Perioperative platelet rich plasma (PRP) in total hip arthroplasty through the Hardinge approach: protocol to study the effectiveness for gluteus medius healing

Abstract

BackgroundPlatelet-rich plasma (PRP) has been used to support tendon regeneration mainly in sports medicine. PRP is a concentrate of platelet-rich plasma proteins derived from whole blood by centrifugation to remove erythrocytes and leukocytes. PRP has high amounts of platelets which may promote healing tendons affected by degenerative conditions. These platelets contain growth factors and are known to facilitate the regeneration of injured tendon structures. Total hip arthroplasty (THA) through the Hardinge approach may leave the patient with impaired gait and poor regeneration of the gluteus medius tendon if the tendon is not reattached properly after closure of the surgical wound.MethodsThe study will be a multicenter, double-blinded and randomized study enrolling 90 patients based on power calculations. The efficacy of perioperative PRP treatment will be assessed by subjective and objective outcome variables. The participants will be randomized (sealed envelope) into either a placebo (saline) or a PRP group (1:1). For subjective outcomes, the Oxford Hip Score (OHS) will be collected before surgery and 3 and 12 months after surgery. The objective measures are findings at magnetic resonance imaging and plain radiographs and recorded values of measured strength.DiscussionWe present the perioperative use and the ways to measure the clinical efficacy of PRP. As PRP may have benefits regarding degenerative tendon regeneration, studies on the use of PRP in hip arthroplasty are warranted to facilitate postoperative recovery.Trial registrationThis study has been approved by the ethics committee of the Hospital District of Southwest Finland and approved by the local institutional research board. The study has been registered in ClinicalTrials.gov (NCT02607462).

The Role of Platelet-Rich Plasma Therapy in Joint Arthroplasty A Mini-Review

“…The resulting high concentration of platelets within the sample is thought to promote the healing of soft tissue affected by traumatic and degenerative conditions. These platelets secrete growth factors and are known to facilitate the regeneration of injured tendon structures and other soft tissues [14]. Specifically, platelet-derived growth factors and transforming growth factors (TGF-α and TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), connective tissue growth factor (CTGF), and insulin-like growth factor (IGF-1) have been shown to regulate collagen synthesis, mitogenesis of fibroblasts, stimulate macrophage and neutrophil chemotaxis, induce angiogenesis, regulate endothelial chemotaxis, stimulate protein synthesis, and promote long-term healing [26,27].…”

“…Further, factors such as the preparation device, time and storage methods, and interactions with other biological materials vary between practices and patients [52]. Studies conducted investigating the efficacy of PRP injections are commonly limited by the use of non-standardized PRP preparations [14]. Difficulties in accessing and controlling the concentration of platelets and leukocytes are frequently reported [54].…”

“…Additionally, some samples of PRP may or may not include leukocytes, which are intrinsically antimicrobial and produce VEGF, further varying the quality of PRP [29]. Furthermore, homogenizing fresh PRP has not yet been adequately described by studies [14].…”

“…PRP therapy has been shown to be relatively safe for the treatment of musculoskeletal conditions and potentially accelerate or augment the soft tissue healing process [13]. PRP therapy has been shown to support tendon regeneration in sports medicine injuries and addresses aspects of the healing process, including cell proliferation and tissue matrix regeneration, inflammation, nociception, infection, and hemostasis [14,15]. PRP can be applied to the site of injury either through an injection performed in the physician's office or intraoperatively during TJA as seen in Figure 1 below [16].…”