Comparing Intra-articular Injections of PRP HA and NS in Treatment of Knee Osteoarthritis: A Randomized Double-blind Triple-paralleled Placebo-Controlled Clinical Trial

Abstract

Osteoarthritis (OA) of the knee is one of the main causes of musculoskeletal disability It is clinically heterogenous and the processes that cause deterioration are still poorly understood Current research efforts are focused on the identification of key biochemical pathways that can be targeted therapeutically through biological intervention and the testing of protein biotherapeutics for restoring the metabolic balance within the joint Autologous platelet-rich plasma (PRP) is a simple low cost and minimally invasive method that allows one to obtain from his/her own blood a natural pool of growth factors The aim of this prospective study was to evaluate the role of PRP in treating degenerative lesions of articular cartilage of the knee analyzing and comparing them with the results obtained with another common injectable treatment hyaluronic acid viscosupplementation and with normal saline being the placebo control This study was designed to be a prospective randomized and placebo-controlled clinical trial The hypothesis was that PRP would improve symptoms and function both statistically and clinically possibly through the release of growth factors and bioactive molecules in patients affected by knee OA From April to August 2014 a total of 87 osteoarthritic knees (53 patients) who met our inclusion criteria were randomly assigned into 3 groups of 3 weekly injections with either leukocyte-poor PRP (31 knees) HA (29 knees) or normal saline (NS) (27 knees) Functional outcomes evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee (IKDC) subjective score were to be collected at baseline and at 1 2 6 and 12 months after treatments Data were analyzed using generalized estimating equations (GEE) All three groups had statistically significant improvement in both outcome measures at 1 month; however only the PRP group sustained such significant improvement in both scores at 12 months (WOMAC 63 71±20 67 21% increased; IKDC 49 93±17 74 40% increased) For the inter-group comparison except for the first month there is a statistically significant difference between the PRP and NS groups in both scores throughout the study duration (WOMAC regression coefficient / P value: 8 72 / 0 0015 7 94 / 0 0155 and 11 92 / 0 0014 at 2- 6- and 12 months respectively; IKDC 9 1 / 0 0001 10 28 / 0 0002 and 13 97 /

Date of Award	2019
Original language	English
Supervisor	Ming-Long Yeh (Supervisor)