Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial

Abstract

Objective:To compare the efficacy of ultrasound-guided hyaluronic acid (HA) versus leukocyte-poor platelet-rich plasma (LP-PRP) injection in the treatment of glenohumeral osteoarthritis.Design:Double-blind randomized controlled trial.Setting:Academic institution.Patients:Seventy patients with chronic glenohumeral osteoarthritis were randomly assigned to receive a single injection of HA (n = 36) or LP-PRP (n = 34).Interventions:Leukocyte-poor platelet-rich plasma was processed using Harvest/TerumoBCT Clear PRP kits. Ultrasound-guided injections of 6 mL HA or 6 mL LP-PRP into the glenohumeral joint were performed. Patients, the injecting physician, and outcomes assessor were blinded to treatment assignments.Main outcome measures:Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) score, current/average numerical rating scale (NRS) pain scores, satisfaction, and side effects were assessed at the 5 follow-up time points over 12 months.Results:Baseline characteristics were similar between groups. There were no significant between-group differences regarding SPADI, ASES, and current/average NRS pain scores at any time point up to 12 months postinjection (P > 0.05). However, significant improvements in SPADI, ASES, and current/average NRS pain scores were observed in both groups starting at 1 or 2 months (P < 0.01, P < 0.01, P < 0.001, and P < 0.01, respectively). These improvements were observed regardless of osteoarthritis severity. For patients who received LP-PRP, there was no effect of platelet yield on outcomes. Side effect and satisfaction rates were similar between groups.Conclusions:There were no differences in pain and functional outcomes after a single injection of LP-PRP versus HA. However, significant improvements in pain and function were observed after both treatments in patients with glenohumeral osteoarthritis.

Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

“…44 Of interest in the aforementioned study was that no differences in outcomes or side effects were present between groups. 44 In a retrospective study, individuals with GHOA under the age of 51 who received a series of three leukocyte-poor PRP injections were able to postpone shoulder arthroplasty by 3.5 years. 42 While these results are promising, patients in the aforementioned study receiving hyaluronic acid had comparable outcomes.…”

“…18,38,39 Evidences, albeit limited, from published studies support the use of autologous injectable procedures such as PRP, lipoaspirate, BMA, and BMAC for treatment of GHOA. 8,23,[40][41][42][43][44] With regard to the use of PRP for GHOA, the evidence is limited albeit promising. 8,42,44 In one study, the effect of single injection of leukocyte-poor PRP was compared to hyaluronic acid in the treatment of GHOA with improvements in pain and function identified 1-2 months following the injection.…”

“…8,23,[40][41][42][43][44] With regard to the use of PRP for GHOA, the evidence is limited albeit promising. 8,42,44 In one study, the effect of single injection of leukocyte-poor PRP was compared to hyaluronic acid in the treatment of GHOA with improvements in pain and function identified 1-2 months following the injection. 44 Of interest in the aforementioned study was that no differences in outcomes or side effects were present between groups.…”

“…8,42,44 In one study, the effect of single injection of leukocyte-poor PRP was compared to hyaluronic acid in the treatment of GHOA with improvements in pain and function identified 1-2 months following the injection. 44 Of interest in the aforementioned study was that no differences in outcomes or side effects were present between groups. 44 In a retrospective study, individuals with GHOA under the age of 51 who received a series of three leukocyte-poor PRP injections were able to postpone shoulder arthroplasty by 3.5 years.…”

“…Thus, clinically important outcomes may be achieved on a more medium-term basis, which The study findings in this cohort are consistent with previous investigations of orthobiologics for GHOA. 8,23,[40][41][42][43][44] Though there are variations in preparation, one area of debate is the use of leukocytes in PRP. 47,48 A concern over potential proinflammatory effects of leukocytes 48,49 may steer practitioners toward leukocyte-poor products, despite evidence to the contrary.…”