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Minerva Orthopedics 2022 October;73(5):458-63

DOI: 10.23736/S2784-8469.22.04210-9


language: English

Intraoperative injection of microfragmented adipose tissue during hip arthroscopy as immediate postoperative pain reliever: a retrospective study

Alessandro APRATO 1 , Andrea FERRERA 1, Alessandro BISTOLFI 1, Riccardo FERRACINI 2, Stefano ARTIACO 1, Alessandro MASSÈ 1

1 School of Medicine, University of Turin, Turin, Italy; 2 Department of Orthopedics, University of Genoa, Genoa, Italy

BACKGROUND: The aim of this study was to evaluate post-operative pain in patients treated with hip arthroscopy associated or not with adipose-derived stem cells (ASCs) injection, obtained from microfragmented adipose tissue (MFAT), at the end of the procedure.
METHODS: Patients selected for arthroscopic hip preservation surgery in two centers from January to July 2017 were enrolled. The two groups showed similar mean ages (23.8 years vs. 24.5 years, P=0.087) and had similar body mass indexes (22.6 kg/m2 vs. 22.8 kg/m2, P=0.253). A single surgeon and a single anesthesiologist performed all the surgical procedures. MFAT was obtained from patient abdomen by lipoaspiration and then processed through the Lipogems® (Lipogems International S.p.A., Milan, Italy) ortho kit before the hip injection. Patients treated in center A underwent MFAT injection at the end of this procedure while patients treated in center B underwent the same procedure without injection. All patients completed modified Harris Hip Score (mHHS) questionnaires preoperatively and at three months. The primary outcome was pain relief at 12 hours from day 1 to day 10, at three months and at one-year follow-up. Numeric Rating Scale was used. Postoperative pain in all patients was managed with the same protocol.
RESULTS: Results at mHHS were similar either in the preoperatory either at three months Differences between preoperative and postoperative scores were significant in both groups (21.2 vs. 24.2-point, P=0.004 and P=0.023). Pain at 24 hours was similar for the two groups NRS resulted significantly lower in the MFAT injection group from day 2 to 7 (P<0.05), then mean NRS were again similar. In MFAT injection cohort 9 patients needed to take paracetamol, in contrast to all patients of the other group (P<0.0001). In the MFAT injection cohort a mean dose of 14 g of paracetamol was assumed, while in the control group 25 g (P<0.0001).
CONCLUSIONS: Intraoperative injection of ASCs from MFAT at the end of hip arthroscopy provides a better postoperatory pain management in the first 7 days. The results of this study show that the intra-articular hip injection of ASCs obtained from MFAT at the end of hip arthroscopy is a good pain reliever in the first 7 days after surgery. On the other hand, the difference in terms of postoperative pain was rescued only by paracetamol, with no need for rescue therapy with oxicodone.

KEY WORDS: Hip; Mesenchymal stem cells; Pain management; Tissue and organ harvesting; Adipose tissue

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