Among new emerging therapies to address knee Osteoarthritis (OA), Platelet Rich Plasma (PRP) is one of the most outstanding treatment. Indeed, intra-articular infiltration of PRP, transports many bioactive mediators within an autologous fibrin network, which are released gradually and considerably reduce pain, improve joint stiffness and
physical function in patients with OA knee, which has been proven by several group.1–3
The term Leucocyte Poor Platelet Rich Plasma (LP-PRP) can be used to describe autologous blood preparation with a platelet concentration higher than baseline (minimum 4 times the normal count) and leucocyte concentration lesser than the baseline (4 times the normal count). This is normally achieved through differential centrifugation.
We have chosen LP-PRP therapy for Grade-IV (Kellgren-Lawrence grading system) Osteoarthritis knee to combat pain and disability to do activities of daily living. Our study included Patients who were not willing to undergo Total Knee Replacement (TKR) for various reasons. They were counselled regarding the benefits of PRP and its limitation.
Our main aim in this study was to provide patients with bilateral grade IV OA knee, a painless free range of movement by using autologous Intra-articular LP-PRP Therapy for a significant period of time.
To assess pain relief in patients with bilateral grade IV osteoarthritis knee by using visual analogue scale (VAS) system and functional outcome by Western Ontario and Mcmaster universities Arthritis index (WOMAC) in patients undergoing intra-articular autologous LP-PRP therapy.
A total number of 50 (n=50) patients who fulfilled the inclusion criteria were included to the study during the period of May 2019 to Jan 2020. Patients included were those who presented with bilateral grade IV OA knee with 4 weeks of failed conservative management in the form of quadriceps exercises and analgesics. They were subjected to intra-articular autologous LP-PRP injection therapy to both the affected knees with an interval of 15 days. Post injection all patients were subjected to standard osteoarthritis rehabilitation protocol, pain relief was assessed by VAS system and functional outcome was assessed by WOMAC index at the end of 1st week, 2nd week, 1st month, 2nd month, 4th month, 6th month and 8th month.
The VAS score reflected highly significant improvement in the pain of the knee with a significant p value of < 0.001 and functional outcome was assessed by WOMAC index with a significant p value of < 0.001. It was noted that when the pre-procedure VAS score (mean VAS score 8.2) were compared with the score of most recent follow up i.e. at the end of 8th month (mean VAS score 1.4) shows a significant improvement in pain.
Intra-articular autologous LP-PRP injection therapy is a Good procedure of choice for treating patients with Grade-IV osteoarthritis knee for short period of time to combat pain and disability with a significant outcome in VAS score and WOMAC index in patients who were not willing for TKR.
1. Sánchez M, Fiz N, Azofra J, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 2012;28:1070–8.
2. 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;20:2082–91.
3. Vaquerizo V, Plasencia MÁ, Arribas I, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy 2013;29:1635–43