2017 ISAKOS Biennial Congress ePoster #1607

 

Is Platelet-Rich Plasma the Better Intra-Articular Injection Choice for the Treatment of Knee Osteoarthritis? A Prospective, Double-Blind, Randomized, Placebo-Controlled Trial

Kuan-Yu John Lin, MD, PhD, Gaoxiong, Taiwan TAIWAN
Jenn-Huei Renn, MD, PhD, Kaohsiung City TAIWAN
Ming-Long Yeh, PhD, Tainan City TAIWAN

Kaohsiung Veterans General Hospital, Kaohsiung City, TAIWAN

FDA Status Not Applicable

Summary

In treating knee osteoarthritis, intra-articular PRP injection may provide a significant short-term clinical improvement for at least one year, and its functional efficacy was statistically better than that obtained with the HA injection which evidently provided no better results than a placebo treatment.

Abstract

Introduction

Various nonoperative treatments are used to alleviate the symptoms of patients with osteoarthritis (OA) of the knee, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). Recent research efforts have focused on the biological interventions that could stimulate the regeneration of articular cartilage, including the use of platelet-rich plasma (PRP).
However, despite the promising preclinical findings and the huge interest in its clinical application, most questions on PRP applicability and efficacy remain unanswered; a conclusive evidence in the literature that supports its real usefulness for the management of chondropathy and OA is still lacking. Thus, the aim of this study was to evaluate the efficacy provided by PRP in treating knee OA in comparison with another common injective treatment: Hyaluronic acid.

[Study Design]
Prospective, double-blind, randomized, placebo-controlled trial; Level of evidence: I

Materials And Methods

A total of 91 knees affected by clinically and radiographically documented knee OA, after meeting our inclusion criteria, were included in this study. The 91 knees were computer-randomized into 3 study groups of different injections: PRP (RegenKit THT, Regen Lab, Switzerland), HA (Hyruan PlusTM, LG Corporation, Korea), and normal saline (NS). Each knee received 3 weekly intra-articular injections. All patients were prospectively evaluated with the Western Ontario and McMaster (WOMAC) score, and the International Knee Documentation Committee (IKDC) subjective score at baseline and then at 1, 2, 6, and 12 months of follow-up. Adverse events were also recorded. Data were analyzed using Generalized Estimating Equations (GEE).

Results

Among the three study groups, the statistically highest improvement in both the WOMAC and IKDC scores was noted in the PRP group; in fact, comparing to its respective baseline score, an improvement of 21% for the WOMAC score and 40% for the IKDC score were observed at the conclusion of the study (12 months). Comparing to their respective pre-injection scores, all three groups had significant improvement on both outcome measurements at the 1-month follow-up; but thereafter, only the PRP group sustained such statistic improvements on both scores throughout the entire study during. The mean WOMAC score of the HA group improved with significance only up to 2 months of follow-up, while its mean IKDC score, along with both the WOMAC and IKDC scores of the NS group, gradually deteriorated at each following evaluation time after the first month (p<0.0125). Furthermore, there was no significant functional outcome difference between HA and NS groups at any follow-up time. Age was found to have an inverse effect on both functional scores while gender only made a statistic difference on the IKDC score (male had better outcome); Ahlback stage and BMI were not influential factors statistically. No serious adverse events were noted in any group during the entire study period.

Conclusion

In treating knee osteoarthritis, intra-articular PRP injection may provide a significant short-term clinical improvement for at least one year, and its functional efficacy was statistically better than that obtained with the HA injection which evidently provided no better results than a placebo treatment.