PRP, stem cells may provide a positive impact for knee OA
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Leukocyte-poor platelet-rich plasma, adipose derived stem cells and bone marrow aspirate concentrate may have a positive impact on knee osteoarthritis, according to a presenter at the Current Concepts of Joint Replacement Winter Meeting.
When it comes to treating knee OA with injections, Jay R. Lieberman, MD, said that while corticosteroid injections relieve pain, it has limited benefits. He also noted previously published literature showed inconsistent results in the use of viscosupplementation with hyaluronic acid in knee OA.
“In fact, the [American Academy of Orthopaedic Surgeons] AAOS clinical practice guideline in 2012 did not recommend it, basically because the studies were of low quality and there was publication bias, but I think in our practices we know that it can provide pain relief for certain patients,” Lieberman said in his keynote address. “In the more recent literature, [hyaluronic acid] HA has been found more effective than placebo for knee OA with few side effects.”
However, Lieberman said leukocyte-poor PRP seems to have an effect on knee OA, with patients who received leukocyte-poor PRP reporting pain relief and functional improvement, according to the published literature. When compared with HA, he noted leukocyte-poor PRP led to better IKDC and VAS scores as well as a decrease in pro-inflammatory cytokines.
“So, [leukocyte-poor PRP] does seem to work and have an impact on patients with knee pain from OA,” Lieberman said. “The question is which patients?”
Finally, although bone marrow aspirate concentrate and adipose-derived stromal vascular fraction both improved pain scores, Lieberman noted research showed adipose-derived stromal vascular fraction had a greater effect.
“The problem is that these studies presented little data on the cell preparation or the cell characterization, and the real question is did they have disease modification or not?” Lieberman said.
Research has also shown one and two injections of culture expanded adipose-derived stem cells yielded clinically significant improvements in pain and function at 12 months, according to Lieberman. He added a majority of patients who received two injections of culture expanded adipose-derived stem cells had no further cartilage loss or osteophyte formation.
“So autologous adipose-derived stem cells do have the potential for treatment OA and so does leukocyte-poor PRP. The question is in which patients is it going to work?” Lieberman said.
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Lieberman JR. Biologics and other things you can inject into a (knee) joint. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-11, 2021; Orlando (hybrid meeting).
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