Efficacy of Intraarticular Knee Injection of PRP (Platelet Rich Plasma) vs Steroid (Triamcinolone Acetate) for the Treatment of Primary Knee Osteoarthritis Grade I & II
DOI:
https://doi.org/10.51273/esc23.2519215Keywords:
Platelet rich plasma, Osteoarthritis, Chronic, Pain, Visual Analogue Scale, WOMAC, Western Ontario, McMaster Universities Osteoarthritis IndexAbstract
Objective: To assess the effectiveness of PRP (Platelet Rich Plasma), and to compare with Triamcinolone 40mg (Steroid) on functional activity, stiffness and pain in Grade I & II Knee OA.
Method: A comparative cross sectional study was conducted at outdoor departments of Advanced Pain Relief Center, Lifeline Hospital Lahore (Pakistan) from January 2022 to December 2022. The present study included a total of 235 participants, out of whom 190 individuals were deemed eligible for inclusion based on predetermined criteria. The remaining 45 participants were excluded from the study due to non-adherence to eligibility criteria and lack of approval from institutional ethical committee. Out of a total of 190 subjects enrolled in the study, 64 (33%) were characterized as male while 126 (67%) were classified as female. The participants' mean age was 53.5 ± 6.4 years. Alternative patients were treated with intra-articular injection of either triamcinolone 40mg or PRP. Patients randomized in Steroid group (n=95) were gives intraarticular 40mg Triamcinolone acetate (1ml) along with 2ml of Local anaesthetic Lignocaine 1%, whereas patients randomized in PRP group (n=95) were injected 5ml PRP. “The Western Ontario and McMaster Universities Arthritis Index” (WOMAC) Scale was used for functional disability and pain before and after the therapy for the targeted knee joint at the baseline 1 week, 5 weeks, 8 weeks and 20 weeks follow-ups. Visual Analogue Scale (VAS) scores were also recorded for pain. Data analysis was done by using SPSS version 20.
Results: There wasn't any serious adverse effect observed during the study and follow-ups. 25 WOMAC functional activity scale showed statistically significant improvement with Intraarticular knee injection of PRP compared to steroids(40.64±1.87vs.27.17±6.01)(p=0.000). WOMACpainscaleresultsalsodemonstrated that intraarticular knee injection of PRP was more effective in reducing knee pain than steroids (p = 0.000) at 20 weeks follow-up.
Conclusion: On the basis of the results of our study, we concluded that platelet rich plasma is more effective than intra-articular steroids in terms of improvement in functional activity and reduction of pain in patients with Grade I & II knee osteoarthritis. Both PRPand steroid intraarticular injections are safe.
References
Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino AJ, Mont MA. Knee osteoarthritis: a primer. The Permanente Journal. 2017;21.
Palo N, Chandel SS, Dash SK, Arora G, Kumar M, Biswal MR. Effects of Osteoarthritis on Quality of life in Elderly Population of Bhubaneswar, India: A Prospective Multicenter Screening and Therapeutic Study of 2854 Patients. Geriatric orthopaedic surgery & rehabilitation. 2015 Dec;6(4):269-75.
Chu CR, Millis MB, Olson SA. Osteoarthritis: from palliation to prevention: AOA critical issues. The Journal of bone and joint surgery. American volume. 2014 Aug 6;96(15).
LaPrade RF, Dragoo JL, Koh JL, Murray IR, Geeslin AG, Chu CR. AAOS research symposium updates and consensus: biologic treatment of orthopaedic injuries. The Journal of the American Academy of Orthopaedic Surgeons. 2016 Jul;24(7):e62.
Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Therapeutic advances in musculoskeletal disease. 2013 Apr;5(2):77-94.
Felson DT. Clinical practice. Osteoarthritis of the knee. N Engl J Med 2006;354:841-8
Everts PA, Hoogbergen MM, Weber TA, Devilee RJ, van Monftort G, de Hingh IH. Is the use of autologous platelet-rich plasma gels in gynecologic, cardiac, and general, reconstructive surgery beneficial? Curr Pharm Biotechnol 2012;13:1163-72
Sánchez M, Azofra J, Anitua E, Andía I, Padilla S, Santisteban J, et al. Plasma rich in growth factors to treat an articular cartilage avulsion: a case report. Med Sci Sports Exerc 2003;35:1648-52
Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg 2011;131:311-7.
Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, et al. Platelet-rich plasma: intraarticular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010;18:472-9.2
Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil 2014;95:562-75
Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil 2010;89:961-9.
Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair Arthritis Res Ther 2014;16:204.
26. 27. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, et al. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med 2013;23:238-9.
28. Kara M, Tiftik T, Öken Ö, Akkaya N, Tunc H, Özçakar L. Ultrasonographic measurement of femoral cartilage thickness in patients with spinal cord injury. J Rehabil Med 2013;45:145-8.
29.. Kwon DR, Park GY, Lee SU, Kwon DR, Park GY, Lee SU. The effects of intra-articular platelet-rich plasma injection according to the severity of collagenaseinduced knee osteoarthritis in a rabbit model. Ann Rehabil Med 2012;36:458-65
