Single Shot of Knee Intraarticular Injection of Platelets Rich Plasma versus Hyaluronic Acid Injections for Symptomatic Knee Osteoarthritis. An Observational Prospective Study

Yıl 2024, Cilt: 7 Sayı: 2, 342 - 350, 25.03.2024

Dheyaa Mohammed Abdulwahab , Saad Abdul Azeez Abdul Lateef , Waleed Faris , Younis Abdul Rahman Rasheed Al Radhwany

https://doi.org/10.33438/ijdshs.1389727

Öz

The aim of this study was to evaluate the effectiveness and safety of intra-articular PRP and HA in KOA patients. Methods: The current work was prospective randomized observational. Participants were divided into two groups. Group 1; 1 intra-articular PRP injection (15 mL) in 72 patients and Group 2; A single intra-articular injection of HA (80 mg/4 mL) was administered to 72 patients. All patients were evaluated before infiltration and 1, 3, 6, and 12 months after injection. Results: No significant difference was detected in the demographic distribution (gender and age) and Grade RT, Grade RL, Grade II OA and Grade III OA classifications of patients who received intra-articular PRP or HA injection for knee OA (p>0.05). Compared with the HA group WOMAC mean of 48.8 and p<0.05, there was no significant change in the PRP groups with the WOMAC mean of 68.9. At month 3, each group had significantly reduced overall WOMAC score compared to baselines in both groups. The mean WOMAC was 48.2 in the HA and 47.9 in the PRP group (P<0.001). At 6 months, the average WOMAC score of the PRP group was 39.4, while this rate was 56.3 in the HA group (P<0.001). The PRP group showed a steady improvement, while those treated with HA showed a rapid deterioration. At 12 months, the HA group's WOMAC scores (74.1) returned to baseline levels. The mean WOMAC of the PRP group was (58.9) (P<0.001). Conclusion: The overall PRP improvement outweighs HA injections

Anahtar Kelimeler

Hyaluronic acid, Intra-articular, Platelet rich plasma

Kaynakça

• Anitua E, Sanchez M, Orive G, et al. (2007); The potential impact of the preparation rich in growth factors (PRGF) in different medical fields. Biomaterials. 28(31):4551–60. [Pubmed]
• Campbell KA, Saltzman BM, Mascarenhas R, et al. (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):2213–21. [Pubmed]
• Campo G, Avenoso A, Nastasi G, Micali A, Prestipino V, Vaccaro M, D'Ascola A, Calatroni A, Campo S. (2011); Hyaluronan reduces inflammation in experimental arthritis by modulating TLR-2 and TLR-4 cartilage expression. Biochim Biophys Acta. 1812:1170–81. [Pubmed]
• Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. (2012); Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 40(12):2822–7.. [Pubmed]
• Chen P, Huang L, Ma Y, et al. (2019); Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res. 14:385. [Pubmed]
• Cook CS, Smith PA. (2018); Clinical Update: Why PRP Should be your first choice for injection therapy in treating osteoarthritis of the knee. Curr Rev Musculoskelet Med. 11:583–92. [Pubmed]
• Dai WL, Zhou AG, Zhang H, et al. (2017); Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy; 33(3):659–70. [Pubmed]
• Dahl L, Dahl I, Engström-Laurent A, Granath K. (1985). Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis. 44(12):817–22. [Pubmed]
• Di Sante L, Villani C, Santilli V, et al. (2016); Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis. Med Ultrason. 18(4):463–8. [Pubmed]
• Di Y, Han C, Zhao L, et al. (2018); Is local platelet-rich plasma injection clinically superior to hyaluronic acid for treatment of knee osteoarthritis? A systematic review of randomized controlled trials. Arthritis Res Ther. 20:128. [Pubmed]
• Duymus TM, Mutlu S, Dernek B, et al. (2017); Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 25:485–92. [Pubmed]
• Ferreira RM, Duarte JA, Goncalves RS. (2018); Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: an umbrella review. Acta Reumatol Port. 43:182–200. [Pubmed]
• Filardo G, Di Matteo B, Di Martino A, et al. (2015); Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med. 43:1575–82. [Pubmed]
• Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, Fornasari PM, Marcacci M. (2012); Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 13:229. [Pubmed]
• Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, Fornasari PM, Marcacci M. (2012); Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 13:229. [Pubmed]
• Fonsi M, El Amrani AI, Gervais F, et al. (2020);Intra-articular hyaluronic acid and chondroitin sulfate: pharmacokinetic investigation in osteoarthritic rat models. Curr Ther Res Clin Exp. 92:100573. [Pubmed]
• Guermazi M, Poiraudeau S, Yahia M, Mezganni M, Fermanian J, Habib Elleuch M, et al. (2004);Translation, adaptation and validation of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for an Arab population: the Sfax modified WOMAC. Osteoarthritis Cartilage; 12: 459–68. [Pubmed]
• Hiraoka N, Takahashi KA, Arai Y, Sakao K, Mazda O, Kishida T, Honjo K, Tanaka S, Kubo T. (2011); Intra-articular injection of hyaluronan restores the aberrant expression of matrix metalloproteinase-13 in osteoarthritic subchondral bone. J Orthop Res. 29(3):354–60. [Pubmed]
• Huang, TL., Tsai, CH. (2021) Safety and efficacy of single CHAP Hyaluronan injection versus three injections of linear Hyaluronan in pain relief for knee osteoarthritis: a prospective, 52-week follow-up, randomized, evaluator-blinded study. BMC Musculoskelet Disord ;22, 572. [CrossRef]
• Jevsevar DS, Brown GA, Jones DL, et al. (2013); The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Joint Surg Am. 95(20):1885–6. [Pubmed] Johnson VL, Hunter DJ. (2014). The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol.;28(1):5–15. [Pubmed]
• Julovi SM, Yasuda T, Shimizu M, Hiramitsu T, Nakamura T. (2004); Inhibition of interleukin-1β-stimulated production of matrix metalloproteinases by hyaluronan via CD44 in human articular cartilage. Arthritis Rheum. 50(2):516–25. [Pubmed]
• Karna E, Miltyk W, Surażyński A, Pałka JA. (2008); Protective effect of hyaluronic acid on interleukin-1-induced deregulation of β 1-integrin and insulin-like growth factor-I receptor signaling and collagen biosynthesis in cultured human chondrocytes. Mol Cell Biochem. 308(1–2):57–64. [Pubmed]
• Kayo, M.; Minako, M.; Kazuo, Y.; Tomohiro, K.; Hiroshi, N. (2009). Anti-inflammatory effects of hyaluronan in arthritis therapy: Not just for viscosity. Int. J. Gen. Med. 2, 77–81. [Pubmed]
• Lin KY, Yang CC, Hsu CJ, et al. (2019); Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy. 35:106–17. [Pubmed]
• Malemud CJ. (2015); Biologic basis of osteoarthritis: state of the evidence. Curr Opin Rheumatol. 27(3):289–94. [Pubmed]
• McAlindon TE, Bannuru RR, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S, Hawker G, Henrotin Y, Hunter D, Kawaguchi H. (2014); OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 22(3):363–88. [Pubmed]
• McDonough CM, Jette AM. (2010). The contribution of osteoarthritis to functional limitations and disability. Clin Geriatr Med.;26(3):387–99. [Pubmed]
• Migliore A, Bizzi E, De Lucia O, Sedie AD, Bentivegna M, Mahmoud A, Foti C. (2016); Differences among branded hyaluronic acids in italy, part 1: data from in vitro and animal studies and instructions for use. Clin Med Insight. 9:CMAMD. S38857. [Pubmed]
• Milants C, Bruyère O, Kaux JF. (2018); Knee osteoarthitis and platelet-rich plasma treatment: how to improve the efficency? Osteoporosis Int. 29(1):S392. [CrossRef]
• Moreland LW. (2003); Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 5(2):54. [Pubmed]
• Mishra A, Harmon K, Woodall J, et al. (2012); Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 13(7):1185–95. [Pubmed]
• Neogi T. (2013); The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil. 21(9):1145–53. [Pubmed] Peng H, Zhou J-L, Liu S-Q, Hu Q-J, Ming J-H, Qiu B. (2010); Hyaluronic acid inhibits nitric oxide-induced apoptosis and dedifferentiation of articular chondrocytes in vitro. Inflamm Res. 59(7):519–30. [Pubmed]
• Shen L, Yuan T, Chen S, et al. (2017); The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 12(1):16. [Pubmed]
• Tascιoglu F, Öner C. (2003); Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Clin Rheumatol. 22(2):112–7. [Pubmed]
• Turajane, T., Chaveewanakorn, U., Fongsarun, W. Aojanepong, J. and Papadopoulos, K. (2017). Avoidance of total knee arthroplasty in early osteoarthritis of the knee with intra-articular implantation of autologous activated peripheral blood stem cells versus hyaluronic acid: A randomized controlled trial with differential effects of growth factor addition. Stem Cells Int;20178925132. [Pubmed]
• Vaquerizo V, Víctor V, Miguel Ángel P, Ignacio A, et al. (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-the Journal of Arthroscopic & Related Surgery. 29:1635–1643. [Pubmed]
• Wallace I, Worthington S, Felson D, Jurmain R, Wren K, Maijanen H, Woods R, Lieberman D. 2017;Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci. 114:201703856. [Pubmed]
• Xu Z, Luo J, Huang X, et al. (2017); Efficacy of platelet-rich plasma in pain and self-report function in knee osteoarthritis: a best-evidence synthesis. Am J Phys Med Rehabil. 96(11):793–800. [Pubmed]
• Yatabe T, Mochizuki S, Takizawa M, Chijiiwa M, Okada A, Kimura T, Fujita Y, Matsumoto H, Toyama Y, Okada Y. (2009); Hyaluronan inhibits expression of ADAMTS4 (aggrecanase-1) in human osteoarthritic chondrocytes. Ann Rheum Dis. 68(6):1051–8. [Pubmed]
• Zhang HF, Wang CG, Li H, et al. (2018); Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Des Devel Ther. 12:445–53. [Pubmed] Zhang HF, Wang CG, Li H, et al. (2018); Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Des Devel Ther. 12:445–53. [Pubmed]