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Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis

A prospective randomized controlled study

Intraartikuläre Injektionen mit plättchenreichem Plasma, Hyaluronsäure oder Kortikosteroiden bei Kniearthrose

Eine prospektive, randomisierte, kontrollierte Studie

Abstract

Background

Knee osteoarthritis (KOA) is a degenerative joint disease leading to pain and disability for which no curative treatment exists. Intra-articular (IA) therapies are part of this multimodal approach and are approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA). Platelet-rich plasma (PRP), hyaluronic acid (HA), and corticosteroids (CS) have been increasingly used in recent years to treat KOA.

Purpose

To determine whether IA-PRP was superior to IA-HA or IA-CS administration routes in these patients.

Material and methods

In this trial the patients were randomized to IA-HA (2 ml/week, for 3 weeks), IA-CS (1 ml) or IA-PRP (3 times, 4 ml, every 3 weeks) groups. The outcome was assessed using the Western Ontario and McMaster Universities (WOMAC) score prior to the first injection and then at 3, 6, 9 and 12 months. Pain was evaluated by a visual analogue scale (VAS) prior to treatment and after 12 months.

Results

In this study 120 patients were randomized into 3 groups. There was a significant improvement in all scores (WOMAC, VAS) in each group compared to the pretreatment values (P< 0.05). The mean WOMAC scores for the IA-HA group from pretreatment to 3, 6, 9, and 12 months were 47.23 ± 5.37, 25.02 ± 4.98, 26.38 ± 5.20, 27.86 ± 4.34, and 30.64 ± 8.36, respectively. Similar improvements were noted in the IA-CS and IA-PRP groups. There were no significant differences in the WOMAC scores between the 3 groups 3 months after treatment (P > 0.05) but IA-PRP showed significantly lower scores 6, 9 and 12 months after treatment (P < 0.05).

Conclusion

Intra-articular PRP injections into the knee for symptomatic early stages of KOA are a valid treatment option. The clinical efficacy of IA-PRP is comparable to that of the IA-HA and IA-CS forms after 3 months and the long-term efficacy of IA PRP is superior to IA-HA and IA-CS.

Zusammenfassung

Hintergrund

Kniearthrose ist eine degenerative Gelenkerkrankung, die mit Schmerzen und Einschränkungen einhergeht, für die es keine kurative Behandlung gibt. Intraartikuläre (IA) Therapien sind Teil dieses multimodalen Therapieansatzes und wurden von der Food and Drug Administration (FDA) und der Europäischen Arzneimittel-Agentur (EMA) zugelassen. Plättchenreiches Plasma (PRP), Hyaluronsäure (HA) und Kortikosteroide (CS) wurden in den letzten Jahren zunehmend zur Behandlung der Kniearthrose verwendet.

Zweck

Es sollte festgestellt werden, ob bei diesen Patienten IA-PRP einer Behandlung mit IA-HA oder IA-CS überlegen ist.

Material und Methoden

In dieser Studie wurden die Patienten in eine IA-HA-Gruppe (2 ml/Woche für 3 Wochen), eine IA-CS-Gruppe (1 ml) oder eine IA-PRP-Gruppe (3-mal 4 ml alle 3 Wochen) randomisiert. Die Ergebnisse wurden vor der ersten Injektion und dann nach 3, 6, 9 und 12 Monaten mittels des Western Ontario and McMaster Universities (WOMAC) Score ausgewertet. Die Schmerzen wurden vor der Behandlung und 12 Monate danach mittels der visuellen Analogskala (VAS) bewertet.

Ergebnisse

In dieser Studie wurden 120 Pateinten in 3 Gruppen randomisiert. In allen Scores (WOMAC, VAS) zeigte sich eine signifikante Verbesserung in jeder Gruppe im Vergleich zu den Werten vor der Behandlung (p< 0,05). Die mittleren WOMAC-Scores der IA-HA-Gruppe vom Zeitpunkt vor der Behandlung bis zu 3, 6, 9 und 12 Monaten betrugen 47,23 ± 5,37, 25,02 ± 4,98, 26,38 ± 5,20, 27,86 ± 4,34 bzw. 30,64 ± 8,36. Ähnliche Verbesserungen wurden in der IA-CS- und IA-PRP-Gruppe festgestellt. Es gab keine signifikanten Unterschiede in den WOMAC-Scores zwischen den 3 Gruppen 3 Monate nach der Behandlung (p > 0,05), aber IA-PRP zeigte signifikant niedrigere Scores 6, 9 und 12 Monate nach der Therapie (p < 0,05).

Schlussfolgerung

Intraartikuläre PRP-Injektionen ins Kniegelenk im symptomatischen Frühstadium einer Kniearthrose stellen eine valide Behandlungsoption dar. Die klinische Wirksamkeit von IA-PRP ist vergleichbar mit der Wirksamkeit der IA-HA- und IA-CS-Therapie nach 3 Monaten. Bezüglich der Langzeit-Wirksamkeit ist IA-PRP der Behandlung mit IA-HA und IA-CS überlegen.

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Abbreviations

BMI:

Body mass index

CS:

Corticosteroids

DVT:

Deep venous thrombosis

EQ-VAS:

EuroQol-VAS

HA:

Hyaluronic acid

HIV:

Human immunodeficiency virus

IA:

Intra-articular

IGF-1:

Insulin-like growth factor 1

IKDC:

International Knee Documentation Committee

KOA:

Knee osteoarthritis

KOOS:

Knee injury and osteoarthritis outcome score

MRI:

Magnetic resonance imaging

PRP:

Platelet-rich plasma

RCF:

Relative centrifugal force

TGF-beta:

Transforming growth factor beta

VAS:

Visual analog scale

VEGF:

Vascular endothelial growth factor

WOMAC:

Western Ontario and McMasters Universities

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Acknowledgements

The authors would like to thank the research assistants from Jining No. 1 People’s Hospital of Shandong for their support and the patients enrolled in this study.

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Correspondence to Junbin Liu.

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Conflict of interest

Y. Huang, X. Liu, X. Xu and J. Liu declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the Jining No. 1 People’s Hospital of Shandong. Informed consent was obtained from all individual participants included in the study.

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Huang, Y., Liu, X., Xu, X. et al. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis. Orthopäde 48, 239–247 (2019). https://doi.org/10.1007/s00132-018-03659-5

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  • DOI: https://doi.org/10.1007/s00132-018-03659-5

Keywords

  • Degenerative joint disease
  • Visual analog scale
  • Multimodal treatment
  • Assessment, outcomes
  • Viscosupplementation

Schlüsselwörter

  • Degenerative Erkrankung
  • Visuelle Analogskala
  • Multimodale Therapie
  • Bewertung, Ergebnisse
  • Viskosupplementation