by experts in London has found that 60% hip osteoarthritis
patients experienced an improvement in pain over a 2-year period as a
result of micro-fragmented adipose tissue (MFAT) injections.
The study is the largest of its type to be recorded and measures the
effectiveness of micro-fragmented adipose tissue (MFAT) injections,
and separately the combination treatment of MFAT with platelet-rich
plasma (PRP).
The research is a joint project between experts at The Regenerative
Clinic, London, The George Emil Palade University, Romania, Manchester
Metropolitan University, Manchester and University of Ferrara, Italy.
147 patients suffering from grade 1–4 hip osteoarthritis took part in
the study. Hip osteoarthritis (OA) is a major contributor to reduced
quality of life and concomitant disability associated with lost working
life months.
The peer reviewed research has been published in The Journal of
Clinical Medicine in February 2022 and is available as a downloadable
pdf. Key findings are:
• Over 60% patients report an improvement in pain
• This is using both visual analogue score for pain (VAS) and Oxford hip
score (OHS)
• It shows that an intra-articular injection of MFAT + PRP suggest
a positive role for patients with a lower BMI where there may be
difficulty in obtaining sufficient MFAT
• In each of the MFAT and MFAT + PRP groups, only 10 patients went
on to have a total hip replacement as they did not respond to the
treatment. Of these 20, most had higher grades of osteoarthritis (KL
3 and 4)
• No infections or thromboembolic events were observed
• In this first of its kind clinical study, researchers have shown the
efficacy of MFAT and combinational preparation in successful
amelioration of hip pain together with improved joint function in
patients treated with osteoarthritis
• A larger clinical trial is warranted to determine long-term benefits
over 2–5 years, and any gender-related differences in response
Professor Nima Heidari, Consultant Orthopaedic and Trauma Surgeon,
said; “In this first of its kind clinical study, we have shown the efficacy
of MFAT and combinational preparation in successful amelioration of
hip pain together with improved joint function in patients treated with
osteoarthritis. Both types of intra-articular injections were equally
effective in improving pain scores over 6–12 months. We look forward to
a larger clinical trial characterize in detail the effectiveness in patients
with different grades of osteoarthritis, to determine long-term benefits
over 2–5 years, and any osteoarthritis gender-related differences in
response.”
He continues; “This work has provided an insight into the optimal time
period for MFAT treatments to be effective. Some participants went
on to have hip replacement because the hip had deteriorated too far
before MFAT treatment commenced. When hip osteoarthritis is very
advanced, and the femoral head loses its natural spherical shape then
it is unlikely that these kinds of treatments can provide long term
effective pain relief.”
Osteoarthritis (OA) is the most common joint disease, affecting more
than 250 million people worldwide and being the fourth leading cause
of disability in men. Over 95,000 hip replacements are conducted in
the United Kingdom each year, while worldwide the number is over 1
million.
Intra-articular injection of various biological materials has shown
promise in alleviating symptoms and potentially slowing down the
degenerative process. MFAT treatments may offer alternative treatment
pathways for the rejuvenation of osteoarthritic joints, pain reduction,
aiding recovery from surgery or trauma, and as an alternative to joint
replacement or to delay the need for joint replacement.
Micro-fragmented adipose tissue (MFAT) possesses unique biological
properties. The adipose tissue has an innate anti-inflammatory quality
and contains the highest concentration of MSCs of any tissue in the body
(up to 2% of cells sited in the MFAT tissue are MSC compared to a 0.02%
in the bone marrow), being derived from the micro vessel pericytes,
these multipotent cells maintain the capacity to differentiate into
chondrocytes with adequate stimuli.
Patients
The mean patient age at the time of the treatment for the MFAT group
was 60 and for MFAT+ PRP was 60 (Table 1). Both groups had a range
in grade of hip OA of between 1–4 (median 3) on the KL scale and ASA
1–3 (median of 2; Table 2)). The mean BMI for the MFAT group was
29 and for the MFAT+ PRP was 27. Patients were not separated into
different groups for grade of arthritis for the statistical analysis and
power calculations due to the overall small numbers of patients in the
study. A significant number of patients had severe grade 4 OA at the
time of treatment (61/147).
Academic Editors: Diego Delgado and Mikel Sánchez
J. Clin. Med. 2022, 11(4), 1056; https://doi.org/10.3390/jcm11041056
Received: 15 December 2021 / Revised: 14 February 2022 / Accepted:
16 February 2022 / Published: 17 February 2022
Coming Soon – Cambridge University Press
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Fundamentals of Operating Department Practice
2nd Edition
• EDITORS:
• Daniel Rodger, London South Bank University
• Kevin Henshaw, Edge Hill University, Birmingham
• Paul Rawling, Edge Hill University, Birmingham
• Scott Miller, St Helens and Knowsley Hospitals NHS Trust
• PUBLICATION PLANNED FOR: August 2022
• AVAILABILITY: Not yet published - available from August 2022
• FORMAT: Paperback
• ISBN: 9781108819800
10 THE OPERATING THEATRE JOURNAL www.otjonline.com