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Platelet-rich plasma gel fails to heal critical bone defects in basic science study
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Platelet rich plasma has been shown to stimulate healing in various clinical situations. Spanish researchers, however, found from their experimental New Zealand White rabbit model that it did not perform well for healing critical bone defects.
Daniel L. Bonete, MD, of the University of Valencia, Spain, presented data at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons showing that defects treated with growth factors alone in the form of platelet-poor plasma (PPP) had better healing in some instances vs. those treated with platelet-rich plasma (PRP).
“In the overall analysis of all of our variables, we found no significant differences, but we found a lower bone mineral density (BMD) in the fibular defect treated with PRP compared with controls, but a statistical difference was borderline,” he said.
Healing assessed three ways
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Source: J Clin Oncol. 2007;25:1489-1497.Bonete and colleagues conducted a prospective, comparative, controlled study of PRP vs. PPP in two groups of 15 rabbits. In both legs of each rabbit, they created a 6-mm bone defect in the proximal tibial metaphyseal bone and in the diaphyseal fibular bone. Rabbits received either PRP or PPP gel prepared according to standard methods. As a control the defects in their left legs were left untreated.
After sacrifice at 8, 12 and 16 weeks, researchers determined the amount of healing in 111 defects based on 3-D CT scan reconstructions, BMD and results of histological analyses.
“The control defects never healed,” Bonete said, noting that they did not see any differences in healing in either the tibial defects or the fibular defects treated with either the PRP or PPP gel.
He said they saw a suppression trend over time where the controls treated with PPP had increased BMD in the weeks following treatment. “However, in the group treated with PRP it decreased over time.”
Any differences detected between PRP and PPP were not statistically significant. – by Susan M. Rapp
Editor’s note: Be sure to read the cover story on PRP in the July issue of Orthopedics Today.
References:
- Carrasco J, Gomar F, Bonete DL. Platelet rich plasma in critical bone defect. Paper #377. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
- Daniel L. Bonete, MD, can be reached at Cortes Valencianas 37, Pta 3, Valencia, 46015 Spain; 34-96-340-1614.
The take home message of this study is platelet-rich plasma (PRP) is not the “magic healing bullet” that we had hoped it would be despite the large number of growth factors it contains. It has little to no effect in healing segmental defects in an animal model and did not function as an osteoinductive material. The study adds to the literature in supporting the variability of PRP results that we see. It also supports the lack of correlation between serum platelets and their concentration in PRP.
– Animesh Agarwal, MD
Associate
Professor
Chief, Division of Orthopaedic Traumatology
Department of
Orthopaedics, UTHSCSA
Director of Orthopaedic Trauma, University Hospital,
San Antonio, Texas