COVID-19 immune history and post-PRP injection reactions in knee osteoarthritis

Omar M. Awad; Marek Lacko; Juraj Barej; Ahmad Gharaibeh; Michal Strážik; Vladimír Filip

doi:10.18203/issn.2455-4510.IntJResOrthop20263884

Authors

Omar M. Awad Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia https://orcid.org/0009-0003-5118-951X
Marek Lacko Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia
Juraj Barej Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia
Ahmad Gharaibeh Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia
Michal Strážik Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia
Vladimír Filip Department of Orthopedics and Traumatology of Locomotor Apparatus, P. J. Šafárik University and L. Pasteur University Hospital, Košice, Slovakia

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263884

Keywords:

COVID-19 vaccination, SARS-CoV-2 infection, Regenerative medicine, Post-injection reactions, Platelet-rich plasma, Knee osteoarthritis

Abstract

Background: Intra-articular platelet-rich plasma (PRP) is a widely used orthobiologic treatment for knee osteoarthritis (OA). Whether COVID-19 vaccination history or prior SARS-CoV-2 infection influences local post-injection reactions has not been studied.

Methods: This exploratory retrospective cohort study included 57 patients who underwent 166 intra-articular PRP injection sessions for knee OA (March 2024–January 2026). Two per-patient outcomes were defined: pain rate (proportion of sessions with VAS pain>0) and swelling rate (proportion of sessions with recorded swelling). Patients with a single injection and no follow-up were excluded. Four Spearman correlations between vaccination dose count, prior infection count, and both outcomes were computed with bootstrapped 95% BCa confidence intervals (1,000 samples) and Holm correction applied across the four p values. Subgroup analyses used the Kruskal-Wallis test. The analytical sample comprised 40 complete cases.

Results: All quantitative variables except age were non-normally distributed (Shapiro-Wilk p<0.001). After Holm correction, none of the four primary correlations reached statistical significance. The strongest directional signal was an inverse association between prior infection count and swelling rate (ρ=−0.339, Holm-adjusted p=0.132, BCa 95% CI (−0.560, −0.064), n=40). Post-injection pain (VAS>0) occurred in 20 of 72 assessed sessions (27.8%); swelling in 8 of 75 (10.7%). No febrile reactions were documented.

Conclusions: Prior SARS-CoV-2 infection count showed a directional inverse association with post-PRP swelling rate that did not survive Holm correction for multiple comparisons. These findings are exploratory and hypothesis-generating only, and do not support clinical recommendations at this stage.

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