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Evidence-based orthopaedic treatment: What about PRP?
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Orthopaedic and sports medicine treatments with platelet-rich plasma are gaining popularity on a global level, and have become a topic of great interest at international orthopaedic meetings.
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Platelet-rich plasma (PRP) is now widely used to treat several musculoskeletal soft-tissue lesions. After reading this latest issue of Orthopaedics Today Europe and attending sessions that addressed the use of PRP during the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego, USA, I have become deeply worried as to how we as orthopaedic surgeons sometimes rush to implement new techniques and treatment before we have valid clinical data from randomized and blinded clinical trials supporting their use.
There are scant data available on PRP treatment, resultant from the fact that this is a treatment using the patient’s own blood — without any specific knowledge on what the active components are in PRP — if any active component does exist at all. Most of the studies published do not have calculated outcomes that can be attributed to the PRP treatment administered alone. Therefore, is the effect seen from the treatment only the recognized placebo-effect?
I am surprised that a scientifically unproven treatment modality can be introduced by orthopaedic colleagues and be heavily supported by industry without supporting data. We must build all new treatments on evidence-based medical concepts — otherwise we are not reliable suppliers of medical service to our patients or the community. All new treatments/philosophies must start with basic animal studies, case series and phase I through III studies before clinical, randomized studies can be performed. To implement a treatment like PRP to this huge level without scientifically supported data, is a problem and may even result in legal actions from patients and claims from authorities that reimbursement cannot be given.
So, before PRP becomes a gold standard in the treatment of an arsenal of musculoskeletal lesions, the technique must be documented in randomized trials and reported in peer-reviewed journals, to follow internationally recognized good clinical practice in introducing new treatment modalities. Until such publications exist, PRP should be reported as an experimental, non-proven treatment to both medical professionals and patients.