Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis (original) (raw)
Related papers
International Journal of Research in Orthopaedics, 2017
BACKGROUND Knee osteoarthritis (OA) is a very common progressive articular disease usually affecting old age people. Current treatments for knee osteoarthritis are mostly palliative and attack the symptoms rather than influencing the biochemical environment of the joint. Platelet-Rich Plasma (PRP) therapy is being used recently to prevent the progress of the disease in addition to palliation of symptoms. The aim of this interventional study was to assess the effect of intra-articular injection of platelet-rich plasma in 100 patients suffering from knee joint osteoarthritis, attending our pain clinic. METHODS A prospective interventional study was undertaken on 100 patients of American Society of Anaesthesiologist (ASA) Physical Status 1, 2 and 3, aged 30-80 years, suffering from knee joint osteoarthritis Grade I, II and III using the Kellgren-Lawrence radiographic classification scale, attending the pain clinic who did not respond to pharmacological or physical therapy for more than three months. Visual Analogue Scale (VAS) Score was used to assess the intensity of pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Score was used to assess pain, stiffness and physical function of the joint before and after intraarticular injection of PRP at 2,4,8 and 12 weeks. RESULTS The results showed improvement in both the scores from 2 nd week onwards itself after injection of PRP in all groups. Grade I and II groups showed significant improvement compared to Grade III at 12 weeks, p<0.01. CONCLUSIONS Intra-articular PRP is effective and safe treatment to relieve pain and disability in patients suffering from knee joint osteoarthritis.
Clinical Interventions in Aging
Introduction: Osteoarthritis (OA) is a chronic joint disease that usually occurs in older people and leads to pain and disabilities. OA treatment ranges from drug therapy to surgery. Drug and rehabilitation therapy are preferred over surgery, and, especially, there is a tendency toward compounds causing regenerative changes in the knee joint. In the present study, the effects of platelet-rich plasma (PRP) injection and prolotherapy (PRL) were examined on the level of pain and function of the knee joint in patients with OA. Methodology: After fulfilling the inclusion criteria and signing the informed consent form, 42 patients with knee OA were scheduled for intra-articular injection in the present randomized, double-blind, clinical trial. Following admission to the operating pain room, the condition of the patient's knee was evaluated first via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and, then, ultrasound-guided knee injection was done. Accordingly, patients in the PRP therapy group received 7 mL PRP solution and those in the PRL group received 7 mL 25% dextrose. Using the WOMAC, levels of pain and knee function were evaluated and recorded for each patient immediately prior to the first injection as well as at 1 month (immediately prior to the second injection), 2 months (a month after the second injection), and 6 months later. Data collected were analyzed using the SPSS v.20. Results: During the first and second months, a rapid decrease in the overall WOMAC score was observed in both groups. The overall WOMAC score increased at the sixth month, but was lower than the overall WOMAC score in the first month. Statistical analysis indicated that the overall WOMAC score significantly decreased in both groups of patients over 6 months. Conclusion: Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL. This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA.
The use of PRP injections in the management of knee osteoarthritis
Cell and Tissue Research
Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented.
The Egyptian Journal of Hospital Medicine, 2015
Background: Osteoarthritis (OA) is the most common type of arthritis. It is a degenerative joint disease. OA is usually defined according to radiographic changes. Conventional radiographs (CR) were considered the most relevant outcome measure to assess the progression of OA in clinical trials and epidemiological studies. Many modalities are used in treatment of knee OA. There is a distinct need for new procedures that are cost effective by reducing the need for pharmaceutical and surgical management, while targeting the biochemical process of OA. Platelet-rich plasma (PRP) is one of these new procedures. PRP was found to increase hyaluronic acid (HA) concentration, stabilizing angiogenesis in patients with osteoarthritic knees. Aim of the study: Was to assess the value of intra articular injection of autologous platelet rich plasma in management of knee osteoarthritis. Patients and methods: This study was conducted on 40 patients with primary knee osteoarthritis, divided into 2 groups; study group treated with 3 injections of PRP, and control group treated with single dosed high-molecular weight HA. Clinical assessment and visual analogue scale (VAS) scoring were done pretreatment and 3 months post treatment. Results: Clinical improvement and reduction of VAS in both groups which is significant at the study group. Conclusion: PRP injection could be considered as a simple, safe, effective and nonpalliative treatment that may promote cartilage healing in knee osteoarthritis as it improve the clinical condition and the function of the joint. Hence, it may represent a useful addition to the available therapeutic options for knee osteoarthritis.
SVOA Orthopaedics, 2023
Introduction: Osteoarthritis (OA) is the most frequently presented joint disorder, and its treatment is often challenging. Current literature has controversial results regarding the efficacy of Platelet Rich Plasma therapy (PRP) when compared to placebo injections. This systematic review investigates the role of intra-articular PRP injections as a recommended treatment option for knee OA with the potential to establish appropriate guidelines for treating physicians. Method: This review used PUBMED, Cochrane and CINHAL database. A thorough review of literature examining PRP injections as treatment options for knee OA was performed. Two independent reviewers evaluated the studies against inclusion and exclusion criterias. The WOMAC stiffness score, VAS Score, and KOOS score were used to assess efficacy of PRP treatment. Twelve articles met the criteria for inclusion and were analysed in this study. Results: PRP injections caused a significantly better improvement in WOMAC stiffness score (25.5%), VAS Score (31.7%), and KOOS score (6.2%) after six months of treatment. Conclusion: This review demonstrated significant improvement in pain relief and stiffness levels in patients with knee OA receiving intra-articular PPR when compared to placebo. Further research is required to establish the optimum dose and duration of treatment with PRP injections for knee OA.
Platelet Rich Plasma (PRP) Injection in Osteoarthritis (OA) Knee
https://www.ijhsr.org/IJHSR\_Vol.13\_Issue.2\_Feb2023/IJHSR-Abstract05.html, 2023
Osteoarthritis (OA) is the most common degenerative joint disease in developing countries, including Indonesia. Although OA can affect all joints, the knee joint is the joint most commonly affected. The high prevalence of OA is due to increased life expectancy and the prevalence of obesity, which triggers chronic disability and increases social and economic burdens in developing countries. Treatment of knee OA is a challenge because the knee joint has low regenerative and recovery capabilities. Conservative therapies such as acetaminophen, non-steroidal anti-inflammatory drugs, and opioids are only effective in managing pain and reducing inflammation. One of the regenerative therapies currently being developed to treat knee OA is injection of platelet-rich plasma (PRP), which is an autologous blood product with high concentrations of platelets, growth factors, and cytokines. The use of PRP can be an alternative because it not only reduces inflammation, but has the ability to initiate and regenerate damaged tissue. However, even though PRP can be considered as a safe therapy for the treatment of knee OA, there are still pros and cons related to the technique used and the variation in the composition of the PRP used. This article will present the latest information regarding the mechanism and effectiveness of PRP in treating knee OA.
Role of Triple Injection Platelet-Rich Plasma for Osteoarthritis Knees: A 2 Years Follow-Up Study
Indian Journal of Orthopaedics, 2021
Purpose To assess the clinical outcomes of intra-articular Platelet-rich plasma (PRP) injection in knee osteoarthritis (OA) at 2 year follow-up. Methods This was a prospective interventional study. 68 cases (105 knees) with Kellgren-Lawrence (KL) grades I, II and III knee OA received 3 intra-articular injections of PRP 1 month apart. The cases were followed up for 2-years. Outcomes were measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Visual analog scale (VAS) scores. Results The mean age was 51.7 years. 18 knees had KL grade I, 55 had grade II and 32 had grade III OA. The mean pretreatment VAS score decreased significantly at 1 year (mean difference − 5.3, p = 0.003) and 2 year follow-up (mean difference − 6, p = 0.007). The mean pre-treatment WOMAC score decreased significantly at 1 year (mean difference − 45.9, p = 0.011) and at 2 year (mean difference − 52.4, p = 0.009). The WOMAC and VAS scores improved significantly from baseline to final follow-up across all KL grades (p = 0.001 and 0.001, 0.009 and 0.007, 0.021 and 0.017 for WOMAC and VAS across KL grade I, II and III, respectively). There was no significant differences in WOMAC and VAS scores between three KL grades at final follow-up (p = 0.17 and 0.09, respectively), although the baseline scores had significant difference (p = 0.001 for both VAS and WOMAC) with worse scores in higher KL grades. The variables like age, sex, BMI, KL grade, baseline VAS and baseline WOMAC did not predict the final VAS and WOMAC scores. Conclusion Triple injection of intra-articular PRP given one month apart significantly relieves the symptoms of knee OA till 2 years in KL grade I, II and III. The improvement in symptoms at 2-year follow-up did not differ across different KL grades.
Outcome of platelet rich plasma injection in osteoarthritis knee
International Journal of Orthopaedics Sciences, 2020
Background: Osteoarthritis (OA) knee is one of the most prevalent musculoskeletal disorders in elderly population. It has got various treatment options but most are unsatisfactory. PRR (Platelet rich plasma) injection is a relatively new procedure. Following injection activated platelets secrete growth factors (platelet derived growth factor, epidermal growth factor). These growth factors reduce inflammation, cartilage degradation and promote chondrocyte proliferation. Aim and Objectives: To compare the efficacies of treatment with PRP injection and conservative treatment with NSAIDS and exercise in OA knee. Materials and Methods: This was a observational study in which comparisons of different outcomes were made on the efficacies of the treatments with PRP injection and compared to conservative treatment with NSAIDS and exercise in OA knee. The study was conducted in the Department of Orthopaedics in Ramkrishna Mission Seva Pratishthan. A total number of 60 patients with power 80% were randomly selected from the patients with OA attended OPD during the period from September 2017 to September 2019. The patients were divided into two groups of 30 patients in each group. The patients of the one group were treated with intra-articular PRP injection and the patients of another group were treated conservatively with NSAIDS and exercise. After the completion of treatments the patients were followed-up for 6 months and the outcomes of the treatments were assessed by WOMAC (The Western Ontario and McMaster Universities Osteoarthritis Index) knee assessment scoring system. Results: At 6 month the completion of treatments it was found that both clinical and functional improvements of the patients were significantly better than the initiation of treatments (p<0.0001). However, the improvements of the patients treated with PRP injection were significantly better than the patients treated conservatively with NSAIDS and exercise (p<0.001). Conclusion: From the results of the study it may be concluded that PRP injection is better than conservative treatment with NSAIDS and exercise to treat OA knee.
Knee Surgery, Sports Traumatology, Arthroscopy, 2014
Purpose To assess the outcome of intra-articular plateletrich plasma (PRP) injections into the knee in patients with early stages of osteoarthritis (OA) and to determine whether cyclical dosing would affect the end result. Methods This is a prospective, randomized study in which 93 patients (119 knees) were followed up for a minimum of 2 years. Fifty knees were randomly selected prior to the first injection, to receive a second cycle at the completion of 1 year. A cycle consisted of three injections, each given at a monthly interval. The outcome was assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS), Tegner and Marx scoring systems, recorded prior to the first injection and then at 12, 18 and 24 months. Results There was a significant improvement in all scores over time compared to the pre-treatment value (p \ 0.001). At 12 months, both groups showed similar and significant improvement. At 18 months, except for KOOS (Symptoms) and Tegner score, all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle (p \ 0.001). At 2 years, the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores. Conclusion Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option. There is a significant reduction in pain and improvement in function after 12 months, which can be further improved at 18 months by annual repetition of the treatment. Although the beneficial effects are ill sustained at 2 years, the results are encouraging when compared to the pre-treatment function. Level of evidence II.