PRP may relieve pain, improve function in patients with knee OA
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Published results showed platelet-rich plasma led to improved outcomes in patients with symptomatic knee osteoarthritis at a minimum of 6-months compared with plasma rich in growth factors, hyaluronic acid, corticosteroids and placebo.
Jorge A. Chahla, MD, PhD, Harsh Singh, BA, and colleagues performed a systematic review and developed a frequentist network meta-analysis to compare the effects of hyaluronic acid, corticosteroids, PRP, plasma rich in growth factors and placebo on patient-reported outcomes in patients with symptomatic knee OA. Researchers recorded mean or mean change from baseline and standard deviation for outcome scores regarding pain and function at the 6-month follow-up and converted this to either a VAS score for pain or WOMAC score for function.
All intra-articular treatments except corticosteroids had a statistically significant improvement in outcomes compared with placebo, according to results. Researchers found the compared with corticosteroids and placebo, PRP had a clinically meaningful difference in function-related improvement due to large effect sizes. Results showed plasma rich in growth factors had a significant improvement in outcomes compared with placebo due to large effect sizes. However, plasma rich in growth factors had a potentially clinically significant difference vs. placebo in pain evaluation, according to results. Researchers noted PRP had the highest probability of efficacy with regard to improvements in pain relief, function and both of these combined, followed by plasma rich in growth factors, hyaluronic acid, corticosteroids and placebo.
“With growing curiosity into the role of PRP in the treatment of degenerative orthopedic diseases, this study provides meaningful data to physicians and surgeons for long-term nonoperative management of knee osteoarthritis,” Chahla told Healio Orthopedics. “Patients with knee osteoarthritis may need close to 13 years of nonoperative management prior to end of life or total knee arthroplasty. As such, our results demonstrate the potential for PRP to become a mainstay in long-term management of knee osteoarthritis. Taking the results from this study, future studies can investigate the role of PRP and other injections in treatment of osteoarthritis of other joints.”
Reference:
www.jorgechahlamd.com/biologic-injections/
Perspective
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This was a systematic review and network meta-analysis of 23 studies to determine the efficacy of five types of knee injections with a minimum 6-month follow-up. The five intra-articular treatments were analyzed and ranked in order of efficacy regarding pain and function: PRP, plasma rich in growth factors, hyaluronic acid, corticosteroids and placebo. Limitations of the study included: only 23 studies included with a different number of injections in each group (hyaluronic acid 2,371; PRP, 446; placebo 1,120; corticosteroid, 521; plasma rich in growth factors, 146), the heterogeneity of injections used (type of corticosteroid, PRP preparation, type of plasma rich in growth factors), the heterogeneity of outcome measures used in each study, limited 6-month follow-up and some treatment groups included fewer studies.
This study determines that all treatments had some benefit, but PRP may have more benefit at 6 months compared to the other treatments. Ideally, a large, multicentered, prospective randomized-controlled trial with 2-year follow-up would allow us to better determine the efficacy of these treatment options for knee OA.
I commend the authors on this well-performed analysis that attempts to answer our question on the “best” treatments for knee OA. Often in orthopedics, the more we know, the more we learn how much more we have yet to know.
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