Background & Aims

Unlike the early grades of Knee osteoarthritis (KOA) where the main goal of treatment is to prevent or to slow the further degradation of joint, the aim of management in Kellgren-Lawrence (K-L) Grade IV KOA is to improve quality of life by combating pain, stiffness and improving mobility. The treatment of choice for Grade IV KOA is total knee arthroplasty (TKA); however, a large proportion of people in the middle and lower-income countries are not willing to undergo TKA due to lack of financial support and fear of surgery. There are only a few studies that have evaluated autologous PRP as a therapeutic measure for patients with advanced OA knee. The purpose of this study was to evaluate whether serial intra-articular (IA) Platelet-Rich Plasma (PRP) injections improve pain and function in patients of Grade IV primary knee osteoarthritis (KOA), not willing for arthroplasty or having relative contraindications for surgery

Methods

90 patients (84 available at final follow-up) of Grade IV KOA were given 3 PRP or Normal Saline injections at 1-month interval. Pain and functional assessment was done with Visual analog scale (VAS) and Western Ontario and McMaster universities osteoarthritis index (WOMAC) respectively, at baseline and then at three and six months of follow-up. Both groups were homogenous with similar baseline characteristics. Statistical analysis was done using statistical package for social sciences (SPSS 22.00 for windows). Significance level was set at P < 0.05. Tukey HSD post hoc test was used for comparison among groups and the effect of independent variables on outcome measures was studied with regression analysis.

Results

Both groups showed statistically significant improvements in the outcome scores but only PRP showed minimal clinically important difference (25% in WOMAC and > 2 cm difference of mean in VAS at follow-up). For inter-group comparison, PRP showed better results as there was statistically significant difference in WOMAC at 3 months (Difference = ? 9.220, 95% CI = ? 13.1945 to ? 5.2455, P < 0.0001) and at 6 months (Difference = ? 10.360, 95% CI = ? 14.5358to ? 6.1842, P < 0.0001). Similar results were seen for VAS also (Difference = ? 0.580, 95% CI = ? 1.1412 to ? 0.0188,P = 0.04 at 3 months, Difference = ? 0.870, 95% CI ? 1.3993 to ? 0.3407, P = 0.001 at 6 months). Outcome scores significantly correlated with age and sex but not with body mass index (BMI

Conclusions

The important findings of this study are that the clinical outcome scores of VAS and WOMAC were significantly better with serial intra-articular PRP injection therapy than with placebo at 3 and 6 months of follow-up in Grade IV KOA. VAS and WOMAC continued to slightly improve in the PRP group and worsened in the Saline group from 3 to 6 months, but the change was statistically not significant. In our study it was observed that VAS & WOMAC score does not improve significantly from 3 to 6 months; Showing a short term clinical improvement. It was interesting to see that the VAS and WOMAC scores improved in NS group also, which suggests that there was a placebo effect, affirming the role of placebo and lack of investigator bias.

References

1. Pal, C. P., Singh, P., Chaturvedi, S., Pruthi, K. K., & Vij, A.(2016). Epidemiology of knee osteoarthritis in India and related factors. Indian Journal of Orthopaedics, 50(5), 518–522.

2. Vina, E., & Kwoh, C. (2018). Epidemiology of osteoarthritis: Literature update. Current Opinion in Rheumatology, 30(2),160–167.

3. Kellgren, J., & Lawrence, J. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases, 16(4), 494-502

4. Fendrick, A. M., & Greenberg, B. P. (2009). A review of the benefits and risks of nonsteroidal anti-inflammatory drugs in the management of mild-to-moderate osteoarthritis. Osteopathic Medicine and Primary Care, 3, 1.

5. Kabiri, A., Esfandiari, E., Esmaeili, A., Hashemibeni, B.,Pourazar, A., & Mardani, M. (2014). Platelet-rich plasma appli-cation in chondrogenesis. Advanced Biomedical Research, 3, 138

6. Bendinelli, P., Matteucci, E., Dogliotti, G., Corsi, M. M., Banfi,G., Maroni, P., & Desiderio, M. A. (2010). Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: Mechanisms of NF-?B inhibition via HGF. Journal of Cellular Physiology, 225(3), 757–766

Presenting Author

Amit Saraf

Poster Authors

Amit Saraf

MD

Teerthanker Mahaveer Medical College and Hospital

Lead Author

E-mail

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science