Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

Abstract

In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss. Persistent limited motion directly after surgery may ultimately result in arthrofibrosis. To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss, decrease the impaired range of motion and the incidence of arthrofibrosis. All patients were consecutively operated and assigned to the study or control groups. Study group patients (n = 85) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery. Eighty patients were operated without the use of platelet gel and fibrin sealant, and served as the control group. The postoperative hemoglobin decrease, range of motion and length of hospitalization were recorded. During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis. In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group. They also showed a superior postoperative range of motion when compared to those of the control group (P < 0.001). The incidence of arthrofibrosis and subsequent forced manipulation was significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty, decreases the length of stay and may reduce the incidence of arthrofibrosis.

Exogenous Application of Platelet-Leukocyte Gel during Open Subacromial Decompression Contributes to Improved Patient Outcome

“…Furthermore, PLGtreated patients did not experience an increased incidence of arthrofibrosis at postoperative evaluations. This is in accordance with results recently published by our group in patients in whom PLG was injected intracapsularly after total knee replacement [35] . Nonetheless, in these PLG-treated patients, a significantly decreased incidence of arthrofibrosis was observed.…”

O uso do plasma rico em plaquetas associado ao aspirado de medular óssea na osteotomia tibial tipo puddu

“…O PRP foi utilizado nas ATJ (6,7) , diminuindo o sangramento e a ocorrência de artrofibrose. Em nosso modelo de aplicação clínica, a osteotomia tibial proximal por cunha de adição medial, não verificamos diferença no sangramento entre os grupos com a utilização do PRP associado ao aspirado de medular óssea (p = 0,820 e p = 0,323).…”

“…Para a avaliação do sangramento oriundo do procedimento cirúrgico foram obtidos os índices hematimétri-cos: níveis de hemoglobina (Hb) e hematócrito (Ht) (7) . Esses índices foram obtidos no dia do procedimento cirúrgico e 24 horas após a realização do mesmo.…”

“…A utilização clínica do PRP vem crescendo consideravelmente, tendo sido aplicado em diversas situações: artroplastias de joelho (ATJ), reparos tendíneos, tratamento de lesões de cartilagem e como substituto ósseo (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) . O PRP mostrou-se capaz de diminuir o sangramento, a dor e a ocorrência de artrofibrose quando aplicado no período perioperatório nas ATJ (6,7) .…”

“…O PRP mostrou-se capaz de diminuir o sangramento, a dor e a ocorrência de artrofibrose quando aplicado no período perioperatório nas ATJ (6,7) . O presente estudo tem como objetivo avaliar os resultados obtidos com a aplicação do PRP, no que se refere a dor e sangramento, nas osteotomias tibiais proximais por cunha de adição medial (OTCAM).…”