Does intraarticular PRP injection improve function, pain and quality of life in patients with OA of knee? Case control study of 50 patients

Knee osteoarthritis (OA) is a common debilitating chronic disease. Up to one in 5 people over the age of 45 suffer from knee OA and typical symptoms include significant pain, restricted mobility and difficulty to indulge in activities of daily living. Other than knee replacement, no other reliable treatment exists to manage symptomatic knee OA. Platelet Rich Plasma (PRP) is a form of Prolotherapy and is increasingly used to manage OA patients, although the evidence is largely anecdotal. We conducted a case-control study to assess efficacy of PRP comparing it for pain relief in OA Knee. We studied two groups of 25 patients each. One group of 25 patients was given therapeutic exercises and Acetaminophen for pain relief (control group). Second group of 25 patients (PRP group) was injected with two courses of intra-articular injection of Leucocyte rich PRP with interval of 6 weeks. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was recorded pre-intervention, at six months & one year post-intervention in both the groups. Change scores were assessed for statistical significance. No compilations were noted in both groups and none of the cases needed further surgical intervention during the follow up period. Mean changes of total WOMAC, in PRP group showed significantly better improvement than control group (P < 0.05) at all time intervals. This study showed that intra articular PRP knee injection combined with therapeutic exercise can be more effective in pain reduction and improvement of stiffness and quality of life, compared with therapeutic exercise alone

Meaningful effectiveness of platelet-rich plasma in treating patients with osteoarthritis of the knee: Meta-analysis and review

Background: Osteoarthritis (OA) of the knee is a significant cause of disability. The current conservative treatment options include physiotherapy, analgesia, intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid, or corticosteroids. Regarding PRP, some meta-analyses studies have been reported. However, these studies focused on the effectiveness of intra-articular PRP when compared to other controls, and none thoroughly investigated the anchored-based effectiveness concerning the minimal clinically important difference (MCID). Objective: We, therefore, conducted this work to address this apparent knowledge gap and to provide objective data that could be used by decision-makers. Methods: Electronic databases were searched to identify relevant publications. We included controlled trials that evaluated the efficacy of PRP for the treatment of OA of the knee. All included studies must have had a minimum follow-up of 24 weeks as well as pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Results: A total of 12 studies, involving 405 patients, were included in this analysis. The primary endpoint of this study was to compare the treatment effect measured by WOMAC scores improvement to MCID. For WOMAC score analyses, the mean difference (MD) between baseline and 6-month scores was utilized. The pooled data established significant functional improvement as demonstrated by MD of 25.5 ± 3.3 (95% confidence interval: 19.1–31.9, P< 0.001). In addition, the overall comparison of MD (25.5) to MCID (7.9) showed that the MD was approximately three-fold higher. Due to the known impact of the baseline scores on the MD, we conducted further analyses comparing MD values to the corresponding MCID for various baseline severity grades (i.e. high, intermediate, and low). The analyses showed significantly higher MD values in all categories. Conclusions: In conclusion, evidence from studies of low-to-moderate methodological quality shows that intra-articular PRP has the potential to provide a clinically meaningful symptomatic benefit for OA of the knee, at least in the short term