Treatment of Knee Osteoarthritis with Intraarticular Umbilical Cord-Derived Wharton's Jelly: A Case Report

Abstract

We present the case of a 27-year-old male with grade II knee osteoarthritis (OA) that was intraarticularly injected with a 2 mL umbilical cord-derived Wharton's jelly (UC-derived WJ) formulation. The patients' baseline radiographs were taken and baseline numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), 7-point Likert scale, and a 36-item short form survey (SF-36) were recorded. The NPRS was re-recorded immediately after the injection, and at 24 h, 48 h, 1 week, 6 weeks, and at 3 months follow-up post-injection. The KOOS and 7-point Likert scale was re-recorded at the patients' 1week, 6 week, and 3month follow-up, and SF-36 was re-recorded at 3 months. A final set of X-rays were also performed at 3 months follow-up post-injection. No adverse effects from the injection were reported over the duration of the study. No significant difference nor progression in OA on X-rays compared to baseline was observed. NPRS decreased by 50% and the 7-point Likert scale increased to Extremely Satisfied. KOOS increased overall by 10% and the SF-36 overall change was 25%. These results indicate the potential application of UC-derived WJ in the treatment of knee OA. Larger, long term, non-randomized and randomized control trials are warranted to adequately assess the safety and efficacy of UC-derived WJ and ultimate clinical use.

Keywords: Wharton’s jelly; biologics; cytokines; exosomes; extracellular vesicles; growth factors; hyaluronic acid; knee osteoarthritis; regenerative medicine; umbilical cord.

Figure 1

Plain Radiography. No significant difference nor progression in OA via X-Rays was observed.

Figure 2

Numeric Pain Rating Scale (NPRS); 50% pain reduction over a period of 3 months compared to baseline.

Figure 3

Knee Injury and Osteoarthritis Outcomes Score (KOOS): (A) KOOS Overall; (B) KOOS Pain Subtotal; (C) KOOS Function, Sports, and Recreational Activities; (D) KOOS Symptoms and Stiffness Subtotal; (E) KOOS Function, Daily Subtotal; and (F) KOOS Quality of Life. 12% difference (improvement) was observed over a period of 3 months compared to baseline in overall KOOS; 11%, 10%, 14%, 3%, and 19% difference (improvement) was observed over a period of 3 months compared to baseline in individual KOOS subscales including Pain Subtotal; Function, Sports, and Recreational Activities; Symptoms and Stiffness Subtotal; Function, Daily Subtotal; and Quality of Life, respectively.

Figure 4

7-point Likert Scale. Patient was “extremely satisfied” at end of 3 months compared to “not sure” at baseline.

Figure 5

36-Item Short Form Survey (SF-36). SF-36 showed 25% improvement in overall Health change at 3 months follow-up compared to baseline. The individual SF-36 subscales analysis showed improvements in Physical Functioning (5%), Role limitations due to Physical Health (75%), Energy/Fatigue (15%), Emotional Well-being (8%), Pain (55%), and General Health (20%) at 3 months follow-up compared to baseline. The patient did not report any concerns with SF-36 subscales of Role limitation due to Emotional Problems and Social Functioning at baseline.