Triple injection of intra-articular PRP given one month apart significantly relieves knee OA symptoms

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-09-02T20:00:01+05:30 | Updated On 2 Sept 2022 9:55 PM IST

Najmul Huda et al found in the study that - Triple injection of intra-articular PRP given one month apart significantly relieves the symptoms of knee OA till 2 years in Kellgren-Lawrence (KL) grade I, II and III. The improvement in symptoms at 2-year follow-up did not differ across different KL grades.

PRP is the autologous plasma part of the blood that has high concentration of platelets, which contain many growth factors in their alpha granules [like platelet derived growth factor (PDGF), epidermal growth factor, vascular endothelial growth factor(VEGF), transforming growth factor, fibroblast growth factor, hepatocyte growth factor, insulin like growth factor-1,2]. These growth factors increase the anabolic activity within the joint, favour chondrocyte proliferation, increased synthesis of collagen, chondral remodeling and production of matrix molecules which leads to healing. PRP has now become an almost established treatment for OA knees.

The literature reporting a follow-up of more than one year is scarce. Hence the authors aimed to find out whether the effect of PRP, persists beyond one year. All the patients in this study were followed up for 2 years.

The authors conducted a prospective interventional study.

68 cases (105 knees) with KL grades I, II and III knee OA received 3 intra-articular injections of PRP 1 month apart. The cases were followed up for 2-years. Outcomes were measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Visual analog scale (VAS) scores.

The observations of the study were:

• The mean age was 51.7 years. 18 knees had KL grade I, 55 had grade II and 32 had grade III OA.

• The mean pre treatment VAS score decreased significantly at 1 year (mean difference − 5.3, p=0.003) and 2 year follow-up (mean difference − 6, p=0.007).

• The mean pre-treatment WOMAC score decreased significantly at 1 year (mean difference − 45.9, p=0.011) and at 2 year (mean difference − 52.4, p=0.009).

• The WOMAC and VAS scores improved significantly from baseline to final follow-up across all KL grades (p=0.001 and 0.001, 0.009 and 0.007, 0.021 and 0.017 for WOMAC and VAS across KL grade I, II and III, respectively).

• There was no significant differences in WOMAC and VAS scores between three KL grades at final follow-up (p=0.17 and 0.09, respectively), although the baseline scores had significant difference (p=0.001 for both VAS and WOMAC) with worse scores in higher KL grades.

• The variables like age, sex, BMI, KL grade, baseline VAS and baseline WOMAC did not predict the final VAS and WOMAC scores.

The limitations of the study are a lack of a placebo group. A double blinded study would have been better. Though PRP showed significant functional improvement, association of this with actual changes in the articular cartilage could have been evaluated by imaging studies like MRI.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751