Human Growth Hormone as a Therapeutic Treatment Option in Orthopaedics

Background: Administering recombinant human growth hormone (rHGH) in a medically directed fashion has emerged as an investigational therapeutic intervention in clinical research to improve orthopaedic and sports medicine-related outcomes. Literature suggests that rHGH administration may improve athletic performance and influence osteoporosis and hip fracture outcomes. The purpose of this systematic review is to examine dosage regimens, identify adverse events, and summarize published peer-reviewed data of clinical outcomes where rHGH has been used in orthopaedic surgery human clinical studies to identify potential patient population targets, gaps in knowledge, and risks of use. Methods: Three databases (Embase, PubMed, and MEDLINE) were searched using search terms including but not limited to “human growth hormone,” “muscle strength,” and “bone healing.” Duplicate studies were removed and were subsequently screened first by title and abstract, followed by full-text. The reference lists of included studies were also evaluated with title screen. Data were abstracted and underwent pooled analysis, including meta-analysis where possible. Results: The initial search produced 2,047 unique studies. A total of 22 studies with moderate methodological quality were included, which comprised 1,157 total patients, with a mean age of 54.3 years and a mean daily rHGH dose of 1.49 mg/d. Administration of rHGH led to a dose-dependent increase in serum insulin-like growth factor 1 (mean increase +133.2%). Lean body mass increased in 15 of the 23 studies (mean difference of +3.63% vs. placebo). Leg extension strength increased for rHGH administration vs. placebo (mean difference +3.17%). The most common adverse events in GH patients were peripheral edema (odds ratio OR = 3.03), carpal tunnel symptoms (OR = 3.85), and arthralgias (OR = 2.94). Conclusion: rHGH administration led to improvements in clinical outcomes; however, the noteworthy side effects should also be taken into consideration when designing a treatment regimen for orthopaedic-related pathologies. Level of Evidence: Therapeutic Level II , systematic review of Level I and II studies. See Instructions for Authors for a complete description of levels of evidence.