The Publications Book
The Heidari Publications
94 publications · 23 years of research · click or drag a page corner to turn
Royal College
British Orthopaedic
AO Trauma
Churchill
Limb Recon
Specialist Reg.
Borg TM, Heidari N, Noorani A, Slevin M, Cullen A, Olgiati S, et al..
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.
What did we look at?
Whether women and men respond differently to an injection of micro-fragmented adipose tissue (MFAT — a small sample of the patient’s own fat) for painful knee osteoarthritis, followed up over two years.
Why did we look at it?
For decades, women have been under-represented in orthopaedic trials, and many published studies do not separate the results by sex. That can hide real differences in how a treatment works. We deliberately set out to analyse the men and women in our group separately, using open-source statistical software so that anyone can reproduce the analysis.
What did we find?
Women showed a greater improvement in pain and function after MFAT than men, and that difference was both statistically significant and clinically meaningful. Both sexes improved — this is not a treatment that works only for women — but the size of the effect was larger in women. The reasons are likely a combination of genetic, hormonal, environmental, and age-related factors.
What does this mean for patients?
The result is encouraging for women considering MFAT for knee arthritis, but it is also an example of why studies should always look at men and women separately. We do not yet know exactly why the response differs — that needs more research — but acknowledging the difference is the first step to refining the treatment for everyone.
Stem Cells International 2021;2021:6648437. doi:10.1155/2021/6648437