Treatment Options in Knee Osteoarthritis: Total Knee Arthroplasty Versus Platelet‐Rich Plasma

Klatt, Brian A.; López, Héctor Hugo Bustos; Segal, Neil A.; Chimes, Gary P.

doi:10.1016/j.pmrj.2011.03.007

Cited by 12 publications

(2 citation statements)

References 52 publications

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“…Four studies were excluded after reviewing the full text. Two were excluded because they did not examine the intervention of interest33 34 and one was a point/counterpoint discussion 35. The search in the trial registers resulted in three trials, two ongoing trials and one trial which was characterised as completed.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis

Laudy

Bakker

Rekers³

et al. 2014

Br J Sports Med

300

222

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BackgroundThe effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. We investigated the effect of PRP injections in patients with knee OA based on decreasing pain, improving function, global assessment and changes regarding joint imaging. Methods We performed a comprehensive, systematic literature search in computerised databases (MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science and PEDro) until June 2014 for randomised or nonrandomised controlled trials. These were graded for risk of bias and a level of evidence was provided. If possible, meta-analysis was performed. Results Ten trials were included. In these, intraarticular PRP injections were more effective for pain reduction (mean difference (MD) −2.45; 95% CI −2.92 to −1.98; p value <0.00001 and MD −2.07; 95% CI −2.59 to −1.55; p value <0.00001, single and double PRP injections, respectively) compared with placebo at 6 months postinjection. Intra-articular PRP injections were compared with hyaluronic acid and showed a statistically significant difference in favour of PRP on pain reduction based on the visual analogue scale and numeric rating scale (standardised mean difference −0.92; 95% CI −1.20 to −0.63; p value <0.00001) at 6 months postinjection. Almost all trials revealed a high risk of bias. Conclusions On the basis of the current evidence, PRP injections reduced pain more effectively than did placebo injections in OA of the knee (level of evidence: limited due to a high risk of bias). This significant effect on pain was also seen when PRP injections were compared with hyaluronic acid injections (level of evidence: moderate due to a generally high risk of bias). Additionally, function improved significantly more when PRP injections were compared with controls (limited to moderate evidence). More large randomised studies of good quality and low risk of bias are needed to test whether PRP injections should be a routine part of management of patients with OA of the knee.

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Section: Resultsmentioning

confidence: 99%

Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis

Laudy

Bakker

Rekers³

et al. 2014

Br J Sports Med

300

222

View full text Add to dashboard Cite

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confidence: 99%

Re: “Treatment Options in Knee Osteoarthritis: Total Knee Arthroplasty Versus Platelet‐Rich Plasma”

Jain

Higgins

2011

PM&R

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We commend the authors and PM&R for an interesting and provocative Point/Counterpoint discussion on the treatment options for tricompartmental knee osteoarthritis [1]. However, we take issue with the opinion that platelet-rich plasma (PRP) has documented value for knee osteoarthritis. Furthermore, total knee arthroplasty (TKA) has proven value for this condition.TKA is a surgical option that has excellent patient outcomes (pain relief and functional improvement) [2][3][4]. This is supported by a comprehensive report on TKA by the Agency for Healthcare Research and Quality [5]. Conversely, almost no data support the effectiveness of PRP therapy in improving patient outcomes when compared with placebo. This is the case for the use of PRP in tendinopathies and more so for knee osteoarthritis, where the biologic basis for its use is also uncertain. Hence, in our opinion, the issue is not whether the patient should undergo a TKA versus treatment with PRP; these options are completely different, with a disparate profile of evidence, risks, and consequences. Undergoing TKA is a major decision and likely will lead to lifelong functional limitations for this patient, such as being unable to ski downhill. The patient should only undergo TKA when he or she believes that the symptoms are severe enough to warrant the risks and limitations after surgery. However, in the meantime, the option to provide a "trial of PRP" is not supported by data in the current literature and is not the practice of evidence-based medicine. In fact, the current data support the ineffectiveness of PRP.Informed consent in this case involves an understanding on behalf of the patient that no evidence exists to support the use of PRP in persons with knee osteoarthritis. The doctrine that "just as there is insufficient evidence to conclude that PRP will help this patient to return to skiing, there is insufficient evidence to conclude PRP will not help this patient return to skiing" has little basis because the burden of proof for a treatment lies with the treating clinician or the investigator.We present a few pieces of evidence regarding TKA and PRP, in addition to the ones presented in the article. In a recent cost-effectiveness analysis, Losina et al [6] reported that qualityadjusted life years increased from 6.822 to 7.957 after TKA. The incremental cost-effectiveness ratio was $18,300 per qualityadjusted life year, making TKA a cost-effective treatment. One of the best-designed studies for the in vivo use of PRP in musculoskeletal disorders by de Vos et al [7] showed that a PRP injection compared with a saline solution injection did not result in greater improvement in pain and activity. This study had limitations such as patient selection and lack of localization under imaging guidance. In the postdebate commentary, Dr Segal notes the limitations of other studies in which the authors reported the effectiveness of PRP in knee osteoarthritis. The 2 investigations cited by Dr Lopez on the efficacy of PRP for lateral epicondylitis were some of the firs...

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Novel Techniques in the Treatment of Chondral Lesions of the Hip

Mardones

Birrell

2016

Hip Joint Restoration

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Treatment Options in Knee Osteoarthritis: Total Knee Arthroplasty Versus Platelet‐Rich Plasma

Cited by 12 publications

References 52 publications

Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis

Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis

Re: “Treatment Options in Knee Osteoarthritis: Total Knee Arthroplasty Versus Platelet‐Rich Plasma”

Novel Techniques in the Treatment of Chondral Lesions of the Hip

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