PRP injections may not improve function or relieve symptoms in patients with ankle OA
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Compared with placebo injections, intra-articular platelet-rich plasma injections did not significantly improve function or relieve symptoms in patients with ankle osteoarthritis, according to published results.
Liam D. A. Paget, MD, of the department of orthopedic surgery at Amsterdam UMC, and colleagues randomly assigned 100 patients with ankle OA to receive two ultrasonography-guided intra-articular injections of either PRP (n=48) or saline (n=52) across six sites in the Netherlands. Researchers included patients in the study if they had tibiotalar joint space narrowing and a score of at least 40 for ankle OA pain severity on the VAS during daily activities. Researchers considered the American Orthopaedic Foot and Ankle Society score during 26 weeks of follow-up as the primary outcome.
Results showed the mean AOFAS score improved by 10 points in the PRP group and by 11 points in the saline group at 26-week follow-up compared with baseline values. Researchers found an adjusted between-group difference of –1 in 26 weeks.
Although one serious adverse event was reported in the saline group, researchers noted it was unrelated to the intervention. The PRP group had 13 other adverse events, and the saline group had eight other adverse events, according to results.
Perspective
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End-stage ankle arthritis is as debilitating as hip arthritis, kidney failure and congestive heart failure; however, it affects younger and typically more active individuals. This poses a unique and challenging treatment paradigm. Unfortunately, there are limited effective nonsurgical treatment options available. Furthermore, it is less common than other pathologies, such as hip and knee arthritis, which makes large clinical trials difficult to conduct.
Liam D. A. Paget, MD, and colleagues should be commended on their efforts to successfully conduct a well-designed, randomized, double-blinded, placebo-controlled trial on a potentially valuable nonsurgical treatment option for patients with this debilitating and challenging condition. The study design featuring a variety of practice settings increases the generalizability of the results.
Unfortunately for patients, this study did not find any significant improvement in symptoms or function following PRP injections vs. placebo. This finding further underscores the challenges in treating this debilitating condition. Hopefully with further well-done studies, such as this one, we can find more options for our patients with this condition.
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