Evaluation of efficacy and safety of intraarticular injections of leucocyte poor platelet rich plasma in osteoarthritis knee patients
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232002Keywords:
K-L classification, KOOS score, Osteoarthritis, PRP injections, VAS scoreAbstract
Background: The present study evaluates the safety and efficacy of intraarticular injections of leucocyte poor platelet rich plasma (LP-PRP) in osteoarthritis (OA) knee patients. Patients with early osteoarthritis (K-L grading 1 and 2)-clinically and radiologically and those who gave consent to participate in the study were injected with 2.4 ml per knee of LP-PRP over unilateral or bilateral knees at 0, 1, 2 and 6 months of LP-PRP injections.
Methods: 100 patients with osteoarthritis knee pain were injected with LP-PRP at 0.1.2 months on OPD basis. LP-PRP was prepared in a centrifugation machine at 2000 RPM for 4 minutes and 2000 RPM for 10 minutes for two consecutive times and then injected into knee with a medial suprapatellar approach using 20/21 G needle. This was repeated at 1 and 2 months of follow-up. Assessment of efficacy in terms of pain relief was done on the basis of visual analog score (VAS) and clinical outcomes on the basis of knee injury and osteoarthritis outcome scores (KOOS) at 0, 1, 2, 6 months following injection of LP-PRP.
Results: The mean VAS at pre-injection was 7.22±0.965 which reduced to 3.06±1.223 at post-injection follow-up at 6 months. The mean KOOS at pre injection was 33.4±7.51 which increased to 78.86±8.80 at post-injection follow-up at 6 months.
Conclusions: LP-PRP has emerged as an intriguing therapy option for knee OA, and our study has shown that it is effective after 6 months.
References
Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E: The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis and cartilage. 20111, 19:1270-85. 10.1016/j.joca.2011.08.009
Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarth Cartil. 2013;21:1627-37.
Sekiya I, Muneta T, Horie M, Koga H. Arthroscopic transplantation of synovial stem cells improves clinical outcomes in knees with cartilage defects. Clin Orthop Rel Res. 2015;473:2316-26.
Fang D, Jin P, Huang Q, Yang Y, Zhao J, Zheng L. Platelet‐rich plasma promotes the regeneration of cartilage engineered by mesenchymal stem cells and collagen hydrogel via the TGF‐β/SMAD signalling pathway. Journal of Cellular Physiology. 2019;234:15627-37.
Whitney KE, Liebowitz A, Bolia IK, Chahla J, Ravuri S, Evans TA, et al. Current perspectives on biological approaches for osteoarthritis. Ann N Y Acad Sci. 2017;1410(1):26-43.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS. 2007;89(4):780-5.
Guillibert C, Charpin C, Raffray M, Benmenni A, Dehaut FX, El Ghobeira G, et al. Single injection of high volume of autologous pure PRP provides a significant improvement in knee osteoarthritis: a prospective routine care study. Int J Mol Sci. 2019;20(6):1327.
Sclafani A, Romo T, Ukrainsky G, McCormick S, Litner J, Kevy S, et al. Modulation of wound response and soft tissue ingrowth in synthetic and allogeneic implants with platelet concentrate. Arch Facial Plast Surg. 2005;7:170-1.
Ranly D, Lohmann C, Andreacchio D, Boyan B, Schwartz Z. Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice. J Bone Joint Surg Am. 2007;89:139-47.
Van Buul GM, Koevoet WL, Kops N, Bos PK, Verhaar JA, Weinans H, Bernsen MR, Van Osch GJ. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med. 2011;39(11):2362-70.
Cao R. Brakenhielm E, Pawliuk R, Wariaro D, Post MJ, Wahlberg E, et al. Angiogenic synergism, vascular stability and improvement of hind-limb ischemia by a combination of PDGF-BB and FGF-2. Nat Med. 2003;9:604-13.
Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012;4(2):162-72.
A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LP. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410-8.
Wei LC, Lei GH, Sheng PY, Gao SG, Xu M, Jiang W, et al. Efficacy of platelet‐rich plasma combined with allograft bone in the management of displaced intra‐articular calcaneal fractures: a prospective cohort study. J Orthop Res. 2012;30(10):1570-6.8
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356-64.
Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3):610-8.
Kon E, Filardo G, Di Matteo B, Perdisa F, Marcacci M. PRP-augmented scaffolds for cartilage regeneration: a systematic review. Operat Tech Sports Med. 2013;1:108-15.
Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesth Surg. 2014;7:189-97.
Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM. Knee injury and osteoarthritis outcome score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarth Cartil. 20161;24:1317-29.
Pourcho AM, Smith J, Wisniewski SJ, Sellon JL. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil. 2014;1:108-21.
Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol. 2008;26:910-3.
Hassan AS, El-Shafey AM, Ahmed HS, Hamed MS. Effectiveness of the intra-articular injection of platelet rich plasma in the treatment of patients with primary knee osteoarthritis. Egypt Rheumatol. 2015;37:119-24.
Gobbi A, Lad D, Karnatzikos G. The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;23:2170-7.
Simental-Mendía M, Acosta-Olivo CA, Hernández-Rodríguez AN, Santos-Santos OR, de la Garza-Castro S, Peña-Martínez VM, et al. Intraarticular injection of platelet-rich plasma in knee osteoarthritis: single versus triple application approach Pilot study. Acta Reumatol Portug. 2019;44:138-44.
Huda N, Kumar H, Pant A, Awasthi S, Bishnoi S, Islam M. Role of triple injection of Platelet rich plasma as a therapeutic strategy for osteoarthritis knee: a single blind prospective, hospital based study. Cytotherapy. 2020;22:172.
Glynn LG, Mustafa A, Casey M. Platelet-rich plasma (PRP) therapy for knee arthritis: a feasibility study in primary care. Pilot Feasibil Stud. 2018;4:93-100.
Filardo G, Kon E, Di Matteo B, Di Marino A, Sessa A, Merli ML, et al. Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints. 2014;1:112-20.
Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil. 2010;89:961-9.
Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95:562-75.
Aquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013;29:1635-43.
