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08.01.2019 | Originalien

Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis

A prospective randomized controlled study

verfasst von: Yong Huang, Xiaolu Liu, Xinliang Xu, Junbin Liu

Erschienen in: Die Orthopädie | Ausgabe 3/2019

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Abstract

Background

Knee osteoarthritis (KOA) is a degenerative joint disease leading to pain and disability for which no curative treatment exists. Intra-articular (IA) therapies are part of this multimodal approach and are approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA). Platelet-rich plasma (PRP), hyaluronic acid (HA), and corticosteroids (CS) have been increasingly used in recent years to treat KOA.

Purpose

To determine whether IA-PRP was superior to IA-HA or IA-CS administration routes in these patients.

Material and methods

In this trial the patients were randomized to IA-HA (2 ml/week, for 3 weeks), IA-CS (1 ml) or IA-PRP (3 times, 4 ml, every 3 weeks) groups. The outcome was assessed using the Western Ontario and McMaster Universities (WOMAC) score prior to the first injection and then at 3, 6, 9 and 12 months. Pain was evaluated by a visual analogue scale (VAS) prior to treatment and after 12 months.

Results

In this study 120 patients were randomized into 3 groups. There was a significant improvement in all scores (WOMAC, VAS) in each group compared to the pretreatment values (P < 0.05). The mean WOMAC scores for the IA-HA group from pretreatment to 3, 6, 9, and 12 months were 47.23 ± 5.37, 25.02 ± 4.98, 26.38 ± 5.20, 27.86 ± 4.34, and 30.64 ± 8.36, respectively. Similar improvements were noted in the IA-CS and IA-PRP groups. There were no significant differences in the WOMAC scores between the 3 groups 3 months after treatment (P > 0.05) but IA-PRP showed significantly lower scores 6, 9 and 12 months after treatment (P < 0.05).

Conclusion

Intra-articular PRP injections into the knee for symptomatic early stages of KOA are a valid treatment option. The clinical efficacy of IA-PRP is comparable to that of the IA-HA and IA-CS forms after 3 months and the long-term efficacy of IA PRP is superior to IA-HA and IA-CS.

Curl WW, Krome J, Gordon ES, Rushing J (1997) Cartilage injuries: A review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460CrossRefPubMed

Litwic A, Edwards MH, Dennison EM et al (2013) Epidemiology and burden of osteoarthritis. Br Med Bull 105(1):185–199CrossRefPubMed

Tang X, Wang S, Zhan S et al (2016) The prevalence of symptomatic knee osteoarthritis in China: results from the China health and retirement longitudinal study. Arthritis Rheumatol 68(3):648–653CrossRefPubMed

Ling X, Michael CN (2003) High prevalence of knee, but not hip or hand osteoarthritis in Beijing elders: comparison with data of Caucasian in United States. Chung Hua I Hsueh Tsa Chih 83(14):1206–1209

Riddle DL, Jiranek WA, Hayes CW (2014) Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatol 66(8):2134–2143CrossRefPubMedPubMedCentral

Altman RD, Devji T, Bhandari M, Fierlinger A (2016) Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: a systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum 46(2):151–159CrossRefPubMed

He WW, Kuang MJ, Zhao J, Sun L (2017) Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg 39:95CrossRefPubMed

Nguyen C, Boutron I, Baron G (2017) Evolution of pain at 3 months by oral resveratrol in knee osteoarthritis (ARTHROL): protocol for a multicentre randomised double-blind placebo-controlled trial. BMJ Open 7(9):e17652CrossRefPubMedPubMedCentral

Tammachote N, Kanitnate S, Yakumpor T, Panichkul P (2016) Intra-articular, single-shot hylan G‑F 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. J Bone Joint Surg Am 98(11):885–892CrossRefPubMed

10.

Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE (2015) Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 162(1):46–54CrossRefPubMed

11.

Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD (2016) Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 32(3):495–505CrossRefPubMed

12.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502CrossRefPubMedPubMedCentral

13.

Sturgill LP, Snyder-Mackler L, Manal TJ, Axe MJ (2009) Interrater reliability of a clinical scale to assess knee joint effusion. J Orthop Sports Phys Ther 39(12):845–849CrossRefPubMed

14.

Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27(3):158CrossRefPubMed

15.

DeLong JM, Russell RP, Mazzocca AD (2012) Platelet-rich plasma: the PAW classification system. Arthroscopy 28(7):998–1009CrossRefPubMed

16.

Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62(4):489–496CrossRefPubMed

17.

Lacci KM, Dardik A (2010) Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med 83(1):1–9PubMedPubMedCentral

18.

Nikolidakis D, Jansen JA (2008) The biology of platelet-rich plasma and its application in oral surgery: literature review. Tissue Eng Part B Rev 14(3):249–258CrossRefPubMed

19.

Osterman C, McCarthy MB, Cote MP et al (2015) Platelet-rich plasma increases anti-inflammatory markers in a human coculture model for osteoarthritis. Am J Sports Med 43(6):1474–1484CrossRefPubMed

20.

Sakata R, McNary SM, Miyatake K et al (2015) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma. Am J Sports Med 43(6):1467–1473CrossRefPubMedPubMedCentral

21.

Zhou Q, Xu C, Cheng X et al (2016) Platelets promote cartilage repair and chondrocyte proliferation via ADP in a rodent model of osteoarthritis. Platelets 27(3):212–222CrossRefPubMed

22.

Sakata R, Reddi AH (2016) Platelet-rich plasma modulates actions on articular cartilage lubrication and regeneration. Tissue Eng Part B Rev 22(5):408–419CrossRefPubMed

23.

Sundman EA, Cole BJ, Karas V et al (2014) The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 42(1):35–41CrossRefPubMed

24.

van Buul GM, Koevoet WL, Kops N et al (2011) Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med 39(11):2362–2370CrossRefPubMed

25.

Cook JL, Smith PA, Bozynski CC et al (2016) Multiple injections of leukoreduced platelet rich plasma reduce pain and functional impairment in a canine model of ACL and meniscal deficiency. J Orthop Res 34(4):607–615CrossRefPubMed

26.

Campbell KA, Saltzman BM, Mascarenhas R et al (2015) Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping Meta-analyses. Arthroscopy 31(11):2213–2221CrossRefPubMed

27.

Gobbi A, Lad D, Karnatzikos G (2015) The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 23(8):2170–2177CrossRefPubMed

28.

Laudy AB, Bakker EW, Rekers M et al (2015) Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 49(10):657–672CrossRefPubMed

29.

Montanez-Heredia E, Irızar S, Huertas PJ et al (2016) Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the Spanish national health care system. Int J Mol Sci 17(7):E1064CrossRefPubMed

30.

Smith PA (2016) Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med 44(4):884–891CrossRefPubMed

31.

Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A (2013) Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 41(2):356–364CrossRefPubMed

32.

Hart R, Safi A, Komzák M, Jajtner P, Puskeiler M, Hartová P (2013) Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg 133(9):1295–1301CrossRefPubMed

33.

Torrero JI, Aroles F, Ferrer D (2012) Treatment of knee chondropathy with platelet rich plasma. Preliminary results at 6 months of follow-up with only one injection. J Biol Regul Homeost Agents 26(2 Suppl 1):71–78

34.

Filardo G, Kon E, Pereira Ruiz MT et al (2012) Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc 20(10):2082–2091CrossRefPubMed

35.

Kon E, Mandelbaum B, Buda R, Filardo G et al (2011) Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 27(11):1490–1501CrossRefPubMed

36.

Gormeli G, Gormeli CA, Ataoglu B et al (2017) Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc 25(03):958–965CrossRefPubMed

37.

Paterson KL, Nicholls M, Bennell KL et al (2016) Intra-articular injection of photo-activated platelet rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study. BMC Musculoskelet Disord 17(1):1–9CrossRef

38.

Forogh B, Mianehsaz E, Shoaee S et al (2015) Effect of single injection of Platelet-Rich Plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness 56(7–8):901–908PubMed

39.

Napolitano M, Matera S, Bossio M et al (2012) Autologous platelet gel for tissue regeneration in degenerative disorders of the knee. Blood Transfus 10(1):72–77PubMedPubMedCentral

40.

Filardo G, Kon E, Buda R et al (2011) Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(4):528–535CrossRefPubMed

41.

Kon E, Buda R, Filardo G et al (2010) Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 18(4):472–479CrossRefPubMed

42.

Jang SJ, Kim JD, Cha SS (2013) Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol 23(5):573–580CrossRefPubMed

Titel: Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis
A prospective randomized controlled study
verfasst von: Yong Huang
Xiaolu Liu
Xinliang Xu
Junbin Liu
Publikationsdatum: 08.01.2019
Verlag: Springer Medizin
Erschienen in: Die Orthopädie / Ausgabe 3/2019
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI: https://doi.org/10.1007/s00132-018-03659-5

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