Avoidance of Total Knee Arthroplasty in Early Osteoarthritis of the Knee with Intra-Articular Implantation of Autologous Activated Peripheral Blood Stem Cells versus Hyaluronic Acid: A Randomized Controlled Trial with Differential Effects of Growth Factor Addition
Table 4
Time/groups
6 months
12 months
WOMAC score
Total
Pain
Stiffness
Function
Total
Pain
Stiffness
Function
Total knee arthroplasty (TKA)
Group 1 versus group 2
S
S
NS
S
NS
NS
S
NS
Group 1 versus group 3
S
S
S
S
S
S
S
S
Group 2 versus group 3
S
S
BS
NS
S
S
BS
S
Groups 1 + 2 versus group 3
S
S
S = significant; NS = nonsignificant; BS = borderline significance. Group 1 improved significantly quicker than group 2 in the total WOMAC score at 6 months, but that difference disappeared at 12-month follow-up. Similarly, pain and function improved quicker in group 1 than in group 2 at 6 months, but no difference was noted at 12 months while stiffness was better in group 1 at 12 but not at 6 months. Group 1 scores (stem cell and G-CSF group) were superior to those of group 3 (nonstem cell control group) at all points and in all modalities, total or subscale. Group 2 improved significantly versus the control group 3 at 6 and 12 months on total WOMAC score and pain similar to group 1 versus group 3, but stiffness improvement was only of borderline significance at both time points while function improved significantly only at 12 months. Pain subsided quickest in group 1 versus all groups at 6-month follow up and may have led to increased function as well since patients become pain free. Stiffness depends more on connective tissue rearrangements as well as on new cartilage which probably needs time. The stem cell group 1 with G-CSF displayed a quicker response than the control group 3 at all time points and also than the non-G-CSF stem cell group 2 at 6 months (except for stiffness).
