Combining Bone Realignment Surgery with Lipogems® for Bow-Leg Arthritis
Stefano Magnanelli, Daniele Screpis, Paolo Di Benedetto, Simone Natali, Araldo Causero, Claudio Zorzi · Acta Biomedica · 2020
85 patients tested two approaches for varus knee arthritis
This Italian study compared outcomes for patients with bow-leg knee arthritis. All patients had surgery to realign their leg bones. About half also received an injection of their own processed fat tissue. Researchers wanted to know if adding Lipogems® would improve results beyond surgery alone.
Varus knee osteoarthritis causes the leg to bow inward. This puts extra stress on the inner part of the knee joint. High tibial osteotomy (HTO) is a surgery that corrects this alignment. However, the damaged cartilage may not fully heal even after alignment is fixed.
All 85 patients showed significant improvement after one year
Every patient in this study improved after treatment. Researchers used several validated questionnaires to measure pain, function, and quality of life. Scores were collected before surgery and one year later. Both groups—those who had surgery alone and those who had surgery plus Lipogems®—showed meaningful gains.
The study included patients with mild to moderate arthritis. The same surgeon performed all procedures using identical equipment. This careful approach helped ensure fair comparisons between the two groups.
Daily activities improved more with Lipogems® added
Patients who received the Lipogems® injection showed a significant advantage in one key area. Their ability to perform daily activities improved more than those who had surgery alone. This was measured using the KOOS score, a well-established tool for assessing knee function.
The KOOS questionnaire covers five areas:
Pain levels
Other symptoms like stiffness and swelling
Daily living activities
Sports and recreation
Quality of life
While both groups improved across all categories, only daily activities showed a statistically significant difference favoring the Lipogems® group (p<0.05).
Patients with milder arthritis showed promising pain trends
When researchers looked more closely at patients with early-stage arthritis, an interesting pattern emerged. Those with mild osteoarthritis who received Lipogems® showed a trend toward better pain relief. This compared to similar patients who had surgery without the injection.
Although this finding did not reach statistical significance, it suggests that earlier intervention with regenerative treatment may offer additional benefits. The researchers noted this as an area worth exploring in future studies.
No additional risks from the Lipogems® procedure
Adding Lipogems® to the surgical treatment did not cause any reported complications. The injection uses micro-fragmented adipose tissue (specially processed fat) from the patient's own body. Because it comes from your own tissue, the risk of rejection or adverse reaction is very low.
All patients returned one year after their initial surgery to have their bone-alignment plates removed. X-rays taken at this time showed no significant differences in arthritis progression between the two groups.
What this means for your treatment decision
This study suggests that combining bone realignment surgery with Lipogems® may provide extra benefits for daily function. The treatment appears safe and well-tolerated. For patients with bow-leg knee arthritis considering HTO surgery, asking about Lipogems® as an addition may be worthwhile.
Keep in mind that this was a retrospective study with 85 patients. Larger studies with longer follow-up periods would strengthen these findings. However, the results align with other research showing that micro-fragmented adipose tissue can support cartilage healing and improve clinical outcomes.
If you have varus knee osteoarthritis, discuss with your doctor whether combining alignment surgery with regenerative injection could be right for you.
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Source: Magnanelli et al., Acta Biomedica, 2020.
Original Publication
Open-wedge high tibial osteotomy associated with Lipogems® intra-articular injection for the treatment of varus knee osteoarthritis - retrospective study
Stefano Magnanelli, Daniele Screpis, Paolo Di Benedetto, Simone Natali, Araldo Causero, Claudio Zorzi · Acta Biomedica · 2020
Open-wedge high tibial osteotomy (HTO) is an established treatment for varus knee medial osteoarthritis through restoration of the lower limb's mechanical axis. Autologous adipose-derived stem cells (aASCs) have shown promise in cartilage regeneration and early osteoarthritis treatment. This retrospective study analyzed clinical and radiological outcomes in patients with initial varus medial knee osteoarthritis treated with HTO, with or without intra-articular aASCs injection. Eighty-five patients treated between November 2016 and November 2018 were included: 43 received HTO alone (Group A) and 42 received HTO with Lipogems® aASCs injection (Group B). All patients had mild-to-moderate osteoarthritis (Kellgren-Lawrence grades I-III), underwent surgery by the same surgeon using identical fixation plates, and had no associated procedures. Clinical evaluation used KOOS, Lysholm/Tegner, and IKDC scores at baseline (T0) and one-year follow-up (T1). Radiological assessment employed the Kellgren-Lawrence scale. Both groups showed significant clinical improvement at follow-up. While IKDC and Lysholm/Tegner scores showed no significant differences between groups, Group B demonstrated significantly better KOOS scores for daily living activities (p<0.05). No significant radiological differences were observed. A trend toward symptom improvement was noted in mild osteoarthritis patients receiving combined treatment. The addition of aASCs to HTO appears to enhance functional outcomes, particularly in daily living activities, suggesting potential benefits for cartilage regeneration.