THE RELATIONSHIP OF THE EFFECT OF INTRA-ARTICULAR PLATELET-RICH PLASMA (PRP) ADMINISTRATION WITH THE SEVERITY OF KNEE OSTEOARTHRITIS

Yıl 2020, Cilt: 22 Sayı: 2, 172 - 179, 31.08.2020

Birhan Oktas , İbrahim Deniz Canbeyli

https://doi.org/10.24938/kutfd.693499

Öz

Amaç: Trombositten zengin plazma uygulamaları son dönemde diz osteoartritinde cerrahi dışı tedaviler arasında yer almaya başlamıştır. Plasebo ve proloterapi gibi tedavilere üstünlüğü gösterilmiştir. Ancak halen erken dönem ve geç dönem diz osteoartriti üzerine etkisinin değişiklik gösterip göstermediği tam net değildir. Biz bu çalışmamızda farklı evredeki diz osteoartriti olan hastalarda tek doz trombositten zengin plazma uygulamasının etkinliğini karşılaştırmayı amaçladık. 

Gereç ve Yöntemler: Tek dizine tek doz trombositten zengin plazma uygulanmış ve enjeksiyon öncesi Lysholm diz fonksiyonelliği skoru anketi doldurulmuş olan toplam 80 hasta çalışmaya dahil edildi. Bu hastaların daha önce çekilmiş grafileri üzerinden Kallgren-Lawrence osteoartrit sınıflaması kullanılarak sınıflama yapıldı. Evre I ve II osteoartriti olanlar 1. gruba dahil edilirken, evre III ve IV osteoartriti olanlar 2. gruba dahil edildi. Bu hastaların enjeksiyon öncesi ve sonrasında doldurulmuş olan Lysholm diz fonksiyonelliği anketleri değerlendirildi. Elde edilen veriler her iki grup arasında varyans analizi kullanılarak (ANOVA) karşılaştırıldı.

Bulgular: Her iki grubun Lysholm skorlarında enjeksiyon sonrası iyileşme mevcuttu. Her iki grupta da hem ağrı hem fonksiyonellik açısından daha iyi sonuçlar elde edildi. Enjeksiyon öncesi ve sonrası skorlardaki değişim ele alındığında, birinci gruptaki değişim ikinci gruba göre anlamlı olarak daha fazlaydı. (p<0,05)

Sonuç: Trombositten zengin plazma uygulaması erken evre diz osteoartritli hastalarda daha etkili idi. Tek doz uygulama hem ağrının azaltılmasında hem de fonksiyonelliğin artırılmasında yeterli bulunmuştur. Ancak ileri evre osteoartritli hastalarda en az 3 doz yapılması, cevap alınamadığında bir sonraki tedavi yöntemlerinin düşünülmesi gereklidir.

Anahtar Kelimeler

Osteoartrit, diz, trombositten zengin plazma, Lysholm diz skoru

Destekleyen Kurum

yoktur

Proje Numarası

yoktur

Teşekkür

Yazının dizaynındaki, verilerin yorumlanmasındaki ve son halinin verilmesindeki yardımlarından dolayı Doç. Dr. Meriç Çırpar'a teşekkür ederiz.

Eklem İçi Uygulanan Trombositten Zengin Plazmanın (TZP) Etkisinin Diz Osteoartritinin Şiddeti ile İlişkisi

Öz

Objective: Platelet-rich plasma applications have recently become one of the non-surgical treatments in knee osteoarthritis. It has been shown to be superior to treatments such as placebo and prolotherapy. However, it is not entirely clear whether its effect on early or late knee osteoarthritis varies. In this study, we aimed to compare the effectiveness of single dose platelet-rich plasma administration in patients with different stages of knee osteoarthritis. 

Material and Methods: A total of 80 patients who received a single dose of platelet-rich plasma to a single knee joint and whose Lysholm knee functionality score questionnaires were filled before injection were included in the study. Knee radiographies of all patients were evaluated according to Kellgren-Lawrence classification. Stage I and II osteoarthritic patients were included in Group 1 whereas Stage III and IV osteoarthritic patients were included in Group 2. Knee scores of all patients acquired before and after injection therapies were evaluated. Demographic data were also evaluated. All data obtained were compared between two groups using statistical analysis ANOVA. 

Results: Scores of both groups were increased as compared to pre-injection scores. Better results were obtained in both groups in terms of pain and functionality. When the changes in scores before and after injection of both groups were compared, the first group had a better result statistically (p<0,05). 

Conclusion: Platelet-rich plasma application was more effective in early stage osteoarthritic patients. Single dose administration has been found to be effective in pain control and functionality. However, in case of late stage osteoarthritis, a minimum dose of 3 injections should be administered or other treatment modalities can be tried.

Anahtar Kelimeler

Osteoarthritis, knee, platelet-rich plasma, Lysholm knee score

Proje Numarası

yoktur

Kaynakça

• 1. Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A et al. Knee replacement. Lancet. 2018;392(10158):1672-82.
• 2. Dhillon MS, Patel S, John R. PRP in OA knee - update, current confusions and future options. SICOT J. 2017;3:27.
• 3. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356-64.
• 4. Gobbi A, Fishman M. Platelet-rich plasma and bone marrow-derived mesenchymal stem cells in sports medicine. Sports Med Arthrosc Rev. 2016;24(2):69-73.
• 5. Braun HJ, Kim HJ, Chu CR, Dragoo JL. The effect of platelet-rich plasma formulations and blood products on human synoviocytes: implications for intra-articular injury and therapy. Am J Sports Med. 2014;42(5):1204-10.
• 6. Celik D, Coskunsu D, Kilicoglu O. Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability. Clin Orthop Relat Res. 2013;471(8):2602-10.
• 7. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502.
• 8. Di Y, Han C, Zhao L, Ren Y. 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. 2018;20(1):128.
• 9. Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73-9.
• 10. Guillibert C, Charpin C, Raffray M, Benmenni A, Dehaut FX, El Ghobeira G et al. Single injection of high volume of autologous pure prp provides a significant improvement in knee osteoarthritis: A prospective routine care study. Int J Mol Sci. 2019;20(6).
• 11. Martini LI, Via AG, Fossati C, Randelli F, Randelli P, Cucchi D. Single Platelet-Rich Plasma Injection for Early Stage of Osteoarthritis of the Knee. Joints. 2017;5(1):2-6.
• 12. Levy DM, Petersen KA, Scalley Vaught M, Christian DR, Cole BJ. Injections for knee osteoarthritis: corticosteroids, visco-supplementation, platelet-rich plasma and autologous stem cells. Arthroscopy. 2018;34(5):1730-43.
• 13. Sucuoglu H, Ustunsoy S. The short-term effect of PRP on chronic pain in knee osteoarthritis. Agri. 2019;31(2):63-9. 14. Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis: A prospective randomized controlled study. Orthopade. 2019;48(3):239-47. 15. Bansal H, Comella K, Leon J, Verma P, Agrawal D, Koka P et al. Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis. J Transl Med. 2017;15(1):141.
• 16. Frechette JP, Martineau I, Gagnon G. Platelet-rich plasmas: growth factor content and roles in wound healing. J Dent Res. 2005;84(5):434-9.
• 17. Xing D, Wang B, Zhang W, Yang Z, Hou Y, Chen Y et al. Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations. Int J Rheum Dis. 2017;20(11):1612-30.
• 18. Noth U, Steinert AF, Tuan RS. Technology insight: adult mesenchymal stem cells for osteoarthritis therapy. Nat Clin Pract Rheumatol. 2008;4(7):371-80.
• 19. Southworth TM, Naveen NB, Tauro TM, Leong NL, Cole BJ. The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis. J Knee Surg. 2019;32(1):37-45.
• 20. Fotouhi A, Maleki A, Dolati S, Aghebati-Maleki A, Aghebati-Maleki L. Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis. Biomed Pharmacother. 2018;104:652-60.
• 21. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-72.
• 22. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609-16.
• 23. Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. Am J Sports Med. 2016;44(3):792-800.
• 24. Kanwat H, Singh DM, Kumar CD, Alka B, Biman S, Aman H. The effect of intra-articular allogenic platelet rich plasma in Dunkin-Hartley guinea pig model of knee osteoarthritis. Muscles Ligaments Tendons J. 2017;7(3):426-34.