Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis

Abstract

Objectives: This study aims to assess whether platelet rich plasma (PRP) is an effective treatment for knee osteoarthritis (OA), and compare its efficiency with corticosteroid treatment in terms of pain control, physical function, and quality of life. Patients and methods: The study included 50 patients (4 males, 46 females; mean age 61.6±6.9 years; range 50 to 75 years) who were diagnosed as grade 3 knee OA. Patients were randomized into three groups as corticosteroid group (receiving one corticosteroid injection), single PRP group (receiving one PRP injection), and three PRP group (receiving three PRP injections with one week interval). All patients were given a home exercise program. Patients were evaluated with Visual Numeric Scale (VNS), Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC), Lequesne index and the Hospital Anxiety and Depression Scale before treatment, and at second and sixth months following the implementation of injections. Results: In single and three PRP groups; VNS, WOMAC and Lequesne scores decreased significantly at second month follow-up; also, sixth month scores showed a slight increase but remained significantly lower than baseline. In corticosteroid group, all VNS, WOMAC, and Lequesne scores decreased at second month follow-up; however, at sixth month, rest, night VNS and WOMAC stiffness scores were increased while no significant difference was found with baseline. At sixth month; VNS movement, WOMAC pain, function, and the total and Lequesne scores were worse, but remained significantly lower than baseline. When groups were compared, three PRP group's second month VNS movement scores were significantly lower than the corticosteroid group. Sixth month VNS movement and WOMAC pain scores were significantly lower in single and three PRP groups compared to the corticosteroid group, with no significant difference between the PRP groups. Conclusion: Our findings revealed that PRP is a safe treatment option and efficient in OA symptom control up to six months after application. Treatment response obtained with corticosteroid injection has a shorter duration than PRP treatment.

The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery—A Systematic Review and Meta-Analysis

“…Follow-up ranged from 6 months up to 2 years; thus, for such a large group as OA, heterogeneity will be too high due to our inability to compare outcomes at the same time point. Twenty-eight studies compared PRP versus control groups [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]73,[76][77][78][79]82,83,[86][87][88][89]91], five studies compared PRP with the addition of another substance (MSC or HA) versus the control groups [74,79,81,91], six studies compared multiple injections of PRP [54,59,80,[85][86][87], three studies compared PRGF-Endoret versus control groups [71,75,90], two studies compared autologous conditioned plasma (ACP) versus control groups [72,84], and one study compared intraosseous injection versus intra-articular injection versus the control group [67]. In twenty-three studies, HA …”

“…Twenty-three studies reported pain via the VAS comparing PRP versus placebo [54][55][56][57]69,86], corticosteroids [58,59,77] or HA [54,[60][61][62][63][65][66][67][68][69][70][71][76][77][78][79]87] (Figure 10). Placebo and HA subgroups showed significant differences in favor of PRP (p < 0.00001), despite the steroid subgroup showing non-significant differences in favor of PRP (p = 0.23).…”

“…One study was excluded from meta-analysis due to the reporting of only WOMAC pain scores [63]. Twenty-five studies compared PRP versus control groups: placebo [55][56][57]64,69,72,73,86,88,89,91], corticosteroids [59,77] or HA [62,63,65,[67][68][69]71,75,77,79,[82][83][84]87,[89][90][91] (Figure 12). The pooled estimates for these studies showed significant differences in favor of PRP (p < 0.00001); furthermore each subgroup showed significant differences in favor of PRP (p < 0.00001).…”

“…The pooled estimates for these studies showed significant differences in favor of PRP (p < 0.00001); furthermore each subgroup showed significant differences in favor of PRP (p < 0.00001). Functional outcomes were also analyzed in five studies [59,80,[85][86][87] comparing single versus multiple injections and showed significant differences in favor of multiple injections (p < 0.00001), both in all studies and subgroups ( Figure 13). Six studies evaluated functional outcomes in IKDC rating scores [54,60,63,66,70,78,89] and showed significant differences in favor of PRP (p = 0.002) ( Figure 14).…”

“…The pooled estimates for these studies showed non-significant differences in KOOS sport (p = 0.60), quality of life (p = 0.78), and ADL (p = 0.69) sub-scales in favor of PRP (p > 0.05), but in KOOS symptoms (p = 0.23) and pain (0.97) sub-scales were in favor of the control groups (p > 0.05). Functional outcomes were also measured with the KSS score in one study [68], Lysholm score in two studies [63,68], Tegner score in four studies [60,68,70,79], Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) pain measure in three studies [56,75,90], and Lequesne score in five studies [59,68,71,75,90]. Quality of life was measured with SF-36 scores in five studies [56,57,64,82], SF-12 in two studies [55,76], and European Quality of Life (EQoL) in two studies [61,76].…”