Background
Specific growth factors have been proposed as therapeutic proteins for cartilage repair.
Purpose
Hypothesis: Platelet-rich plasma (PRP) provides symptomatic relief in early osteoarthritis (OA) of the knee.
Methods
Study Design: Randomized controlled trial; Level of evidence, 1.
- A total of 78 patients (156 knees) with bilateral OA were divided randomly into 3 groups.
- Group A (52 knees) received a single injection of PRP, group B (50 knees) received 2 injections of PRP 3 weeks apart, and group C (46 knees) received a single injection of normal saline.
- White blood cell (WBC)–filtered PRP with a platelet count 3 times that of baseline (PRP type 4B) was administered in all.
- All the groups were homogeneous and comparable in baseline characteristics.
- Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before treatment and at 6 weeks, 3 months, and 6 months after treatment.
- They were also evaluated for pain by a visual analog scale, and overall satisfaction with the procedure and complications were noted.
Results
- Statistically significant improvement in all WOMAC parameters was noted in groups A and B within 2 to 3 weeks and lasting until the final follow-up at 6 months, with slight worsening at the 6-month follow-up.
- The mean WOMAC scores (pain, stiffness, physical function, and total score) for group A at baseline were 10.18, 3.12, 36.56, and 49.86, respectively, and at final follow-up were 5.00, 2.10, 20.08, and 27.18, respectively, showing significant improvement.
- Similar improvement was noted in group B (mean WOMAC scores at baseline: 10.62, 3.50, 39.10, and 53.20, respectively; mean WOMAC scores at final follow-up: 6.18, 1.88, 22.40, and 30.48, respectively).
- In group C, the mean WOMAC scores deteriorated from baseline (9.04, 2.70, 33.80, and 45.54, respectively) to final follow-up (10.87, 2.76, 39.46, and 53.09, respectively).
- The 3 groups were compared with each other, and no improvement was noted in group C as compared with groups A and B ( P < .001).
- There was no difference between groups A and B, and there was no influence of age, sex, weight, or body mass index on the outcome.
- Knees with Ahlback grade 1 fared better than those with grade 2.
- Mild complications such as nausea and dizziness, which were of short duration, were observed in 6 patients (22.2%) in group A and 11 patients (44%) in group B.
Conclusions
A single dose of WBC-filtered PRP in concentrations of 10 times the normal amount is as effective as 2 injections to alleviate symptoms in early knee OA. The results, however, deteriorate after 6 months. Both groups treated with PRP had better results than did the group injected with saline only.
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