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Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell-based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions—a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up.

Methods

The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM.

Results

Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47 years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score–Activities of Daily Living (p < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting.

Conclusions

Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations.

Level of evidence

IV.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This study was performed at the American Hip Institute Research Foundation.

Author information

Authors and Affiliations

  1. American Hip Institute Research Foundation, Chicago, IL, 60018, USA

    Tracy George, Andrew J. Curley, Sheema K. Saeed, Benjamin D. Kuhns, Ali Parsa & Benjamin G. Domb

  2. American Hip Institute, Chicago, IL, 60018, USA

    Benjamin G. Domb

  3. 999 E Touhy Ave, Suite 450, Des Plaines, IL, 60018, USA

    Benjamin G. Domb

Authors
  1. Tracy George
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  2. Andrew J. Curley
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  3. Sheema K. Saeed
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  4. Benjamin D. Kuhns
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Contributions

TG: data collection/analysis and writing of the manuscript. AJC: data collection/analysis and writing of the manuscript. SKS: data collection/analysis and writing of the manuscript. BDK: data interpretation and revision of the manuscript. AP: data interpretation and revision of the manuscript. BGD: data interpretation and revision of the manuscript.

Corresponding author

Correspondence to Benjamin G. Domb.

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Conflict of interest

B.G.D has received royalties from Arthrex, Inc., DJO Global, Inc., Medacta USA, Inc., Orthomerica; has received speaking fees from Arthrex, Inc., Stryker Corp, Medacta Inc; has received consulting fees from Arthrex, Inc; has received research support from Arthrex, Inc., Ossur, Stryker Endoscopy, and Medacta Inc; has received any other financial or material support from Arthrex, Inc., Stryker Endoscopy. B.G.D serves on the editorial or governing board for Arthroscopy, a board member for the Arthroscopy Journal, American Hip Institute Research Foundation, AANA Learning Center Committee. The American Hip Institute Research Foundation fund research and is where our study was performed. B.D.K is a member of the Arthroscopy Editorial Board. Ms. George, Dr. Curley, Ms. Saeed, and Dr. Parsa have no conflicts of interest to disclose.

Ethical approval

This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study was carried out in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Details that might disclose the identity of the subjects under study have been omitted. This study was approved by the IRB. (IRB ID: 5276).

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George, T., Curley, A.J., Saeed, S.K. et al. Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell-based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions—a systematic review. Knee Surg Sports Traumatol Arthrosc 31, 6020–6038 (2023). https://doi.org/10.1007/s00167-023-07624-4

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