Effect of Platelet-rich Plasma Injection on Disability and Pain in Individuals with Osteoarthritis Knee: A Follow-up Study of Six Months
Mahima Agrawal, Mrinal Joshi
Osteoarthritis knee, Platelet-rich plasma, Visual analog scale, Western Ontario McMaster osteoarthritis index score
Citation Information :
Agrawal M, Joshi M. Effect of Platelet-rich Plasma Injection on Disability and Pain in Individuals with Osteoarthritis Knee: A Follow-up Study of Six Months. Indian J Phy Med Rehab 2019; 30 (2):41-45.
Objectives: To demonstrate the effect of autologous platelet-rich plasma (PRP) injections on pain and functional activities in patients with osteoarthritis (OA) knee. Study design: Prospective interventional study. Materials and methods: A detailed demographic data were collected, and each patient was examined clinically and radiographically. Complete blood counts, prothrombin time (PT)/international normalized ratio (INR), and X-rays of bilateral knees were taken. Radiological grading was done on Kellgren–Lawrence (KL grading) OA scale. Each individual was explained and informed consent was taken before the procedure. Three injections of PRP were given at an interval of 2 weeks. Detailed clinical examination was done at the end of 1 month and 6 months postinjection. Pain assessment was done on visual analog scale (VAS) and Western Ontario McMaster (WOMAC) OA index was used for comprehensive documentation of pain, stiffness, and overall disability experienced by the individual suffering from OA knee. Results: The mean VAS score for pain was 6.53, 4.24, and 3.76 before treatment, 1 month posttreatment, and 6 months postinjection, respectively, in KL grades I and II individuals. On WOMAC scale, mean pain scores were 17.15, 7.90, and 7.39 before treatment, 1 month posttreatment, and 6 months postinjection, respectively. Mean stiffness scores were 5.56, 3.15, and 2.56 39 before treatment, 1 month posttreatment, and 6 months postinjection, respectively. Mean functional capacity scores were 46.49, 27.78, and 23.51 before treatment, 1 month posttreatment, and 6 months postinjection, respectively. Conclusion: An overall reduction in pain and improvement in functional status were observed in all individuals suffering from OA knee of any grade. In the light of other studies, it can be concluded that the use of PRP injection has proven to be a promising treatment modality for OA.
Mehmoudi SF, Toulgui E, Jeddou KB, et al. Quality of life for patient with knee osteoarthritis. Ann Phys Rehabil Med 2016;59:e158–e159. DOI: 10.1016/j.rehab.2016.07.354.
Gomoll AH, Filardo G, de Girolamo L, et al. Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 2012;20(3):450–466. DOI: 10.1007/s00167-011-1780-x.
Gomoll AH, Filardo G, Almqvist FK, et al. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc 2012;20(3):468–486. DOI: 10.1007/s00167-011-1714-7.
Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2011;19(4): 528–535. DOI: 10.1007/s00167-010-1238-6.
Filardo G, Kon E, Di Martino A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord 2012;13:229. DOI: 10.1186/1471- 2474-13-229.
Alsousou J, Thompson M, Hulley P, et al. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br 2009;91(8):987–996. DOI: 10.1302/0301-620X.91B8.22546.
Lee KS, Wilson JJ, Rabago DP, et al. Musculoskeletal applications of platelet-rich plasma: fad or future? AJR Am J Roentgenol 2011;196(3):628–636. DOI: 10.2214/AJR.10.5975.
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008;1(3–4):165–174. DOI: 10.1007/s12178-008-9032-5.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006;34(11): 1774–1778. DOI: 10.1177/0363546506288850.
Wu W, Chen F, Liu Y, et al. Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model. Oral Maxillofac Surg 2007;65(10):1951–1957. DOI: 10.1016/j.joms.2006.11.044.
Anitua E, Sánchez M, Nurden AT, et al. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology (Oxford) 2007;46(12):1769–1772. DOI: 10.1093/rheumatology/kem234.
Sindhu BS, Shechtman O, Tuckey L. Validity, reliability, and responsiveness of a digital version of the visual analog scale. J Hand Ther 2011;24(4):356–363. DOI: 10.1016/j.jht.2011.06.003.
Baron G, Tubach F, Ravaud P, et al. Validation of a short form of the Western Ontario and McMaster Universities Osteoarthritis Index function subscale in hip and knee osteoarthritis. Arthritis Rheum 2007;57(4):633–638. DOI: 10.1002/art.22685.
Ornetti P, Dougados M, Paternotte S, et al. Validation of a numerical rating scale to assess functional impairment in hip and knee osteoarthritis: comparison with the WOMAC function scale. Ann Rheum Dis 2011;70(5):740–746. DOI: 10.1136/ard.2010.135483.
Filardo G, Kon E, Roffi A, et al. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc 2015;23(9):2459–2474. DOI: 10.1007/s00167-013-2743-1.
Pujol JP, Chadjichristos C, Legendre F, et al. Interleukin-1 and transforming growth factor-beta 1 as crucial factors in osteoarthritic cartilage metabolism. Connect Tissu Res 2008;49(3):293–297. DOI: 10.1080/03008200802148355.
Andia I, Sánchez M, Maffulli N. Joint pathology and platelet-rich plasma therapies. Expert Opin Biol Ther 2012;12(1):7–22. DOI: 10.1517/14712598.2012.632765.
Giusti I, Rughetti A, D'Ascenzo S, et al. Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells. Transfusion 2009;49(4):771–778. DOI: 10.1111/j.1537-2995.2008.02033.x.
Raeissadat SA, Rayegani SM, Babaee M, et al. The effect of platelet-rich plasma on pain, function, and quality of life of patients with knee osteoarthritis. Pain Res Treat 2013;2013:165967. DOI: 10.1155/2013/165967.
Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 2001;10(4):225–228. DOI: 10.1097/00008505-200110000-00002.
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet rich plasma (P-PRP) to leucocyte- and platelet- rich fibrin (L-PRF). Trends Biotechnol 2009;27(3):158–167. DOI: 10.1016/j.tibtech.2008.11.009.
Andia I, Maffulli N. Platelet rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 2013;9(12): 721–730. DOI: 10.1038/nrrheum.2013.141.
Spaková T, Rosocha J, Lacko M, et al. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 2012;91(5):411–417. DOI: 10.1097/PHM.0b013e3182aab72.
Filardo G, Kon E, Pereira Ruiz MT, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc 2012;20(10):2082–2091. DOI: 10.1007/s00167-011-1837-x.
Sampson S, Reed M, Silvers H, et al. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil 2010;89(12):961–969. DOI: 10.1097/PHM.0b013e3181fc7edf.
Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010;18(4):472–479. DOI: 10.1007/s00167-009-0940-8.
Wang-Saegusa A, Cugat R, Ares O, et al. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg 2011;131(3): 311–317. DOI: 10.1007/s00402-010-1167-3.
Gobbi A, Karnatzikos G, Mahajan V, et al. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health 2012;4(2):162–172. DOI: 10.1177/1941738111431801.
Napolitano M, Matera S, Bossio M, et al. Autologous platelet gel for tissue regeneration in degenerative disorders of the knee. Blood Transfus 2012;10(1):72–77. DOI: 10.2450/2011.0026-11.
Sánchez M, Guadilla J, Fiz N, et al. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford) 2012;51(1):144–150. DOI: 10.1093/rheumatology/ker303.
Sánchez M, Anitua E, Azofra J, et al. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol 2008;26(5):910–913.
Zhu Y, Yuan M, Meng HY, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthritis Cartilage 2013;21(11):1627–1637. DOI: 10.1016/j.joca.2013.07.017.
Anitua E, Sánchez M, Orive G, et al. The potential impact of the preparation rich in growth factors (PRGF) in different medical fields. Biomaterials 2007;28(31):4551–4560. DOI: 10.1016/j.biomaterials.2007.06.037.
Harrison S, Vavken P, Kevy S, et al. Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med 2011;39(4):729–734. DOI: 10.1177/0363546511401576.