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Published in: Clinical Rheumatology 1/2021

01-01-2021 | Knee Osteoarthritis | Original Article

The effects of platelet-rich plasma injection in knee and hip osteoarthritis: a meta-analysis of randomized controlled trials

Authors: Yujie Dong, Butian Zhang, Qi Yang, Jiajing Zhu, Xiaojie Sun

Published in: Clinical Rheumatology | Issue 1/2021

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Abstract

Objective

We conducted this updated meta-analysis to evaluate the effects of PRP in patients with knee or hip OA.

Method

PubMed, Embase, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the efficacy of PRP with other intra-articular injections. The outcomes of interest included Western Ontario and McMaster (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), Harris Hip Score (HHS), and International Knee Documentation Committee (IKDC).

Results

Twenty-four RCTs with 21 at knee OA and three at hip OA were included in this meta-analysis. The PRP injections significantly improved the WOMAC score, VAS score, IKDC score, and HHS score as compared with comparators. The WOMAC pain, stiffness, and physical function scores were also significantly better in the PRP group than in the control group. Most of the evaluated parameters that favored PRP were observed in knee OA but not in hip OA, at short-term (at 1, 2, 3, 6, 12 months) but not long-term follow-up (at 18 months), in RCTs with low risk of bias.

Conclusions

Intra-articular PRP injection provided better effects than other injections for OA patients, especially in knee OA patients, in terms of pain reduction and function improvement at short-term follow-up.
Key Points
• This updated meta-analysis, based on great sample size and high-quality studies, evaluates the effects of PRP in patients with knee or hip OA.
• Intra-articular PRP injection provided better effects than other injections for OA patients.
• Most of the evaluated parameters that favored PRP were observed in knee OA at short term (at 1, 2, 3, 6, 12 months).
Appendix
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Literature
1.
go back to reference Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D, Rubin C, Matzkin EG, Marx RG, Levy BA, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH 3rd, Turkelson CM, Wies JL, Anderson S, Boyer K, Sluka P, St Andre J, McGowan R (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am 92(4):990–993. https://doi.org/10.2106/jbjs.i.00982CrossRefPubMed Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D, Rubin C, Matzkin EG, Marx RG, Levy BA, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH 3rd, Turkelson CM, Wies JL, Anderson S, Boyer K, Sluka P, St Andre J, McGowan R (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am 92(4):990–993. https://​doi.​org/​10.​2106/​jbjs.​i.​00982CrossRefPubMed
6.
go back to reference Montanez-Heredia E, Irizar S, Huertas PJ, Otero E, Del Valle M, Prat I, Diaz-Gallardo MS, Peran M, Marchal JA, Hernandez-Lamas Mdel C (2016) Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the Spanish National Health Care System. Int J Mol Sci 17(7). https://doi.org/10.3390/ijms17071064 Montanez-Heredia E, Irizar S, Huertas PJ, Otero E, Del Valle M, Prat I, Diaz-Gallardo MS, Peran M, Marchal JA, Hernandez-Lamas Mdel C (2016) Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the Spanish National Health Care System. Int J Mol Sci 17(7). https://​doi.​org/​10.​3390/​ijms17071064
7.
go back to reference Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ (2015) Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 31(11):2213–2221. https://doi.org/10.1016/j.arthro.2015.03.041CrossRefPubMed Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ (2015) Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 31(11):2213–2221. https://​doi.​org/​10.​1016/​j.​arthro.​2015.​03.​041CrossRefPubMed
25.
26.
go back to reference Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748PubMed Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748PubMed
28.
go back to reference Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMed Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMed
31.
go back to reference Bastos R, Mathias M, Andrade R, Bastos R, Balduino A, Schott V, Rodeo S, Espregueira-Mendes J (2018) Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(11):3342–3350. https://doi.org/10.1007/s00167-018-4883-9CrossRefPubMed Bastos R, Mathias M, Andrade R, Bastos R, Balduino A, Schott V, Rodeo S, Espregueira-Mendes J (2018) Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(11):3342–3350. https://​doi.​org/​10.​1007/​s00167-018-4883-9CrossRefPubMed
32.
go back to reference Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K (2017) Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc 25(3):958–965. https://doi.org/10.1007/s00167-015-3705-6CrossRefPubMed Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K (2017) Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc 25(3):958–965. https://​doi.​org/​10.​1007/​s00167-015-3705-6CrossRefPubMed
34.
go back to reference Sanchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, Albillos J, Garate R, Aguirre JJ, Padilla S, Orive G, Anitua E (2012) A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 28(8):1070–1078. https://doi.org/10.1016/j.arthro.2012.05.011CrossRefPubMed Sanchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, Albillos J, Garate R, Aguirre JJ, Padilla S, Orive G, Anitua E (2012) A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 28(8):1070–1078. https://​doi.​org/​10.​1016/​j.​arthro.​2012.​05.​011CrossRefPubMed
37.
go back to reference Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S (2013) Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 36(12):e1501–e1508CrossRefPubMed Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S (2013) Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 36(12):e1501–e1508CrossRefPubMed
38.
41.
go back to reference Vaquerizo V, Plasencia MA, Arribas I, Seijas R, Padilla S, Orive G, Anitua E (2013) Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy 29(10):1635–1643. https://doi.org/10.1016/j.arthro.2013.07.264CrossRefPubMed Vaquerizo V, Plasencia MA, Arribas I, Seijas R, Padilla S, Orive G, Anitua E (2013) Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy 29(10):1635–1643. https://​doi.​org/​10.​1016/​j.​arthro.​2013.​07.​264CrossRefPubMed
42.
go back to reference Lana JF, Weglein A, Sampson SE, Vicente EF, Huber SC, Souza CV, Ambach MA, Vincent H, Urban-Paffaro A, Onodera CM, Annichino-Bizzacchi JM, Santana MH, Belangero WD (2016) Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med 12(2):69–78CrossRefPubMedPubMedCentral Lana JF, Weglein A, Sampson SE, Vicente EF, Huber SC, Souza CV, Ambach MA, Vincent H, Urban-Paffaro A, Onodera CM, Annichino-Bizzacchi JM, Santana MH, Belangero WD (2016) Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med 12(2):69–78CrossRefPubMedPubMedCentral
43.
go back to reference Angoorani H, Mazaherinezhad A, Marjomaki O, Younespour S (2015) Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran 29:223PubMedPubMedCentral Angoorani H, Mazaherinezhad A, Marjomaki O, Younespour S (2015) Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran 29:223PubMedPubMedCentral
46.
go back to reference Vaquerizo V, Padilla S, Aguirre JJ, Begona L, Orive G, Anitua E (2018) Two cycles of plasma rich in growth factors (PRGF-Endoret) intra-articular injections improve stiffness and activities of daily living but not pain compared to one cycle on patients with symptomatic knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(9):2615–2621. https://doi.org/10.1007/s00167-017-4565-zCrossRefPubMed Vaquerizo V, Padilla S, Aguirre JJ, Begona L, Orive G, Anitua E (2018) Two cycles of plasma rich in growth factors (PRGF-Endoret) intra-articular injections improve stiffness and activities of daily living but not pain compared to one cycle on patients with symptomatic knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(9):2615–2621. https://​doi.​org/​10.​1007/​s00167-017-4565-zCrossRefPubMed
47.
go back to reference Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA (2017) Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med 45(2):339–346. https://doi.org/10.1177/0363546516665809CrossRefPubMed Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA (2017) Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med 45(2):339–346. https://​doi.​org/​10.​1177/​0363546516665809​CrossRefPubMed
51.
go back to reference Simental-Mendia M, Vilchez-Cavazos JF, Pena-Martinez VM, Said-Fernandez S, Lara-Arias J, Martinez-Rodriguez HG (2016) Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Arch Orthop Trauma Surg 136(12):1723–1732. https://doi.org/10.1007/s00402-016-2545-2CrossRefPubMed Simental-Mendia M, Vilchez-Cavazos JF, Pena-Martinez VM, Said-Fernandez S, Lara-Arias J, Martinez-Rodriguez HG (2016) Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Arch Orthop Trauma Surg 136(12):1723–1732. https://​doi.​org/​10.​1007/​s00402-016-2545-2CrossRefPubMed
59.
Metadata
Title
The effects of platelet-rich plasma injection in knee and hip osteoarthritis: a meta-analysis of randomized controlled trials
Authors
Yujie Dong
Butian Zhang
Qi Yang
Jiajing Zhu
Xiaojie Sun
Publication date
01-01-2021
Publisher
Springer International Publishing
Published in
Clinical Rheumatology / Issue 1/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-020-05185-2

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