Development of a personalized approach concept for the application of regenerative technologies in patients with osteoarthritis and aseptic necrosis of the hip and knee joints

Total joint arthroplasty remains the leading surgical treatment for osteoarthritis (OA) and aseptic necrosis of the hip and knee joints. However, the growing demand for these procedures drives the search for alternative treatment strategies aimed at slowing the increasing rates of joint replacement in the future. One such alternative is regenerative medicine, particularly the use of cell-based therapies. The aim of this study was to develop the principles of a personalized approach to the application of regenerative technologies in patients with osteoarthritis and aseptic necrosis of the hip and knee joints. Materials and methods. A total of 485 patients with osteoarthritis and 182 patients with aseptic necrosis of the hip and knee joints aged between 18 and 88 years were examined, including 408 women and 259 men. The following methods were used: general clinical examination, laboratory tests (complete blood count, analysis of microRNAs 21, 182, and 214 by PCR), and imaging techniques (X-ray, ultrasound, and magnetic resonance imaging). Results. We developed a personalized approach for applying regenerative technologies in patients with osteoarthritis and aseptic necrosis of the hip and knee joints, which includes two key components: patient selection and treatment planning. The patient selection process for osteoarthritis involves five stages: assessment of radiographic stage of OA, identification of the predominant OA phenotype, evaluation of the patient’s treatment expectations, laboratory testing to identify contraindications to regenerative therapies, and analysis of the patient’s medical history. Treatment planning includes choosing the appropriate type or combination of biotechnological products, analyzing patient-reported outcomes related to quality of life using various scales, and reviewing imaging results (MRI or ultrasound) to assess intra-articular and periarticular changes. Conclusions. We propose a concept of a personalized approach to the application of regenerative technologies in the treatment of osteoarthritis and aseptic necrosis of the hip and knee joints. This approach emphasizes that treatment choice should consider not only the clinical diagnosis but also individual patient characteristics, expectations, and the selection of the most appropriate biotechnological product for therapeutic intervention.