Effect of Platelet-rich Plasma Combined With Core Decompression Bone Grafting for Osteonecrosis of Femoral Head: A Meta-Analysis

Abstract

Objective: Core decompression bone grafting usually is used hip-preserving approach for osteonecrosis of femoral head (ONFH). Platelet-rich plasma (PRP) is an adjuvant therapy, combined with core decompression bone grafting for ONFH. However, it remains controversial. Therefore, its efficacy was systematically evaluated and meta-analysis in this study.Methods: Literature on core decompression bone grafting for ONFH was retrieved in CNKI, Wan Fang, PubMed, Embase, Cochrane Library and Web of Science from inception to March 2021. Review Manager 5.3 software and Stata 12.0 software were used for data synthesis.Results: A total of 10 RCTs were included. The results showed at final follow-up that, Harris hip score was significantly difference in the treatment group, adjuvant therapy with PRP (group A) better than the control group (group B), MD=7.53 [95%CI (5.29,9.77)]，P < 0.00001. There was MD=-0.71[95%CI (-0.96, -0.46)], P < 0.00001, of visual analog scale (VAS) of hip pain between the two groups. The excellent and good rate of function of hip was 1.42-fold higher in group A than that in group B, RR=1.42, 95%CI (1.25,1.62), P<0.00001. The progression and total hip arthroplasty were showed improvements, RR=0.37,95%CI (0.21,0.65), P=0.0006 and RR=0.39,95%CI (0.18,0.85), P=0.02, respectively. Begg's and Egger's tests did not indicate publication bias.Conclusion: It was shown that the use of PRP combined with core decompression bone grafting improved the symptoms better than core decompression bone grafting only, and might delay progression and total hip arthroplasty. However, as the study’s limitations, it needed to be fully verified by more large-sample multicenter prospective clinical studies.

Clinical evaluation of platelet-rich plasma therapy for osteonecrosis of the femoral head: A systematic review and meta-analysis

“…Harris hip score (HHS). A total of 13 studies [24,26,27,[29][30][31][32][33][34][35][36][37][38] with 809 participants reported HHS between the treatment groups and control groups. Among the 13 studies, 7 studies [26,27,[31][32][33][34][35] reported HHS at 3 months postoperatively, 9 studies [26,27,[29][30][31][32][33][34][35] reported HHS at 6 months postoperatively, 9 studies [26,27,31,32,[34][35][36][37][38] reported HHS at 12 months postoperatively, and 3 studies [25,30,32] reported HHS at � 24 months postoperatively.…”

“…A total of 13 studies [24,26,27,[29][30][31][32][33][34][35][36][37][38] with 809 participants reported HHS between the treatment groups and control groups. Among the 13 studies, 7 studies [26,27,[31][32][33][34][35] reported HHS at 3 months postoperatively, 9 studies [26,27,[29][30][31][32][33][34][35] reported HHS at 6 months postoperatively, 9 studies [26,27,31,32,[34][35][36][37][38] reported HHS at 12 months postoperatively, and 3 studies [25,30,32] reported HHS at � 24 months postoperatively. Meta-analysis was performed on the last follow-up time points, and at different followup time points postoperatively (3-, 6-, 12-, and � 24-month follow-ups) when those were reported by the respective studies.…”

“…A total of 909 adult participants with ONFH were included in the 14 eligible studies [24,[26][27][28][29][30][31][32][33][34][35][36][37][38]. There were 454 participants in the control group and 455 participants in the treatment group.…”

“…All studies had clear inclusion and exclusion criteria and there were no significant differences in baseline information between the control groups and treatment groups. The 6 studies [24,27,31,32,35,37] were supported by the government or a professional organization. The 8 studies [26, 28-30, 33, 34, 36, 38] did not report the funding.…”

“…The 9 studies [24, 26-29, 31, 32, 34, 36] followed the Association Research Circulation Osseous classification, and 5 studies [30,33,35,37,38] followed the Ficat classification. All of the studies described mechanical structural enhancements, 5 of which used β-tricalcium phosphate bioceramic bone [26,31,32,34,35], 1 of which used porous tantalum rod [27], and 7 of which used autologous bone graft [24,29,30,33,[36][37][38]. All the studies describe the PRP preparation technique, but the details vary (Table 3).…”