Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.06.005
Brazilian Journal of Anesthesiology
Scientific Article

Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: Double blind, randomized comparative study

Efetividade do plasma rico em plaquetas no tratamento da dor em osteoartrite de joelho: estudo comparativo randômico e duplo‐cego

Babita Ghai, Vasudha Gupta, Ashish Jain, Nitika Goel, Devender Chouhan, Yatinder Kumar Batra

Downloads: 0
Views: 91

Abstract

Background
Intra‐articular injections of platelet‐rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet‐rich plasma was administered in one knee and normal saline in another knee of same patient.

Methods
20 patients aged 30‐65years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet‐rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6 months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study.

Results
The baseline VAS score in platelet‐rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6 months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6 month 7.00 ± 4.24 (p < 0.001) in platelet‐rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet‐rich plasma knee as compared to normal saline knee.

Conclusion
The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra‐articular platelet‐rich plasma injection as compared to normal saline.

Keywords

Osteoarthritis knee; Platelet rich plasma; WOMAC score

Resumo

Justificativa e objetivos
Injeções intra‐articulares de plasma rico em plaquetas têm sido usadas com sucesso para tratar os sintomas da osteoartrite de joelho em pacientes jovens. Porém, na maioria desses estudos, os joelhos de controle e teste estavam presentes em diferentes pacientes, o que incorporou uma grande quantidade de viés aos resultados. Portanto, o projeto do presente estudo incluiu pacientes com osteoartrite em ambos os joelhos, com a administração de plasma rico em plaquetas em um dos joelhos e de solução salina normal no outro joelho do mesmo paciente.

Métodos
20 pacientes, de ambos os sexos, com idades entre 30-65 anos e portadores de osteoartrite bilateral de joelho (classificação ASA I e II) foram incluídos no estudo. Os pacientes foram randomizados para receber plasma rico em plaquetas e solução salina normal em um dos dois joelhos. O desfecho primário foram os escores VAS e WOMAC seis meses após o procedimento. O desfecho secundário incluiu alterações na rigidez articular, função física e qualquere feito adverso observado durante o curso do estudo.

Resultados
O escore VAS basal para o joelho que recebeu plasma rico em plaquetas foi 8,4 ± 0,88 e melhorou significativamente para 4,85 ± 2,48 (p < 0,001) após seis meses, comparado ao joelho que recebeu solução salina normal (p = 0,017). A intensidade da dor avaliada com o WOMAC também melhorou de 14,5 ± 1,3 na fase basal para 7,00 ± 4,24 após seis meses (p < 0,001) nos joelhos que receberam plasma rico em plaquetas, enquanto nenhuma mudança significativa ocorreu nos joelhos que receberam solução salina normal entre a fase basal e após seis meses (10,2 ± 1,2 a 10,05 ± 1,23). Além disso, houve uma diminuição significativa da rigidez e melhoria da atividade física nos joelhos que receberam plasma rico em plaquetas, comparados aos joelhos que receberam salina normal.

Conclusão
O presente estudo identificou uma diminuição significativa da dor e da rigidez e uma melhoria das funções físicas da articulação do joelho com a injeção intra‐articular de plasma rico em plaquetas, comparada à solução salina normal.

Palavras-chave

Osteoartrite de joelho; Plasma rico em plaquetas; Escore WOMAC

References

1 G. Kavadar, D.T. Demircioglu, M.Y. Celik, T.Y. Emre Effectiveness of platelet‐rich plasma in thetreatment of moderate knee osteoarthritis: a randomized prospective study J Phys Ther Sci., 27 (2015), pp. 3863-3867

2 Y. Zhang, J.M. Jordan Epidemiology of osteoarthritis Clin Geriatr Med., 26 (2010), pp. 355-369

3 D. Crane, P. Everts Platelet Rich Plasma (PRP) matrix grafts Pract Pain Manage., 8 (2008), pp. 12-26

4 G. Filardo, E. Kon, R. Buda, A. Timoncini, A. Di Martino, A. Cenacchi, et al. Platelet rich plasma intra‐articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis Knee Surg Sports Traumatol Arthrosc., 19 (2011), pp. 528-535

5 E. Kon, R. Buda, G. Filardo Platelet rich plasma: intra‐articular knee injections produced favourable results on degenerative cartilage lesions Knee Surg Sports Traumatol Arthrosc., 18 (2011), pp. 427-479

6 S.G. Boswell, B.J. Cole, E.A. Sundman, et al. Platelet rich plasma: a milieu of bioactive factors Arthroscopy., 28 (2012), pp. 429-439

7 A. Mishra, K. Harmon, J. Woodall, A. Vieira Sports medicine applications of platelet rich plasma Curr Pharm Biotechnol., 13 (2012), pp. 1185-1195

8 S. Patel, M.S. Dhillon, S. Aggarwal, N. Marwaha, A. Jain Treatment with Platelet rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double blind, randomized trial Am J sports Med., 41 (2013), pp. 356-364

9 S. Sampson, M. Gerhardt, B. Mandelbaum Platelet rich plasma injection grafts for musculoskeletal injuries: A review Ethics Science Environmental Politics., 1 (2008), pp. 165-174

10 A. Wang-Saegusa, R. Cugat, O. Ares, R. Seijas, X. Cusco, M. Garcia-Balletbo Infiltration of plasma rich in growth factors for osteoarthritis of the knee short term effects on function and quality of life Archives Orthopand Trauma Surg., 131 (2011), pp. 311-317

11 M. Sanchez, E. Anitua, J. Azofra, J.J. Arguirre, I. Andia Intra‐articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study Clin Exp Rheumatol., 26 (2008), pp. 910-913

12 E. Kon, R. Buda, G. Filardo Platelet rich plasma: intra‐articular knee injections produced favourable results on degenerative cartilage lesions Knee Surg Sports Traumatol Arthrosc., 18 (2010), pp. 472-479

13 S.A. Raeissadat, S.M. Rayegani, E. Ghorbani The effect of Platelet‐Rich Plasma on Pain Function and quality of life of patients with knee osteoarthritis: Pain Res Treat. (2013), pp. 165-967

14 H. Angoorani, A. Mazeherinezhad, O. Marjomaki, S. Younespour Treatment of knee osteoarthritis with platelet risch plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial Med J Islam Repub Iran., 27 (2015), p. 223

15 N. Joshi Jubert, L. Rodríguez, M.M. Reverté-Vinaixa, A. Navarro Platelet‐rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double‐blinded clinical trial Orthop J Sports Med., 13 (2017), p. 5

16 A. Fotouhi, A. Maleki, S. Dolati, A. Aghebati-Maleki, L. Aghebati-Maleki Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis Biomed Pharmacother., 104 (2018), pp. 652-660

17 L. Shen, T. Yuan, S. Chen, X. Xie, C. Zhang The temporal effect ofplatelet‐rich plasmaon pain and physical function in the treatment ofknee osteoarthritis:systematic reviewand meta‐analysis of randomized controlled trials J Orthop Surg Res., 23 (2017), p. 12

18 W.L. Dai, A.G. Zhou, H. Zhang, J. Zhang efficacyofplatelet‐rich plasmain the treatment ofknee osteoarthritis: a meta‐analysis of randomized controlled trials Arthroscopy., 33 (2017), pp. 659-670

19 C.J. Meheux, P.C. McCulloch, D.M. Lintner, K.E. Varner, J.D. Harris Efficacyofintra‐articularplatelet‐rich plasmainjectionsinknee osteoarthritis: asystematic review Arthroscopy., 32 (2016), pp. 495-505

20 L.P. Lai, T.P. Stitik, P.M. Foye, J.S. Georgy, V. Patibanda, B. Chen use ofplatelet‐rich plasmainintra‐articularkneeinjectionsforosteoarthritis: asystematic review PM R., 7 (2015), pp. 637-648

5dc5a7380e88253514593253 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections