Efficacy of combined ozone and platelet-rich-plasma treatment versus platelet-rich-plasma treatment alone in early stage knee osteoarthritis (original) (raw)
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International Journal of Innovative Research in Medical Science (IJIRMS), 2020
Background: Platelet rich plasma (PRP) has been applied for a long time in osteoarthritis (OA). Although there are studies about PRP that examining the effectiveness with agents such as hyaluronic acid and corticosteroid, there are few published literature comparing with ozone therapy (OT). The aim of this study is to compare the pain severity and functional status of OA patients undergoing intraarticular ozone and PRP injections. Methods: In a study which is made as prospective, randomized controlled study (RCS), 49 patients were included the study. In the first group (n = 24) OT, in the second group (n = 25) PRP injections were administered intraarticularly 3 times in total with one week intervals. Visual pain scale (VAS) and severity of pain were compared with Western Ontario McMaster Osteoarthritis Index (WOMAC). Results: In the PRP group, WOMAC pain, physical function and WOMAC total score were significantly lower than the OT group (p ˂ 0.05). Although VAS score decreased significantly (p ˂ 0.05) after treatment in both groups compared to pretreatment, the VAS score in the PRP group was significantly (p ˂ 0.05) lower than the OT group after treatment. Conclusion: Our study contributes to the literature in terms of limited publication about OT. However, this study shows that the results of PRP treatment are superior to OT in the treatment of knee OA.
Anesthesiology and Pain Medicine, 2022
Context: This systematic review and meta-analysis evaluated the effect of the intra-articular injection of platelet-rich plasma (PRP) and oxygen-ozone therapy and provided an evidence-based methodology to treat KOA. Method: Databases, including Cochrane Library, PubMed, and EMBASE, were searched. The retrieval period was before 2021. Two reviewers performed the process of screening and data extraction. Mean differences were calculated [95% confidence interval (CI)] with an inverse-variance method and fixed effect model. Meta-analysis was performed using the latest version of STATA version 16. Results: A total of 12 studies out of 769 articles were evaluated. The mean difference of visual analog scale score between ozone and control groups in the first month after injection was-0.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The purpose of this systematic review was to synthesize the available Level I and Level II literature on plateletrich plasma (PRP) as a therapeutic intervention in the management of symptomatic knee osteoarthritis (OA). Methods: A systematic review of Medline, Embase, Cochrane Central Register of Controlled Trials, PubMed, and www .clinicaltrials.gov was performed to identify all randomized controlled trials and prospective cohort studies that evaluated the clinical efficacy of PRP versus a control injection for knee OA. A random-effects model was used to evaluate the therapeutic effect of PRP at 24 weeks by use of validated outcome measures (Western Ontario and McMaster Universities Arthritis Index, visual analog scale for pain, International Knee Documentation Committee Subjective Knee Evaluation Form, and overall patient satisfaction). Results: Six Level I and II studies satisfied our inclusion criteria (4 randomized controlled trials and 2 prospective nonrandomized studies). A total of 577 patients were included, with 264 patients (45.8%) in the treatment group (PRP) and 313 patients (54.2%) in the control group (hyaluronic acid [HA] or normal saline solution [NS]). The mean age of patients receiving PRP was 56.1 years (51.5% male patients) compared with 57.1 years (49.5% male patients) for the group receiving HA or NS. Pooled results using the Western Ontario and McMaster Universities Arthritis Index scale (4 studies) showed that PRP was significantly better than HA or NS injections (mean difference, À18.0 [95% confidence interval, À28.8 to À8.3]; P < .001). Similarly, the International Knee Documentation Committee scores (3 studies) favored PRP as a treatment modality (mean difference, 7.9 [95% confidence interval, 3.7 to 12.1]; P < .001). There was no difference in the pooled results for visual analog scale score or overall patient satisfaction. Adverse events occurred more frequently in patients treated with PRP than in those treated with HA/placebo (8.4% v 3.8%, P ¼ .002). Conclusions: As compared with HA or NS injection, multiple sequential intra-articular PRP injections may have beneficial effects in the treatment of adult patients with mild to moderate knee OA at approximately 6 months. There appears to be an increased incidence of nonspecific adverse events among patients treated with PRP. Level of evidence: Level II, systematic review of Level I and II studies. O steoarthritis (OA) is a progressively debilitating condition that is associated with pain and morbidity. 1 This condition adversely impacts patient mobility and quality of life. 1 OA management can involve both conservative and operative approaches. 1,2 Conservative management includes physiotherapy, analgesia, nonsteroidal anti-inflammatory agents, and intra-articular injections. 3-7 Although these agents have been beneficial in the short-term, there is a lack of evidence that such interventions alter the natural history or progression of OA. 3-7 Other complementary medications, such as glucosamine and chondroitin, are also commonly used despite equivocal efficacy. 8-11 With respect to surgical options for OA, there is little
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.
[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.
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.
Orthopaedic journal of sports medicine, 2017
Intra-articular injections of platelet-rich plasma (PRP) to treat symptoms of knee osteoarthritis (OA) have been successfully used in young patients and in the early stages of disease. No previous studies have analyzed outcomes of PRP injections during the late stages. PRP reduces pain and leads to a more effective and lasting functional recovery than corticosteroid with local anesthetic. Randomized controlled trial; Level of evidence, 2. A total of 75 patients with symptomatic knee OA (Kellgren-Lawrence grade 3 to 4) were enrolled in this study between August 2013 and July 2014. Patients were randomized to treatment either with a single leukocyte-reduced PRP or corticosteroid intra-articular injection. The primary variable was visual analog scale assessment at 1 month. Secondary outcomes were the Knee injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36) at 1, 3, and 6 months after treatment. Patient satisfaction at final follow-up was assessed. Both groups were ...
The Role of Platelet-rich Plasma in Osteoarthritis of Knee-joint
Scholars Journal of Applied Medical Sciences
Original Research Article Background: Osteoarthritis (OA) is a leading cause of disability and frequent visits to primary care practitioners for those with the condition in comparison to those without. OA affects the knee more often than any other joint of the human body. Platelet-rich plasma (PRP) which is also known as autologous conditioned plasma is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. Now it is used in treating OA also. Aim of the study: The aim of this study was to evaluate the role of platelet-rich plasma in osteoarthritis of knee-joint. Materials and methods: This prospective observational study was conducted in the Department of Orthopaedics & Traumatology, TMSS Medical College, Bogura, Bangladesh during the period from January 2018 to December 2018. In total 120 patients more than 40 years of age, diagnosed with grade I and II arthritis were included in this study as the study population. To all the participants three PRP injections were injected in the knees at 4-week interval. Patients were followed up and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. Results: The mean WOMAC score before the starting of treatment was 82.94 (±5.12) and after 6 months it was reduced to 37.87 (±4.73), which was statistically significant (p= 0.0001). WOMAC score was improved more in the subgroup with patients having symptoms less than 2 years (p=0.0254). On the other hand, in case of subgroups with Kellgren-Lawrence grade 1 or 2 the p value was 0.0730 and there was not any significant difference in the WOMAC score at 6 months among males or females (p=0.1511). Conclusions: The proper sequential use of PRP injection for the treatment of osteoarthritis of knee-joint proved to be effective in our study. The findings of this study may be helpful in the treatment arena of osteoarthritis and in further similar researches.
American Journal of Biochemistry and Biotechnology, 2021
Osteoarthritis (OA) is a multifactorial disease that commonly affects the knee. Tumor Necrosis Factor-α (TNF-α) regulates inflammation during OA. Macrophage Migration Inhibitory Factor (MIF) may be involved in the pathophysiology of arthritis. Platelet-Rich Plasma (PRP) may reduce pain associated with OA. The present study assessed the possible therapeutic effects of PRP in patients with OA of the knee with varying severities. A prospective study was performed in 90 patients diagnosed with mild (30 cases), moderate (30 cases) and severe (30 cases) knee OA. Three Intra-Articular (IA) injections of PRP were administrated, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokine assays to measure Tumor Necrosis Factor-α (TNF-α) and macrophage Migration Inhibitory Factor (MIF) were performed using commercially available ELISA kits. The assays were performed pre-injection (S1), 2 weeks after the first IA injection (S2) and 2 weeks after the second IA injection (S3) for all patients. The mean values of pain score and synovial TNF-α and MIF levels were significantly higher (S1, pre-injection) among severe OA than among those with either mild or moderate cases, p˂0.05 for all. Pain score and synovial TNF-α and MIF levels at S3 were significantly lower in those with mild, moderate and severe OA than the corresponding S1 values, (p˂0.05 for all). There was significant improvement in synovitis in both mild and moderate cases, (p˂0.05 for both). The IA injection of PRP reduces synovial fluid TNF-α and MIF levels significantly and exhibit significant therapeutic effects on synovitis by reducing inflammatory cytokine levels and bone marrow lesions primarily for mild knee OA and to a lesser extent for moderate cases.