Role of autologous platelet rich plasma in treating symptomatic patients with osteoarthritis via double spinning technique
Keywords:
Blood Bank, Intra- articular, Osteoarthritis, Platelet Rich Plasma
Abstract
Background: Platelet rich plasma (PRP) is a hemoderivative containing a platelet concentration well above the normal baseline rich in platelet degranulation products such as cytokines/vasoactive amines and growth factors, which make it a good therapeutic tool for repair and healing in many speciality fields of orthopaedics, dentistry, plastic surgery (including cosmetic and burn therapy) and dermatology. The present study was conducted with aim of seeing the response of PRP on symptomatic alleviation and functional restoration in patients of osteoarthritis. Methods: The present study was undertaken in the department of transfusion medicine in conjunction with department of orthopedics at a tertiary care teaching hospital on 50 cases of OA graded according to Kellgren-Lawrence grading system. In all the cases single intra-articular injection of PRP made by double spin technology was injected and response of the patient followed up at 3, 6 and 12 months with visual analogue score (VAS) and WOMAC (Western Ontario and Mc Master Universities Arthritis) index. Apart from simple statistics of mean and averages; the means of paired samples were compared for the VAS with Student’s t parametric test. The WOMAC index was tested by the non-parametric Wilcoxon’s rank sum test. In both the settings a value < 0.05 was deemed significant.Result: Statistically significant differences (p<0.001) between pre-treatment and follow up values were found for pain, stiffness and functional restoration of the joint as measured by WOMAC index and VAS pain scores. There were no adverse events related to PRP infiltration.Conclusion: The study hence concludes that intra-articular infiltration of autologous PRP prepared by double spinning approach in OA of the knee according to the established protocol is a safe, tolerable and effective tool which results in reduction of pain and is also associated with functional improvement of the joint as well.References
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23.Graziani et al. The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clin Oral Implants Res. 2006 Apr;17(2):212-9.
24. Loeser RF . Age related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med . 2010 Aug ;26 (3):371-86.
25. Dawson J, Jaszczak E, Thorogood M, Marks SA, Dodd C, Fitzpatrick R. An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach . J Epidemiol Community Health . 2003 Oct ;57(10):823-30
26. Mei –Dan O, Lippi G, Sanchez M, Andia T, Maffulli N. Autologous platelet rich plasma: a revolution in soft tissue sports injury management ? Phys Sportsmed. 2010;38:127-135
27. Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intrarticular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011Apr; 19(4):528-535.
28. Kon E, Buda R, Filardo G, Timocini A, Marcacci M, Giannini S. The treatment of severe chondropathies of the knee: platelet rich plasma vs hyaluronic acid. Presented at 8th world congress of the international cartilage repair society (ICRS), Miami, USA, 23–26 May 200
29. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Wenu Y. 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;131:311-317.
30. Sanchez M, Anitua E, Cugat R, et al. Nonunions treated with autologous preparation rich in growth factors. J Orthop Trauma. 2009;23:52-59.
31. Sapoka T, Rosocha J, Lacko M, Harvanova D, Gharaibek A. Treatment of knee joint osteoarthritis with autologous Platelet rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil. 2012;91(5):411-7
32. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet rich plasma is more effective than placebo for knee osteoarthritis. a prospective double blind randomised trial . Am J Sports Med. 2013:41 (2); 356-64
33. Cerza F, Carni S, Carcangui A et al. Comparison between hyaluronic acid and platelet rich plasma, intra articular infilteration in the treatment of gonoarthrosis. Am J Sports Med, 2012, 40:2822-27
2. Marques LF, Stessuk T, Camargo IC, Sabeh Junior N, dos Santos L, Ribeiro-Paes JT. Platelet-rich plasma (PRP): Methodological aspects and clinical applications. Platelets. 2015;26:101–13.
3. 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;27:158–67.
4. Passaretti F, Tia M, D’Esposito V, et al . Growth promoting action and growth factor release by different platelet derivatives . Platelets 2014 ;25:252-6
5. Dhillon MS, Behera P , Patel S, Shetty V. Orthobioloics and platelet rich plasma . Indian J of Orthop. 2014 ;48:1-9
6. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: A review. Curr Rev Musculoskelet Med. 2008;1:165–74
7. Ziltener JL, Allet L, Sclison P, Grosclaude M. How effective are injections of platelet-rich plasma (PRP) for the treatment of sports injuries: a critical review of the literature. J Sports Med Doping Studie 2012; doi:10.4172/2161-0673.S2-003.
8. Brossi PM, Baccarin RY, Massoco CO. Do blood components affect the production of reactive oxygen species (ROS) by equine synovial fluid cells? Pesq Vet Bras. 2012;32:1355–60.
9. Moreira JJ, Moraes APL, Brossi PM, Machado TSL, Michelacci YM, Massoco CO, et al. Autologous processed plasma: cytokine profile and effects upon injection in healthy equine joints. J Vet Sci. 2015;16:47–55.
10. Burnouf T, Goubran HA, Chen TM, Ou KL, El E, et al. Blood-derived biomaterials and platelet growth factors in regenerative medicine. Blood Rev. 2013;27:77–89.
11 Textor J. Autologous biologic treatment for equine musculoskeletal injuries: platelet-rich plasma and IL-1 receptor antagonist protein. Vet Clin North Am Equine Pract. 2011;27:275–98.
12. Chevalier X. Intraarticular treatments for osteoarthritis: new perspectives. Curr Drug Targets. 2010;11:546–60. 7. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. 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;91:987–96.
13. Fortier LA, Barker JU, Strauss EJ, McCarrel TM, Cole BJ. The role of growth factors in cartilage repair. Clin Orthop. 2011;469:2706–15.
14. Gobbi G, Vitale M. Platelet-rich plasma preparations for biological therapy applications and limits. Oper Tech Orthop. 2012;22: 10–5.
15 Akeda K et al. Platelet rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage. 2006;14(12):1272-1280.
16. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18:472-79
17. Mulvaney, S. Treatment of peripheral nerve entrapments with real time ultrasound guided percutaneous hydro-neurolysis. 2010. Presented at AMSSM annual meeting.
18. Misso ML, Pitt VJ, Jones KM, et al . Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of knee and hip :a descriptive overview of published guidelines . Med J Aust, 2008, 189:394-399.
19. Kijowski R, Blankenbaker D, Stanton P, et al:Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint.AJR Am J Roentgenol, 2006, 187:794-799.
20. Dixon JS, Bird HA, :Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis, 1981 , 40 :87-89.
21. Yim Chiplis PK , Talbot LA. Defining and measuring balance in adults. Res Nurs , 2000 , 1 :321-31 .
22. Ferrari Met al. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artif Organs. 1987 Jan;10(1):47-50.
23.Graziani et al. The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clin Oral Implants Res. 2006 Apr;17(2):212-9.
24. Loeser RF . Age related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med . 2010 Aug ;26 (3):371-86.
25. Dawson J, Jaszczak E, Thorogood M, Marks SA, Dodd C, Fitzpatrick R. An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach . J Epidemiol Community Health . 2003 Oct ;57(10):823-30
26. Mei –Dan O, Lippi G, Sanchez M, Andia T, Maffulli N. Autologous platelet rich plasma: a revolution in soft tissue sports injury management ? Phys Sportsmed. 2010;38:127-135
27. Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intrarticular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011Apr; 19(4):528-535.
28. Kon E, Buda R, Filardo G, Timocini A, Marcacci M, Giannini S. The treatment of severe chondropathies of the knee: platelet rich plasma vs hyaluronic acid. Presented at 8th world congress of the international cartilage repair society (ICRS), Miami, USA, 23–26 May 200
29. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Wenu Y. 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;131:311-317.
30. Sanchez M, Anitua E, Cugat R, et al. Nonunions treated with autologous preparation rich in growth factors. J Orthop Trauma. 2009;23:52-59.
31. Sapoka T, Rosocha J, Lacko M, Harvanova D, Gharaibek A. Treatment of knee joint osteoarthritis with autologous Platelet rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil. 2012;91(5):411-7
32. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet rich plasma is more effective than placebo for knee osteoarthritis. a prospective double blind randomised trial . Am J Sports Med. 2013:41 (2); 356-64
33. Cerza F, Carni S, Carcangui A et al. Comparison between hyaluronic acid and platelet rich plasma, intra articular infilteration in the treatment of gonoarthrosis. Am J Sports Med, 2012, 40:2822-27
Published
2016-12-15
Section
Original Article
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