Importância da terapia celular na osteonecrose da cabeça umeral e recuperação da biomecânica do ombro

Abstract

Sickle Cell Disease (SCD)is a genetic condition that primarily affects individuals of African descent, caused by a mutation in hemoglobin that distorts red blood cells into a sickle shape. Predominant in regions with a history of slavery, such as Brazil, SCD leads to serious complications like anemia and osteonecrosis. Early diagnosis is essential for effective interventions, and new therapeutic approaches, such as cell therapy, offer promising treatment alternatives. Objective: This study describes the progression of bone regeneration in shoulder osteonecrosis in patients with sickle cell disease treated with bone marrow- derived mesenchymal cell implants, assessing the degree of biomechanical recovery. Methodology: A non-randomized clinicaltrial was conductedwith adults diagnosed with humeral head osteonecrosis, treated at the Professor Edgard Santos University Hospital Complex (COM-HUPES). Patients used a sling for two days post-treatment, followed by active shoulder mobilization. Information on comorbidities, BMI, and demographic data was collected, along with pre- and post-operative X-ray and MRI exams, repeated12 months aftersurgery. Follow- up visits occurred one week prior to the procedure and at 3 weeks, 3 months, 6 months, and 12 months post-surgery, with evaluations conducted by the orthopedic team.Results: Comparison of pre- and post-operative range of motion showed improvements in flexion, extension, internal and external rotation. Clinical assessment indicated reducedpain and disability. Comparisons between pre- and post-operative MRIs revealeda decrease in bone edemaand the extent of osteonecrosis. No patients showed deformity of the humeral head or signs of osteoarthritis. Conclusion: The therapy using autologous bone marrow mononuclear cell implants demonstrated effectiveness in improving range of motion and SPADI scores in patients with humeral head osteonecrosis secondary to sickle cell disease. There were visible improvements in MRI scans, with reductions in bone edema and necrosis extent after one year, and the treatment proved to be safe with no post-operative complications.