A Retrospective Analysis of Clinical Outcome and Predictive Factors for Responders with Knee Osteoarthritis to a Single Injection of Leukocyte-Poor Platelet-Rich Plasma.

Naoya Kikuchi,Norihito Arai,Akihiro Kanamori,Yu Taniguchi,Kosuke Okuno,Tomokazu Yoshioka,Kojiro Hyodo,Masashi Yamazaki,Hisashi Sugaya

doi:10.3390/jcm10215121

Abstract

Although various platelet-rich plasma (PRP) kits are commercially available, the efficacy of these kits for knee osteoarthritis (KOA) has not been fully investigated. This study aimed to investigate the short-term results of leukocyte-poor PRP (LP-PRP) and the factors that contribute to its efficacy. We retrospectively reviewed 124 patients with KOA who were treated with LP-PRP. White blood cell (WBC) and platelet counts in the whole blood and the LP-PRP were measured. KOA severity was assessed using radiography. Clinical evaluation was performed both prior to injection and after an average of 3.3 weeks after the injection using the Japanese Knee Osteoarthritis Measure (JKOM). Responders were defined based on the JKOM. The contributing factors for responders were examined using a multivariate logistic analysis. The responder rate was 58.1% and the contributing factors for responders were a higher visual analog scale score before injection, WBC count in whole blood, and platelet concentration ratio of LP-PRP. The LP-PRP improved the clinical scores in the short term. Certain patient characteristics before injection and the concentration ratio of LP-PRP may be predictors of its efficacy; these may provide clues for elucidating which components of LP-PRP act on KOA pathologies.

Highlights

Knee osteoarthritis (KOA) is considered “a whole-organ disease of the joint” [1] and causes joint pain and loss of function [2]
(VAS) scores at baseline (OR, 1.02; 95% confidence intervals (CI), 1.01–1.04; p = 0.004), White blood cell (WBC) count in whole blood (OR, 1.60; 95% CI, 0.1.14–223; p = 0.006), and platelet concentration ratio of the LP-platelet-rich plasma (PRP) (OR, 5.27; 95% CI, 0.1.16–23.9; p = 0.031) were significantly associated with responders (Table 4)
The important finding of this study was that a single injection of leukocyte-poor PRP (LP-PRP) was effective in the short term for approximately 60% of the patients with KOA with K/L grades of 2–4

Summary

Introduction

Knee osteoarthritis (KOA) is considered “a whole-organ disease of the joint” [1] and causes joint pain and loss of function [2]. Nonsteroidal anti-inflammatory drugs, hyaluronic acid (HA), and steroids are widely used for the conservative treatment of KOA, platelet-rich plasma (PRP) has been attracting attention as a new treatment modality. PRP therapy involves a complex process in which growth factors found within concentrated platelet alpha granules, cell adhesion molecules, and glycoproteins in the plasma act on tissues while maintaining a physiological balance within the body [4,5]. The efficacy of PRP for KOA has been demonstrated in systematic reviews and meta-analyses [6,7]. There are multiple PRP-purification systems [8,9], and the platelet concentration, degree of leukocyte enrichment, and concentration of the growth factors in PRP vary greatly depending on the preparation method [10,11]. Chala et al [12] noted that approximately

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