Preparation Methods and Clinical Outcomes of Platelet-Rich Plasma for Intra-articular Hip Disorders: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Abstract

Background: Despite its increasing use in the management of musculoskeletal conditions, questions remain regarding the preparation methods of platelet-rich plasma (PRP) and its clinical applications for intra-articular hip disorders, including femoroacetabular impingement syndrome (FAIS), labral pathology, and osteoarthritis (OA). Purpose: To systematically review and assess the preparation methods and clinical outcomes from randomized clinical trials (RCTs) on the use of PRP for intra-articular hip disorders. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in September 2019. The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Ovid Medline, and Embase were queried for studies regarding the use of PRP to treat intra-articular hip disorders. Qualifying articles were English-language RCTs describing the use of PRP for intra-articular hip disorders, either as standalone treatment or surgical augmentation. Two authors independently assessed article eligibility. Data pertaining to patient characteristics, indication for treatment, PRP preparation method, follow-up period, and clinical outcomes were extracted. Study results were qualitatively reported and quantitatively compared using meta-analysis when appropriate. Results: Seven RCTs met inclusion criteria. Four studies described the use of PRP for hip OA and 3 utilized PRP at arthroscopy for FAIS and labral tears. Outcomes after PRP for OA demonstrated improvement in validated patient-reported outcome measures for up to 1 year; however, pooled effect sizes found no statistically significant difference between PRP and hyaluronic acid (HA) regarding pain visual analog scale scores at short-term (≤2 months; P = .27), midterm (4-6 months; P = .85), or long-term (1 year; P = .42) follow-up. When injected at arthroscopy, 1 study reported improved outcomes, 1 reported no difference in outcomes, and 1 reported worse outcomes compared with controls. The meta-analysis demonstrated no statistically significant difference on the modified Harris Hip Score (mHHS) between PRP and control cohorts at a minimum 1-year follow-up. There were considerable deficiencies and heterogeneity in the reporting of PRP preparation methods for both indications. Conclusion: Treatment of OA with PRP demonstrated reductions in pain and improved patient-reported outcomes for up to 1 year. However, there was no statistically significant difference between PRP and HA in pain reduction. Likewise, for FAIS and labral surgery there was no statistically significant difference in mHHS outcomes between patients treated with PRP and controls. Given the limited number of studies and variability in PRP preparations, additional high-quality randomized trials are warranted.

Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis

“…The description of surgical technique was not adequately reported in some studies, which represents a further limitation. Heterogeneity in PRP preparation and processing protocols was evident, as were between-study differences with regard to the initial whole blood volume and centrifugation rate and duration [ 62 – 65 ]. Battaglia et al.…”

Comparison Between the Effects of Ultrasound Guided Intra-Articular Injections of Platelet-Rich Plasma (PRP), High Molecular Weight Hyaluronic Acid, and Their Combination in Hip Osteoarthritis: A Randomized Clinical Trial

“…In a meta-analysis by Garcia et al in 2020, 7 studies regarding the role of PRP on hip disorders (femoroacetabular impingement syndrome (FAIS), labral pathology, and OA) were assessed (31). Among the four studies evaluating PRP in HIP OA, the most important nding was not seeing any statistically signi cant difference between HA, PRP, and PRP + HA in hip OA treatment after one year.…”

“…In addition to age and higher OA stages affecting study results, the difference in the PRP preparation protocol and its contents, and the number of PRP injections have all shown to play a role in the results and ndings, which has also been one of the challenges in meta-analyses (30,31).…”

Comparison of the Effect of MFAT and MFAT + PRP on Treatment of Hip Osteoarthritis: An Observational, Intention-to-Treat Study at One Year

“…A recent systematic review of PRP injection alone in patients with hip OA indicated overall improvements in the majority of albeit, limited trials, Ref. [35] whilst most recently, Kraeutler et al [36] compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and hip flexion from 33 patients treated with either leukocytepoor PRP (LP-PRP) or low molecular weight HA, finding significant improvements up to 12 months after injection, only in the PRP-treated individuals. From a biological perspective, LP-PRP has the capacity to release notable quantities of anti-inflammatory and pro-reparative factors from the platelet granules and in addition, has been previously shown to stimulate HA production in vitro in patient-derived synovitis [37].…”