Adipose-derived mesenchymal stem cells for early hip osteoarthritis: mechanistic insights and possible clinical evidence.

Purpose: Hip osteoarthritis (OA) is increasingly diagnosed in younger, active patients, often linked to femoroacetabular impingement (FAI) and associated cartilage lesions such as acetabular delamination. Conventional surgical options, including total hip arthroplasty, are suboptimal in this population due to implant longevity concerns and high functional demands. Adipose-derived mesenchymal stem cells (AD-MSCs) have emerged as a promising biologic alternative, offering regenerative, anti-inflammatory, and immunomodulatory effects with advantages over bone marrow-derived MSCs in cell yield, harvesting ease, and safety. Methods: We conducted a review of the literature on the possible use of mesenchymal as a treatment for hip osteoarthritis. Results: Processed via manipulative mechanical techniques, AD-MSCs can be delivered intra-articularly to target early- stage OA and focal cartilage damage, aiming to preserve joint integrity and delay progression. Clinical studies report improvements in pain, function, and quality of life, with low complication rates, particularly in Tönnis grade 1 hips. Acetabular delamination, an early and potentially reversible chondral lesion, represents a compelling therapeutic target for biologic intervention. Conclusion: This new possible therapy will be a new minimally invasive option for joint-preservation, in particular for young patients. Limitations include heterogeneity in protocols, lack of standardized dosing, and scarce long-term randomized evidence. Future research should focus on optimized delivery methods, patient selection, and high-quality trials to establish AD-MSCs as a validated component of hip preservation strategies. Clinical trials are needed to confirm their efficacy and long-term benefits.