BONE MARROW INJECTION VS TOTAL KNEE ARTHROPLASTY (TKA)

METHOD: A prospective randomized controlled clinical trial was carried out in 60 knees of 30 patients (mean age 28 years, 18–41) who presented bilateral osteoarthritis secondary to knee osteonecrosis (ON) related to corticosteroids in relation with different severe medical conditions. During the same anesthesia, one knee received total knee arthroplasty (TKA); for the other knee, a bone marrow graft containing an average of 6500 stem cells/mL (counted as CFU-F, range 3420 to 9830) was delivered to the subchondral bone of the femur and tibia.

Fig. 1 Osteonecrosis in a Knee

Fig. 2 Total Knee Arthroplasty

Fig. 3 Subcondral bone injection

RESULTS: Anesthesia related to the TKA side was longer than for the cell therapy group. Medical and surgical complications were more frequent after TKA. A higher number of thrombophlebitis was observed on the side with TKA (15%) versus none on the side with cell therapy (0%). At the most recent follow-up (average of 12 years, range 8 to 16 years), six (out of 30) TKA knees needed subsequent surgery versus only one with cell therapy. 21 patients preferred the knee with cell therapy and 9 preferred the knee with TKA. Knees with cell therapy had improvement on cartilage and bone marrow lesions observed at the site of bone marrow subchondral injection. CONCLUSIONS: Subchondral autologous bone marrow concentrate with stem cells was an effective procedure for treating young patients with knee osteoarthritis following secondary ON of the knee related to corticosteroids with a lower complication rate and a quicker recovery as compared with TKA.