Efficacy of Intra Articular Steroid Injection and Platelet Rich Plasma in Patients with Osteoarthrithis (original) (raw)
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International Journal of Orthopaedics Sciences
Osteoarthritis (OA) is by far the most common form of joint disease throughout the world. It is strongly associated with age, and extremely common in older people, Some studies estimate that over 80% of people over 55 years of age have osteoarthritis of at least one joint. It mainly affects the hips, knees, spine, hands and feet. Hip and knee OA are the most important because of the high prevalence of pain and disability that they cause in older adults. Methodology: Patients visiting the Department Of Orthopaedics, Narayan Medical College and Hospital that meet the inclusion criteria. Patient were be divided into 2 groups randomly (30 in each group).one group was administered intra-articular corticosteroid injection (1 ml of triamcinolone acetonide with 1ml of 2% lignocaine without epinephrine). And the other group was administered intra-articular prp injection into the affected knee (5 ml of prp). Following treatment they were assessed using mcmaster universities arthritis index (womac) [56 visual analogue scale (vas), scoring systems which will be recorded through questionnaires prior to the injection to record baseline scores and post injection then at 6 weeks, 3, 6 and 12months follow-up. Result: Significant difference was seen in mean WOMAC scores in Group A and Group B at 1 week, 4weeks, 8 weeks, 12 weeks and 12 months but no significant differences were observed at 6 months. Significant differences were seen in the VAS score for Group A and Group B subjects at 1 week, 4 weeks, 8 weeks, 12 weeks, 6 months and 12 months when compared using independent t test as p<0.05. Conclusion: For a long duration relief of symptoms and the functional outcome, intraarticular PRP is better than Triamcinolone acetonide injections.
Scholars Journal of Applied Medical Sciences, 2020
Original Research Article Introduction: Osteoarthritis (OA) knee is the most prevalent degenerative joint disease in the relatively elderly population. It is a leading cause of pain and disability in most countries worldwide. Aim of the study: To determine the effects of PRP in patients with OA knee. Material & Methods: A total 60 patients with OA knee were selected irrespective of sexes seeking treatment in the department of Physical Medicine and Rehabilitation, BSMMU, Dhaka and also referred from various outpatient departments of BSMMU and also general practitioners outside the hospital. The diagnosis of OA knee was confirmed by history, clinical examination, laboratory and radiological findings. They were divided into two group from radiological grading (Kellgren-Lawrence grade-I-III).In group-A patients were given intraarticur steroid, exercise and ADL instructions and group-B were treated with Intraarticur PRP, exercise and ADL instruction. All the patient availed 6 follow up at two week interval and two injection were given at 1st and 7th week. In every follow up patients were assessed by Visual analogue scale (VAS) and WOMAC score. All data were analyzed statistically by using the SPSS (version-21) for windows. Both paired and unpaired Student"s "t" test and Chisquired test was done as required, to see the level of significance. The results were expressed as mean standard deviation (SD) and p<0.05 was considered as the level of significance. Results: In both groups, majority of the participants had osteoarthritis in right knee joint. There is no statistical significance regarding knee involvement between two groups as the p-value is not significant. Table-4 showed the radiological grading of two groups. In both the groups most of the patients were enrolled in grade-II (.There is no statistical significance between the two groups. In comparison between two groups, it was found that there was no significant difference in improvement up to Wl to W9 scores, but difference of improvement was found in Group A than Group B at 11 th week. (p= 0.004). There was significant improvement in Group A. In respect to time improvement was started to occur in pretreatment W1 (just before 1 st Intervention) score Vs W3 score 15.8 ±0.65 Vs 12.6±0.85 respectively (p= 0.003). W3 score Vs W5 score was 12.6±0.85 Vs 11.65±0.70 (p= 0.084). W7 (just before 2 nd Intervention) score Vs W9 score10.54±0.74 Vs 5.35± 0.57 (p= 0.004). W9 score Vs W11 score was-5.35± 0.57 Vs 2.15±0.30 (p=0.005). Whereas, in Group B, in respect to time improvement was started to occur in pretreatment W1 (just before 1 st Intervention) score Vs W3 score 16.65 ±0.48 Vs 12.42 ±.57 (p= 0.001). Then W3 score Vs W5 score was12.42 ±.57 Vs 11.38±0.49 (p=0.664). Then W7 (just before 2 nd Intervention) score Vs W9 score 9.46 ±0.58 Vs 7.89±0.85 (p= 0.050). Then W9 score Vs W11 score was 7.89 ±0.85Vs 5.65 ±0.76 (p=0.527). Conclusion: The results from this study showed that intra articular injection of Platelet rich plasma administered to patients with OA knee had significant effects in pain reduction and functional improvement. Although both treatments offered significant effectiveness but PRP injections provided sustain pain reduction and improve physical function. Both treatment was well tolerated.
Introduction: Osteoarthritis is the most common form of arthritis afflicting mankind specially the elderly population. One of the most affected joints is the knee. Characteristic features of osteoarthritis are pain, swelling, and stiffness with the decline in physical function such as walking, climbing stairs and getting in and out of the chair. There is a large population of young and active people with early osteoarthritis who have not yet developed the classical signs of OA. But, who are strong candidates to an increased risk for accelerated development of joint degeneration. Approximately 27 million Americans over the age of 25 currently suffer from OA. This number is predicted to increase by 2030 to a staggering 67million. The number of total hip replacement and total knee replacement operations is expected to reach 572,000 and 3,480,000, respectively by 2030. At present, there are numerous, non-invasive treatment modalities like physical therapy, analgesic, non-steroid anti-inflammatory drugs, glucosamine/chondroitin supplementation, intra-articular injection of hyaluronic acid (HA), intra-articular steroid injection and Platelet Rich Plasma. In almost all published studies, PRP has been shown to have a strong positive effect on chondrocyte proliferation in vitro. Platelet rich plasma (PRP) therapy is a simple, low cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration. This therapy is widely experimented in different fields of medicine to test its potential to enhance tissue regeneration. Aims and Objectives: The aim of the study is to assess the role of PRP in active patients with symptomatic Osteoarthritis knee and to compare the clinical outcome of PRP treatment by using WOMAC and VAS scoring system at different time interval. Materials and Methods: The study was conducted in the Department of Orthopaedics at Santosh hospital Ghaziabad over a period of 24 months (October 2013 to October 2015). Subjects were recruited randomly from patients presenting with pain in knee joint in Orthopaedics OPD, and diagnosed as a case of primary Osteoarthritis Knee after Clinical and Radiological evaluation and satisfying inclusion criteria which includes patients above 35-75 years age with Unilateral or Bilateral Osteoarthritis Knee involvements, history of chronic knee pain or swelling equal to or more than four months, radiological (X-ray) finding of articular cartilage degeneration, including Kellgren-Lawrence (KL) Grade II and III. Patients who signed written informed consent and the patients were excluded following the exclusion criteria viz. systemic disorders like Gouty Arthritis, Rheumatoid Arthritis Diabetic mellitus, any bleeding disorder, metabolic disease or cardiovascular disease, immunosuppressed patients and those receiving anticoagulation therapy, platelets values of <150,000/mmc. Pregnancy, late stages of Osteoarthritis Knee, KL Grade IV. Results: In our study, it was observed that the age distribution of the cases ranged from 35 years to above 65 years, with a maximum number of cases i.e. 58 (53.70%) in the age group of 35-45 years. The mean age of the cases was 49.82 ± 8.62 years. In our study we observed a female preponderance, with 62 out of 108 (57.40%) cases being females. This was in accordance with the study conducted by Sandeep et al, which also had a female preponderance. In the present study the maximum number of patients were homemakers, being 56 (51.85%) cases, followed by labourers 15 (13.88%), maximum number of patients 75 (69.44%) cases had complaints of pain for less than a year while 33 (30.55%) cases had complaints of Pain more than 1 year. In our study 80 out of 108 cases (74.07%) had grade II disease status as per the Kellgren-Lawrence grading scale and 28 out of 108 cases i.e. 25.92% had grade III disease status. This finding differed from that of Gobbi et al who had approximately equal number of cases with KL Grade II and III. However the VAS score in our study showed an improvement at 24 weeks which was 4.29±2.10 and the WOMAC score showed a significant improvement at all follow ups decreasing to 44.55±20.47 at the final follow up of 24 weeks. Conclusion: The hypothesis of this study was that PRP reduces pain and leads to a more effective and lasting functional recovery in mild to moderate osteoarthritis knee patients. Our objective was to assess the efficacy of PRP IAI for relieving pain and improving knee function in Grade 1 and 2 OA Knee using WOMAC and VAS Scoring methods. Total 108 patients diagnosed with osteoarthritis, were included in our study. All patients were given 3 intra articular injections of PRP at 0, 3 and 6 weeks and followed up at 6, 12 and 24 weeks and found better improvement in activities of daily living post PRP therapy. We demonstrated that PRP IAI is potentially safe, simple, and low-cost method to improve articular joint healing, with promising results.
Journal of Medical Science And clinical Research, 2018
Background: Osteoarthritis (OA) is one of the most distressing chronic condition which affecting people specially in elder around the world. Recently PRP has been used for the treatment of knee osteoarthritis globally. Osteoarthritis (OA) is a major reason of knee disability involving cartilage damage related to an inadequate healing response in the inflammatory process. Current non-surgical treatment modalities include physiotherapy, analgesia, non-steroidal anti-inflammatory drugs, and intra-articular injections, such as hyaluronic acid (HA), corticosteroids, or Ozone, with the purpose of reducing symptoms and improving joint function. Now a day's PRP has been used for the treatment of knee osteoarthritis worldwide. Objective: Our main goal is to assess the effectiveness of PRP therapy that reduces pain and leads to a more effective and lasting functional recovery with local anesthetic in intra-articular steroid failure elderly patients. Method: This cross-sectional comparative study was carried out from January 2018 to July 2018at the Department of Transfusion Medicine, Bashundhara Ad-din medical college and hospital, South Keranigonj. During the study 50 purposive voluntary, non-remunerated altruistic patients were studied where Male was 28 and Female was 22. All patient's full history, general examination and complete knee joint examination was categorized and data of the patients were entered on the Statistical Package for Social Science (SPSS). Results: This study result shows that, in advanced aged patients there was improvement of pain after two doses of Platelet Riched Plasma (PRP) where they showed no significant improvement after two doses of intra articular steroid injection earlier. Conclusion: From our result, we can conclude that it was found that intra-articular injection of PRP is an effective and safe method for treatment of knee OA for elderly patients with no complication
The effects of platelet-rich plasma injections in different stages of knee osteoarthritis
European Journal of Orthopaedic Surgery and Traumatology, 2023
Purpose Platelet-rich plasma (PRP) injections are challenging the current treatment options for knee osteoarthritis (KOA). Targeting the treatment to optimal stage of the symptomatic KOA may be crucial in the success and failure of treatment. The aim of this study is to compare the outcomes of PRP injections at different stages of KOA in order to determine the optimal stage of the KOA for PRP injection treatments. Methods A total of 89 consecutive patients with symptomatic KOA Kellgren-Lawrence grade 1 to 3 (Group A grade 1, group B grade 2 and group C grade 3) were given three intra-articular injections of PRP with 2 weeks interval between injections. Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Range of Motion were measured before injection, at 15 days, 6 months, 12 months and, at last follow-up. Intergroup outcomes were compared. Results The comparison of groups A and C showed that WOMAC scores were significantly higher in group C at 15 days [p = 0.047] and at last follow-up [p = 0.008] than in group A, as well as VAS scores at 6 months [p = 0.031] and at last followup [p = 0.008]. The overall WOMAC and VAS scores showed decrease in all the groups in minimum follow-up of 14 months. The other comparisons did not show significant differences in outcomes. Conclusion All the groups showed decrease in WOMAC and VAS, but patients with mild KOA benefit significantly more from the treatments than patients with more severe KOA.
BMC Research Notes, 2012
The aims of the present study were first to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, nonsteroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion. Methods: The study involved 173 patients with osteoarthritis in whom primary care physicians decided to start treatment with non-selective NSAIDs. Assessments at admission and after 6 weeks were conducted. In order to determine the threshold levels associated with a definition of clinically important improvement, the receiver operating characteristic method was used. Three different measures of response to a 6-week NSAIDs treatment were used: one indirect measure (MCID in the total WOMAC score), one direct measure (transition question) and a combination of both criteria. Results: Eighty patients (46.3%) reported "a slightly better" general health status compared to that of 6 weeks before NSAIDs treatment. The MCID proportion is a 16.0% reduction in WOMAC. The most stable pre-treatment predictors on the improvement of health after treatment by NSAIDs were the absence of previous knee injury and a high level of education.
International Journal of Medical and Biomedical Studies, 2023
The present therapeutic line of osteoarthritis of knee is primarily symptomatic, therefore the need to discover treatment modality which tackles the disease process in itself. This study was done with an intention to examine the efficacy of platelet rich plasma in primary osteoarthritis of knee. Materials and Methods: This prospective investigation was done on 100 knees in 100 individuals having early primary osteoarthritis of the knee. Three injections of platelet rich plasma were administered at four weeks interval and the outcome was analyzed by WOMAC and VAS score at pre injection, 3 weeks, 12 weeks and 24 weeks. Ahlback's grading was done at pre-injection and at 6 months. Results: Most of the cases in our series were in the age category of 50-65 years with female predominance (73%), 51% cases had grade 2 disease and the remaining had grade 1 involvement. Improvement in WOMAC score parameters started after 3 weeks with continuing improvement at successive follow-ups. WOMAC score parameters (pain, stiffness, physical function and total score) at pre injection were 14.22, 5.05, 36.41and 55.8 and at 6 months follow up were 5.92, 2.07, 16.78 and 24.11 correspondingly. Similar improvement was noted in VAS score with pre injection score of 7.12 and final score of 2.96. The average WOMAC score was less for grade 1 as compared to grade 2 (43.42 vs 60.41); (43.63 vs 61.36). Improvement was reported in 86% of patients however the level varied from good to slight improvement. There was no problem associated to the treatment in our series. Conclusion: The initial data show that PRP is an effective therapeutic strategy in early grades of primary Osteoarthritis of knee. However, further strong evidence Research is required to check for the long-term impacts and to corroborate the conclusions of this investigation.
Orthopaedic Journal of Sports Medicine
Background: Although several injection-based treatments have been proposed to address knee osteoarthritis (OA), it is often difficult to understand the clinical relevance of the obtained results. The psychometric measures of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were developed to better interpret study findings. Purpose: To establish the MCID and the PASS for the International Knee Documentation Committee (IKDC) Subjective score and the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients treated with intra-articular platelet-rich plasma (PRP) injections for knee OA. Study Design: Case series; Level of evidence, 4. Methods: This study included 215 patients with knee OA (68% men, 32% women; age, 53.2 ± 11.3 years; body mass index, 26.8 ± 4.3 kg/m2) who underwent intra-articular PRP injections. Patients were assessed through the IKDC Subjective score and KOOS subscales, and the MCID and the PASS for both measures were ind...