Abstract
BackgroundPlatelet-rich plasma (PRP) has a still conflicting efficacy for knee osteoarthritis (KOA) and might be a minimally invasive and safe treatment alternative. The potential benefit of only plasma (non-enriched) has never been investigated. Our aim was to evaluate the efficacy of intra-articular platelet-rich plasma (PRP) and plasma to improve pain and function in participants with KOA over 24 weeks.MethodsRandomized, double-blind, placebo-controlled trial with 3 groups (n = 62): PRP (n = 20), plasma (n = 21) and saline (n = 21). Two ultrasound-guided knee injections were performed with a 2-week interval. The primary outcome was visual analog scale 0-10 cm (VAS) for overall pain at week 24, with intermediate assessments at weeks 6 and 12. Main secondary outcomes were: KOOS, OMERACT-OARSI criteria and TUGT.ResultsAt baseline, 92% of participants were female, with a mean age of 65 years, mean BMI of 28.0 Kg/m2and mean VAS pain of 6.2 cm. Change in pain from baseline at week 24 were -2.9 (SD 2.5), -2.4 (SD 2.5) and -3.5 cm (SD 3.3) for PRP, plasma and saline, respectively (p intergroup = 0.499). There were no differences between the three groups at weeks 6 and 12. Similarly, there were no differences between groups regarding secondary outcomes. The PRP group showed higher frequency of adverse events (65% versus 24% and 33% for plasma and saline, respectively, p = 0.02), mostly mild transitory increase in pain.ConclusionsPRP and plasma were not superior to placebo for pain and function improvement in KOA over 24 weeks. The PRP group had a higher frequency of mild transitory increase in pain.Trial registrationClinicalTrials.gov, NCT03138317, 03/05/2017.
Highlights
Platelet-rich plasma (PRP) has a still conflicting efficacy for knee osteoarthritis (KOA) and might be a minimally invasive and safe treatment alternative
platelet-rich plasma (PRP) and plasma were not superior to placebo for pain and function improvement in KOA over 24 weeks
The PRP group had a higher frequency of mild transitory increase in pain
Summary
Platelet-rich plasma (PRP) has a still conflicting efficacy for knee osteoarthritis (KOA) and might be a minimally invasive and safe treatment alternative. Knee osteoarthritis (KOA) is estimated to affect over 10% of the population worldwide [1] with a lifetime risk of 45% [2] Current guidelines recommend both non-drug (such as exercise) and drug therapies (such as anti-inflammatory agents) [3, 4]. These therapies generally have short-term benefits and effect sizes are only small to moderate [5, 6]. Hyaluronic acid (HA) use is controversial, and guidelines provide conditional recommendations [3, 4] Having failed these options, knee arthroplasty is usually an effective definitive treatment, but it is expensive and there is the risk of medical and post-surgical complications [9]. Identifying alternative efficacious and safe treatments for KOA is important
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