Intra-articular injections of platelet-rich plasma decrease pain and improve functional outcomes than sham saline in patients with knee osteoarthritis

Abstract

Purpose To compare the long-term clinical eicacy provided by intra-articular injections of either Pure Platelet-rich Plasma (P-PRP) or sham saline to treat knee osteoarthritis (KOA). Methods This prospective, parallel-group, double-blind, multi-center, sham-controlled randomized clinical trial recruited participants with KOA from orthopedic departments at nine public hospitals (ive tertiary medical centers, four secondary medical units) starting January 1, 2014, with follow-up completed on February 28, 2021. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 1, 2021, to July 15, 2021. Three sessions (1 every week) of P-PRP or sham saline injected by physicians. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, 24, 60 months of follow-up. Secondary outcomes included the International Knee Documentation Committee (IKDC) subjective score, visual analogue scale (VAS) score, intra-articular biochemical marker concentrations, cartilage volume, and adverse events. Laboratory of each hospital analyzed the content and quality of P-PRP. Results 610 participants (59% women) with KOA who received three sessions of P-PRP (n = 308, mean age 53.91 years) or sham saline (n = 302, mean age 54.51 years) injections completed the trial. The mean platelet concentration in PRP is 4.3 fold (95% conidence interval 3.6-4.5) greater than that of whole blood. Both groups showed signiicant improvements in IKDC, WOMAC, and VAS scores at 1 month of follow-up. However, only the P-PRP group showed a sustained improvement in clinical outcome measurements at month 24 (P < 0.001). There were statistically signiicant diferences between the P-PRP and sham saline groups in all clinical outcome measurements at each follow-up time point (P < 0.001). The beneit of P-PRP was clinically better in terms of WOMAC-pain, WOMAC-physical function and WOMAC-total at 6, 12, 24, and 60 months of follow-up. No clinically signiicant diferences between treatments were documented in terms of WOMAC-stifness at any follow-up. A clinically signiicant diference favoring P-PRP group against saline in terms of IKDC and VAS scores was documented at 6, 12, 24 and 60 months of follow-up. At 6 months after injection, TNF-α and IL-1β levels in synovial luid were lower in the P-PRP group (P < 0.001). Tibiofemoral cartilage volume decreased by a mean value of 1171 mm 3 in the P-PRP group and 2311 mm 3 in the saline group over 60 months and the diference between the group was statistically signiicant (intergroup diference, 1140 mm 3 , 95% CI − 79 to 1320 mm 3 ; P < 0.001). Conclusions In this randomized clinical trial of patients with KOA, P-PRP was superior to sham saline in treating KOA. P-PRP was efective for achieving at least 24 months of symptom relief and slowing the progress of KOA, with both P-PRP and saline being comparable in safety proiles.

No Benefit to Platelet-rich Plasma Over Placebo Injections in Terms of Pain or Function in Patients with Hemophilic Knee Arthritis: A Randomized Trial

“…In a prospective study [2], three intraarticular injections at weekly intervals of PRP did not result in improvements in symptoms or joint structure at 12 months among patients with knee osteoarthritis. However, another recent study [7] found a better functional outcome of knee arthritis after three PRP injections. Concentrations of growth factors and cytokines vary depending on the donor’s age, health, and gender.…”

Comparison of the effects of autologous and allogeneic purified platelet-rich plasma on cartilage damage in a rabbit model of knee osteoarthritis

“…In an in vivo experiment in a KOA mouse model, PRP injection in the joint cavity was found to effectively reduce the catabolic activity of chondrocytes and slow down the rate of chondrocyte apoptosis [23]. In addition, researchers also that platelet-rich plasma can reduce pain and synovial thickness by regulating macrophage subtypes through experiments in a mouse OA model [24]; a number of clinical studies have also continued to report the therapeutic value of PRP for KOA [8][9][10][11] .…”

“…Activated PRP can release a variety of growth factors, cytokines and related signaling molecules, making it useful in KOA therapy to promote cartilage repair and regulate the inflammatory response, etc [5][6][7]. PRP is divided into pure platelet-rich fibrin (P-PRF), leukocyte and platelet-rich fibrin (L-PRF), purified platelet-rich plasma (P-PRP), leukocyte and platelet-rich plasma (L-PRP), and in recent years P-PRP has been gradually applied to KOA [8][9][10][11]. Currently, most of the P-PRP used for clinical and research purposes are derived from autologous blood, but it is difficult to prepare autologous P-PRP for patients with blood disorders or frailty, so allogeneic PRP has come into being.…”

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

“…The PRP arm showed statistically significant improvements over sham in IKDC, WOMAC, and VAS out to 60 months. 196 …”

“…The PRP arm showed statistically significant improvements over sham in IKDC, WOMAC, and VAS out to 60 months. 196 Although there has been much variation in treatment protocols and specifically the total number of PRP injections, the optimal number of PRP injections for positive outcomes has been under investigation. In 2019, one systematic review studied the clinical effectiveness of single versus multiple (double or triple) PRP injections for knee osteoarthritis.…”