Gender-Specific Response in Pain and Function to Biologic Treatment of Knee Osteoarthritis: A Gender-Bias-Mitigated, Observational, Intention-to-Treat Study at Two Years

Tiffanie-Marie Borg; Nima Heidari; Ali Noorani; Mark Slevin; Angela Cullen; Stefano Olgiati; Alberto Zerbi; Alessandro Danovi; Adrian Wilson

doi:10.1155/2021/6648437

Gender-Specific Response in Pain and Function to Biologic Treatment of Knee Osteoarthritis: A Gender-Bias-Mitigated, Observational, Intention-to-Treat Study at Two Years

Stem Cells Int. 2021 Feb 25:2021:6648437. doi: 10.1155/2021/6648437. eCollection 2021.

Authors

Tiffanie-Marie Borg¹, Nima Heidari^{2

3

4}, Ali Noorani^{2

3}, Mark Slevin^{2

4}, Angela Cullen², Stefano Olgiati^{3

5}, Alberto Zerbi⁶, Alessandro Danovi⁷, Adrian Wilson²

Affiliations

¹ Academic Plastic Surgery Group, Barts and the London School of Medicine, UK.
² The Regenerative Clinic, 18-22 Queen Anne Street, London, UK.
³ nextAI, London, UK.
⁴ Department of Life Sciences, Manchester Metropolitan University, UK.
⁵ Department of Morphology, Surgery and Experimental Medicine, Faculty of Medicine, University of Ferrara, 44121 Ferrara, Italy.
⁶ University of Milano, Department of Radiology, 20100 Milano, Italy.
⁷ Department of Quantitative Methods, University of Bergamo, 24129 Bergamo, Italy.

Abstract

Knee osteoarthritis is a major cause of disability worldwide. Newer modalities of treatment with less morbidity, such as intra-articular injection of microfragmented fat (MFAT), are showing promise. We report on our novel observation that women show a greater improvement in pain and function to MFAT than men. Traditionally, women have been underrepresented in studies and studies with both sexes regularly fail to analyze the results by sex. To mitigate for this bias and quantify it, we describe a technique using reproducible statistical analysis and replicable results with Open Access statistical software R to calculate the magnitude of this difference. Genetic, hormonal, environmental, and age factors play a role in our observed difference between the sexes. There is a need for further studies to identify the molecular basis for this difference and be able to utilize it to improve outcome for both women and men.