Platelet-Rich Plasma Application and Heterotopic Bone Formation Following Total Hip Arthroplasty

Abstract

Activated blood platelets play a critical, early role in the wound healing response by releasing several types of growth factors at the site of injury which mediate the initial stages of tissue repair. Autologously derived platelet-rich plasma has been applied during surgery as a healing aid and some studies have shown benefit with total joint arthroplasty procedures such as in the knee. However, little has been published regarding the use of platelet-rich plasma during total hip arthroplasty. The hip is especially prone to develop islands of heterotopic bone following arthroplasty which can lead to pain, limited motion, and even ankylosis of the joint. If this condition is exacerbated by platelet-rich plasma, this could present a barrier to the use of this adjuvant in total hip arthroplasty. This retrospective, controlled clinical study examined the effect of platelet rich plasma application during closure following total hip arthroplasty on heterotopic ossification. By one year, 21.3% of the control patients developed heterotopic bone (91 patients, 94 hips, Brooker grades I-III) compared to 12.9% of the treatment patients (76 patients, 85 hips, Brooker grades I-II). These differences were not significant (p = 0.478, power = 0.90). Thus, the use of platelet-rich plasma in this procedure does not appear to influence the incidence or severity of heterotopic ossification which should help to justify further clinical research to more fully understand whether this autologous blood product has a role in total hip arthroplasty.

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“…[17,68,69] In the present study, the patients' clinical symptoms were severe and high that it may decline their QoL before surgery. Other studies also indicated that patients with OA suffer from severe pain and limitation in hip performance before knee replacement or hip arthroplasty surgery [70][71][72] which was consistent with the results of the current study. In terms of patients' satisfaction with the results of knee surgery, the results indicated that satisfaction from surgery was weak and patients were not satisfied.…”

“…[73] However, Klaassen and Pietrzak in a study indicated that satisfaction with the performance of lower extremity and hip joint after surgery was significantly high. [71] Patient dissatisfaction after knee replacement surgery may be related to the patient's expectations of surgery, pain control, and post-operative complications. Bourne et al indicated that failure to meet patient expectations is one of the strongest predictors of patient's satisfaction with knee replacement surgery.…”

A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

“…However, in a study assessing the effects of PRP use during total hip arthroplasty, no increased incidence or severity of heterotopic ossification was observed. 31 Finally, although PRP is typically an autologous product without risk of transmission of diseases such as HIV and hepatitis, bovine thrombin is typically used for PRP activation. Use of bovine thrombin in high doses in cardiac surgery has been associated with coagulopathies due to the formation of anti-bovine antibodies, 11 though none of these complications were reported in the reviewed spinal studies.…”

Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in HaCaT cells

“…Application of autologous PRP has been reported to facilitate wound healing in several fields, including facilitating bone proliferation in orthopedic surgery, regenerating periodontal ligaments and accelerating the wound healing process in diabetic ulcers (2)(3)(4). Therefore, in this study, we applied autologous PRP not only to surgical wounds, but also to various forms of ulcers.…”