Summary

The use of platelet rich plasma during hip arthroscopy may lead to increased risk for postoperative complications, in particular heterotopic ossification.

Abstract

Purpose

Platelet-rich-plasma is becoming an increasingly popular tool orthopedic surgeons use intraoperatively to accelerate healing and recovery; however, little data exists regarding its safety profile in hip arthroscopy.

Methods

We queried the MarketScan database to identify patients who underwent hip arthroscopy from 2007 to 2015. Patients were stratified into groups based on whether or not they received platelet rich plasma during their surgery. Complications, reoperations and costs for both groups were assessed for 90 days after surgery. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors.

Results

35,263 patients met the inclusion criteria of this study, of which n = 253 (0.7%) received PRP at the time of surgery. Age and rates of diabetes, hypertension, hyperlipidemia, obesity, and tobacco use were similar between cohorts. However, there were significant differences in the concomitant procedure distribution. Unadjusted composite complications rates were significantly different between the two cohorts (arthroscopy only 7.9%, arthroscopy + PRP 14.2%, p = 0.0002). Heterotopic ossification was the main driver of this difference, occurring more commonly in the PRP cohort (10.7% vs 5.7%, p = 0.0006). When stratifying by procedure type, intraoperative PRP was associated with higher complications in patients undergoing femoroplasty (25.0% vs 10.4%, p < 0.0001), labral repair (18.8% vs 9.2%, p = 0.0002), and acetabuloplasty (20.3% vs 10.8%, p = 0.0009). In multivariate regression analysis, after controlling for all other variables, PRP did lead to higher rates of postoperative complications after hip arthroscopy (ref: no PRP, OR 1.9, 95% CI 1.3 – 2.7, p = 0.0003.)

Conclusions

Patients receiving intraoperative PRP during hip arthroscopy may be at increased risk of developing a postoperative complication, particularly heterotopic ossification. Consideration should be made on which patients may benefit the most from PRP. Further studies should aim to elucidate whether or not a link exists between the biochemical process of heterotopic ossification and PRP.