ROLE OF AUTOLOGOUS PLATELET RICH PLASMA (PRP) IN MONOCOMPARTMENTAL PRIMARY KNEE OSTEOARTHIRITIS UP TO GRADE-1 AND ITS CLINICAL EVALUATION
Main Article Content
Keywords
Autologous platelet rich plasma(PRP), Monocompartmental primary knee osteoarthritis, Kellegren Lawrence grading scale, WOMAC scale, visual analogue scale
Abstract
A retrospective, cross-sectional observation study of the outcome of the role of autologous platelet-rich plasma(PRP) in mono-compartmental primary knee osteoarthritis upto grade -1 and its clinical evaluation, in department of orthopedics from January 2021to July 2022(18 months) is presented. There were 60 patients participated in the study. Patients attending the OPD of Orthopedic Department of index medical college with complain of knee pain were screened and those diagnosed as primary knee osteoarthritis were included in the study. Patient classified into grade 0 to 4 on Kellegren Lawrence grading scale were included in study .Patients were followed up for months 6 weeks, 3 months , 6 months and functional outcome of the patients will be checked.
Outcome Analysis: The study group and the control group are advised to follow up at 6 weeks, 3 months and 6 months. Outcome analysis for the efficacy was done for reduction in pain, reduction in stiffness and improvement in physical function using WOMAC scale. The Patients were also assessed for reduction in pain using Visual analog scale both at pre injection and at 6 weeks,3 month and 6 months post injection.
Result: We reported a significant improvement in WOMAC Score at 6 weeks, 3 months and 6 months compared to their pre-injection values, and they showed a tendency of gradual decrease over time post treatment with PRP. In present study it was observed that mean VAS score after treatment (3.05±1.241) with PRP was significantly lower as compared to the preinjection VAS score (7.15±0.988). There was a significant improvement in pain score at 6 weeks, 3 months and 6 months follow up post treatment with PRP.
References
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9. Frizziero A, Giannotti E, Ferraro C, et al. Platelet rich plasma intra-articular injections: a new therapeutic strategy for the treatment ofknee osteoarthritis in sport rehabilitation. A systematic review.Sport Sci Health 2012;8:15-22.
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11. Wang-Saegusa A, Cugat R, Ares O, et al. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects onfunction and quality of life. Archives of Orthopaedic and TraumaSurgery 2011;131(3):311-7.
12. Mishra A, Woodall J Jr,Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clinics in Sports Medicine2009;28(1):113-25.
13. Rabago D, Best TM, Zgierska AE, et al. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. British Journalof Sports Medicine 2009;43(7):471-81.
14. Bir SC, Esaki J, Marui A, et al. Angiogenic properties of sustained release platelet-rich plasma: characterization in-vitro and in theischemic hind limb of the mouse. Journal of Vascular Surgery2009;50(4):870-9.
15. Cook JL, Anderson CC, Kreeger JM, et al. Effects of human recombinant interleukin-1 beta on canine articular chondrocytes inthree-dimensional culture. Am J Vet Res 2000;61(7):766-70.
16. Sánchez M, AnituaE, Azofra J, et al. Intra-articular injection of an autologous preparation rich in growth factors for the treatment ofknee OA: a retrospective cohort study. Clin Exp Rheumatol2008;26(5):910-3.
17. Kang YH, Jeon SH, Park JY, et al. Platelet rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration.Tissue Eng Part A 2011;17(3-4):349-59.
18. Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intraarticular knee injections for the treatment of degenerative cartilage lesionsand osteoarthritis. Knee Surg Sports Traumatol Arthrosc2011; 19(4):528-35.
19. Spakova T, Rosocha J, Lacko M, Harvanova D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet-richplasma in comparison with hyaluronic acid. Am J Phys MedRehabil. 2012;91(5):411–417. doi: 10.1097/PHM.0b013e3182aab72.
20. National Institute for Clinical Excellence N. Platelet-rich plasma injections for osteoarthritis of the knee 2014. https://www.nice.org.uk/guidance/ipg491.
21. Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacialsurgery. J Oral Maxillofac Surg 1997; 55: 1294–1299.
22. Filardo G, Kon E, Di Martino A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study designand preliminary results of a randomized controlled trial. BMCMusculoskelet Disord. 2012;13:229. Published 2012 Nov 23.doi:10.1186/1471-2474-13-229
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24. Su, C.A., Kusin, D.J., Li, S.Q., Ahn, U.M., Ahn, N.U., 2018. The association between body mass index and the prevalence, severity, and frequency of low back pain: data from the osteoarthritisinitiative. Spine 43, 848–852.
25. Losina, E., Weinstein, A.M., Reichmann, W.M., Burbine, S.A., Solomon, D.H., Daigle, M.E., Rome, B.N., Chen, S.P., Hunter,D.J., Suter, L.G., 2013. Lifetime risk and age at diagnosis ofsymptomatic knee osteoarthritis in the US. Arthritis Care Res. 65,703–711.
26. AlKuwaity, K.W., Mohammad, T.N., Hussain, M.A., Alkhanani, A.J., Ali, A.M.B., 2018. Prevalence and determinant factors ofosteoarthritis of the knee joint among elderly in Arar, KSA. Egypt.J. Hosp. Med. 72, 5173–5177.
27. Palo, N., Chandel, S.S., Dash, S.K., Arora, G., Kumar, M., Biswal, M.R., 2015. Effects of osteoarthritis on quality of life in elderlypopulation of Bhubaneswar, India: A prospective multicenterscreening and therapeutic study of 2854 patients. Geriatr. Orthop.Surg. Rehabil.6, 269–275.
28. Al-Modeer, M.A., Hassanien, N.S., Jabloun, C.M., 2013. Profile of morbidity among elderly at home health care service in SouthernSaudi Arabia. J. Fam. Community Med. 20, 53.
29. Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., Lu, H., 2020.
30. Global, regional prevalence, incidence and risk factors of kneeosteoarthritis in population-based studies. EClinicalMedicine 29,100587.
31. Sharma, S.K., Yadav, S.L., Singh, U., Wadhwa, S., 2017. Muscle activation profiles and co-activation of quadriceps and hamstringmuscles around knee joint in Indian primary osteoarthritis kneepatients. J. Clin. Diagn. Res. JCDR 11, RC09.
32. Kumar, P., Jain, B., Soni, N., Dwivedi, S., Dey, A.B., Chatterjee, P., Chakrawarty, A., 2022. Spectrum of cardiovascular diseaseswith increasing age and its association with geriatric syndromes. J.Indian Acad. Geriatr. 18, 68.
33. Sanghi, D., Mishra, A., Sharma, A.C., Raj, S., Mishra, R., Kumari, R., Natu, S., Agarwal, S., Srivastava, R.N., 2015. Elucidation ofdietary risk factors in osteoarthritis knee—a case-control study. J.Am. Coll. Nutr. 34, 15–20.
34. Al-Arfaj, A., Al-Boukai, A., 2002. Prevalence of radiographic knee osteoarthritis in Saudi Arabia. Clin. Rheumatol. 21, 142–145.
35. Verma, P., Dalal, K., 2013. Serum cartilage oligomeric matrix protein (COMP) in knee osteoarthritis: a novel diagnostic andprognostic biomarker. J. Orthop. Res. 31, 999–1006.
36. Louis, M.L., Magalon, J., Jouve, E., Bornet, C.E., Mattei, J.C., Chagnaud, C., Rochwerger, A., Veran, J., Sabatier, F., 2018.Growth factors levels determine efficacy of platelets rich plasmainjection in knee osteoarthritis: a randomized double blindnoninferiority trial compared with viscosupplementation. Arthrosc.J. Arthrosc. Relat. Surg. 34, 1530–1540.
37. Kavadar, G., Demircioglu, D.T., Celik, M.Y., Emre, T.Y., 2015.
38. Effectiveness of platelet-rich plasma in the treatment of moderateknee osteoarthritis: a randomized prospective study. J. Phys. Ther.Sci. 27, 3863–3867.
39. Kanchanatawan, W., Arirachakaran, A., Chaijenkij, K., Prasathaporn, N., Boonard,M., Piyapittayanun, P.,Kongtharvonskul, J., 2016. Short-term outcomes of platelet-richplasma injection for treatment of osteoarthritis of the knee. KneeSurg. Sports Traumatol. Arthrosc. 24, 1665–1677.
40. Sánchez, M., Guadilla, J., Fiz, N., Andia, I., 2012. Ultrasound-guided platelet-rich plasma injections for the treatment ofosteoarthritis of the hip. Rheumatology 51, 144–150.
41. Bansal, H., Leon, J., Pont, J.L., Wilson, D.A., Bansal, A., Agarwal, D., Preoteasa, I., 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci.Rep. 11, 1–10.
42. Wu, Y.-T., Hsu, K.-C., Li, T.-Y., Chang, C.-K., Chen, L.-C., 2018.
43. Effects of platelet-rich plasma on pain and muscle strength inpatients with knee osteoarthritis. Am. J. Phys. Med. Rehabil. 97,248–254.
44. Montañez-Heredia, E., Irízar, S., Huertas, P.J., Otero, E., Del Valle, M., Prat, I., Díaz-Gallardo, M.S., Perán, M., Marchal, J.A.,Hernandez-Lamas, M.D.C., 2016. Intra-articular injections ofplatelet-rich plasma versus hyaluronic acid in the treatment ofosteoarthritic knee pain: a randomized clinical trial in the context ofthe Spanish National Health Care System. Int. J. Mol. Sci. 17, 1064.
45. Meheux, C.J., McCulloch, P.C., Lintner, D.M., Varner, K.E., Harris, J.D., 2016. Efficacy of intra-articular platelet-rich plasmainjections in knee osteoarthritis: a systematic review. Arthrosc. J.Arthrosc. Relat. Surg. 32, 495–505.
46. Southworth, T.M., Naveen, N.B., Tauro, T.M., Leong, N.L., Cole, B.J., 2019. The use ofplatelet-rich plasma in symptomatic kneeosteoarthritis. J. Knee Surg. 32, 037–045.
2. Neustadt DH. Osteoarthritis. In: Rakel RE, edr. Conn’s Current therapy. Philadelphia, PA: W.B. Saunders 2003: p. 1075-9.
3. Stewart WF, Ricci JA, Chee E, et al. Lost productive time and cost due to common pain conditions in the US workforce. JAMA2003;290(18):2443-54.
4. Martel-Pelletier J, Boileau C, Pelletier JP, et al. Cartilage in normal and osteoarthritis conditions. Best Pract Res Clin Rheumatol2008;22(2):351-84.
5. McArthur BA, Dy CJ, Fabricant PD, et al. Long term safety, efficacy andpatient acceptability of hyaluronic acid injection inpatients with painful osteoarthritis of the knee. Patient PreferAdherence 2012;6:905-10.
6. Kon E, Filardo G, Drobnic M, et al. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc2012;20(3):436-49.
7. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr RevMusculoskelet Med 2008;1(3-4):165-74.
8. Oliver KS, Crane DM. Platelet rich plasma grafts in musculoskeletal medicine. Journal of Prolotherapy 2010;2(2):371-6.
9. Frizziero A, Giannotti E, Ferraro C, et al. Platelet rich plasma intra-articular injections: a new therapeutic strategy for the treatment ofknee osteoarthritis in sport rehabilitation. A systematic review.Sport Sci Health 2012;8:15-22.
10. Handl M, Amler E, Bräun K, et al. Positive effect of oral supplementation with glycosaminoglycans and antioxidants on theregeneration of osteochondral defects in the knee joint. Physiol Res2007;56(2):243-9.
11. Wang-Saegusa A, Cugat R, Ares O, et al. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects onfunction and quality of life. Archives of Orthopaedic and TraumaSurgery 2011;131(3):311-7.
12. Mishra A, Woodall J Jr,Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clinics in Sports Medicine2009;28(1):113-25.
13. Rabago D, Best TM, Zgierska AE, et al. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. British Journalof Sports Medicine 2009;43(7):471-81.
14. Bir SC, Esaki J, Marui A, et al. Angiogenic properties of sustained release platelet-rich plasma: characterization in-vitro and in theischemic hind limb of the mouse. Journal of Vascular Surgery2009;50(4):870-9.
15. Cook JL, Anderson CC, Kreeger JM, et al. Effects of human recombinant interleukin-1 beta on canine articular chondrocytes inthree-dimensional culture. Am J Vet Res 2000;61(7):766-70.
16. Sánchez M, AnituaE, Azofra J, et al. Intra-articular injection of an autologous preparation rich in growth factors for the treatment ofknee OA: a retrospective cohort study. Clin Exp Rheumatol2008;26(5):910-3.
17. Kang YH, Jeon SH, Park JY, et al. Platelet rich fibrin is a Bioscaffold and reservoir of growth factors for tissue regeneration.Tissue Eng Part A 2011;17(3-4):349-59.
18. Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intraarticular knee injections for the treatment of degenerative cartilage lesionsand osteoarthritis. Knee Surg Sports Traumatol Arthrosc2011; 19(4):528-35.
19. Spakova T, Rosocha J, Lacko M, Harvanova D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet-richplasma in comparison with hyaluronic acid. Am J Phys MedRehabil. 2012;91(5):411–417. doi: 10.1097/PHM.0b013e3182aab72.
20. National Institute for Clinical Excellence N. Platelet-rich plasma injections for osteoarthritis of the knee 2014. https://www.nice.org.uk/guidance/ipg491.
21. Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacialsurgery. J Oral Maxillofac Surg 1997; 55: 1294–1299.
22. Filardo G, Kon E, Di Martino A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study designand preliminary results of a randomized controlled trial. BMCMusculoskelet Disord. 2012;13:229. Published 2012 Nov 23.doi:10.1186/1471-2474-13-229
23. Loeser, R.F., 2010. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin. Geriatr. Med.26, 371–386.
24. Su, C.A., Kusin, D.J., Li, S.Q., Ahn, U.M., Ahn, N.U., 2018. The association between body mass index and the prevalence, severity, and frequency of low back pain: data from the osteoarthritisinitiative. Spine 43, 848–852.
25. Losina, E., Weinstein, A.M., Reichmann, W.M., Burbine, S.A., Solomon, D.H., Daigle, M.E., Rome, B.N., Chen, S.P., Hunter,D.J., Suter, L.G., 2013. Lifetime risk and age at diagnosis ofsymptomatic knee osteoarthritis in the US. Arthritis Care Res. 65,703–711.
26. AlKuwaity, K.W., Mohammad, T.N., Hussain, M.A., Alkhanani, A.J., Ali, A.M.B., 2018. Prevalence and determinant factors ofosteoarthritis of the knee joint among elderly in Arar, KSA. Egypt.J. Hosp. Med. 72, 5173–5177.
27. Palo, N., Chandel, S.S., Dash, S.K., Arora, G., Kumar, M., Biswal, M.R., 2015. Effects of osteoarthritis on quality of life in elderlypopulation of Bhubaneswar, India: A prospective multicenterscreening and therapeutic study of 2854 patients. Geriatr. Orthop.Surg. Rehabil.6, 269–275.
28. Al-Modeer, M.A., Hassanien, N.S., Jabloun, C.M., 2013. Profile of morbidity among elderly at home health care service in SouthernSaudi Arabia. J. Fam. Community Med. 20, 53.
29. Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., Lu, H., 2020.
30. Global, regional prevalence, incidence and risk factors of kneeosteoarthritis in population-based studies. EClinicalMedicine 29,100587.
31. Sharma, S.K., Yadav, S.L., Singh, U., Wadhwa, S., 2017. Muscle activation profiles and co-activation of quadriceps and hamstringmuscles around knee joint in Indian primary osteoarthritis kneepatients. J. Clin. Diagn. Res. JCDR 11, RC09.
32. Kumar, P., Jain, B., Soni, N., Dwivedi, S., Dey, A.B., Chatterjee, P., Chakrawarty, A., 2022. Spectrum of cardiovascular diseaseswith increasing age and its association with geriatric syndromes. J.Indian Acad. Geriatr. 18, 68.
33. Sanghi, D., Mishra, A., Sharma, A.C., Raj, S., Mishra, R., Kumari, R., Natu, S., Agarwal, S., Srivastava, R.N., 2015. Elucidation ofdietary risk factors in osteoarthritis knee—a case-control study. J.Am. Coll. Nutr. 34, 15–20.
34. Al-Arfaj, A., Al-Boukai, A., 2002. Prevalence of radiographic knee osteoarthritis in Saudi Arabia. Clin. Rheumatol. 21, 142–145.
35. Verma, P., Dalal, K., 2013. Serum cartilage oligomeric matrix protein (COMP) in knee osteoarthritis: a novel diagnostic andprognostic biomarker. J. Orthop. Res. 31, 999–1006.
36. Louis, M.L., Magalon, J., Jouve, E., Bornet, C.E., Mattei, J.C., Chagnaud, C., Rochwerger, A., Veran, J., Sabatier, F., 2018.Growth factors levels determine efficacy of platelets rich plasmainjection in knee osteoarthritis: a randomized double blindnoninferiority trial compared with viscosupplementation. Arthrosc.J. Arthrosc. Relat. Surg. 34, 1530–1540.
37. Kavadar, G., Demircioglu, D.T., Celik, M.Y., Emre, T.Y., 2015.
38. Effectiveness of platelet-rich plasma in the treatment of moderateknee osteoarthritis: a randomized prospective study. J. Phys. Ther.Sci. 27, 3863–3867.
39. Kanchanatawan, W., Arirachakaran, A., Chaijenkij, K., Prasathaporn, N., Boonard,M., Piyapittayanun, P.,Kongtharvonskul, J., 2016. Short-term outcomes of platelet-richplasma injection for treatment of osteoarthritis of the knee. KneeSurg. Sports Traumatol. Arthrosc. 24, 1665–1677.
40. Sánchez, M., Guadilla, J., Fiz, N., Andia, I., 2012. Ultrasound-guided platelet-rich plasma injections for the treatment ofosteoarthritis of the hip. Rheumatology 51, 144–150.
41. Bansal, H., Leon, J., Pont, J.L., Wilson, D.A., Bansal, A., Agarwal, D., Preoteasa, I., 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci.Rep. 11, 1–10.
42. Wu, Y.-T., Hsu, K.-C., Li, T.-Y., Chang, C.-K., Chen, L.-C., 2018.
43. Effects of platelet-rich plasma on pain and muscle strength inpatients with knee osteoarthritis. Am. J. Phys. Med. Rehabil. 97,248–254.
44. Montañez-Heredia, E., Irízar, S., Huertas, P.J., Otero, E., Del Valle, M., Prat, I., Díaz-Gallardo, M.S., Perán, M., Marchal, J.A.,Hernandez-Lamas, M.D.C., 2016. Intra-articular injections ofplatelet-rich plasma versus hyaluronic acid in the treatment ofosteoarthritic knee pain: a randomized clinical trial in the context ofthe Spanish National Health Care System. Int. J. Mol. Sci. 17, 1064.
45. Meheux, C.J., McCulloch, P.C., Lintner, D.M., Varner, K.E., Harris, J.D., 2016. Efficacy of intra-articular platelet-rich plasmainjections in knee osteoarthritis: a systematic review. Arthrosc. J.Arthrosc. Relat. Surg. 32, 495–505.
46. Southworth, T.M., Naveen, N.B., Tauro, T.M., Leong, N.L., Cole, B.J., 2019. The use ofplatelet-rich plasma in symptomatic kneeosteoarthritis. J. Knee Surg. 32, 037–045.
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Jul 20, 2023
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Dr porus Batham, Dr Rishi Kaushal, & Dr Mustafa johar. (2023). ROLE OF AUTOLOGOUS PLATELET RICH PLASMA (PRP) IN MONOCOMPARTMENTAL PRIMARY KNEE OSTEOARTHIRITIS UP TO GRADE-1 AND ITS CLINICAL EVALUATION. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 484–496. https://doi.org/10.53555/jptcp.v30i7.2397
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Author Biographies
Dr porus Batham
PG 3rd year resident, Index medical college, morodhat village, Indore 452016
Dr Rishi Kaushal
PG 3rd year resident, Index medical college, morodhat village, Indore 452016
Dr Mustafa johar
Professor & head, department of Orthopedics Dean Research, Index medical college, morodhat, INDORE, 452016