Rev. Soc. Esp. Dolor. 2024; 31(3): 141-149 / DOI: 10.20986/resed.2025.4112/2023
José Cortell, Luis Alberto García, Rosa María Izquierdo, Ruth Robledo, María Pilar Argente, María de los Ángeles Canos
ABSTRACT
Background: Knee osteoarthritis is a frequent musculoskeletal disorder that considerably reduces the quality of life, due to pain, decreased mobility and independence of the people affected. Platelet-rich plasma (PRP) injections are increasingly used to manage osteoarthritis, but the optimal number, duration, and methods of delivering PRP injections and defining their clinical benefit are unknown.
Objectives: To determine the effect of PRP infiltrations by administering a total of three doses of PRP at three-week intervals in reducing pain (measured with the VAS scale) and improving functionality (measured with the WOMAC scale) in patients with knee pain due to osteoarthritis.
Patients and methods: The medical records of 31 patients, 8 men and 23 women, from January 2018 to January 2022, diagnosed with chronic knee pain due to osteoarthritis treated with PRP were reviewed. The patients had been administered three PRP infiltration sessions with 3 weeks intervals, in a total treatment duration of 9 weeks and a follow-up on the VAS and WOMAC scale for up to 24 months.
Results: All patients showed improvement in the VAS and WOMAC scores after each PRP injection, with statistical significance observed at week 9 (third injection). We found that, in a statistically significant manner, obese patients had a worse progression in treatment outcomes. There was a change in the percentage distribution of analgesic treatment modalities, although this change did not reach statistical significance. The duration of the treatment effect had a median of 8 months [P25: 4 months; P75: 13 months] (95 % CI of the mean = 6.78 to 11.61) after the last injection.
Conclusions: Treatment with PRP in patients with knee osteoarthritis is effective in reducing pain measured with the VAS and WOMAC scales and reducing the intake of analgesics. Obesity is a predictor of worse outcome in patients treated with PRP. Further studies are needed to confirm these results and understand the mechanism of action, with different administration protocols and preparation of PRP to obtain better and more durable results.
RESUMEN
Introducción: La artrosis de rodilla es un trastorno musculoesquelético frecuente que reduce considerablemente la calidad de vida. Las inyecciones de plasma rico en plaquetas (PRP) son muy empleadas, pero se desconoce el número, la duración y los métodos óptimos para aplicar las inyecciones.
Objetivos: Determinar el efecto de las infiltraciones de PRP mediante la administración de 3 dosis de PRP en intervalos de 3 semanas en la disminución del dolor (medido con escala EVA) y la mejora de la funcionalidad (medido con escala WOMAC).
Pacientes y metodología: Se revisaron las historias clínicas de 31 pacientes, 8 hombres y 23 mujeres, desde enero de 2018 a enero de 2022, diagnosticados de gonalgia crónica por artrosis. A los pacientes se les había administrado 3 sesiones de infiltración de PRP espaciadas cada 3 semanas, con una duración total del tratamiento de 9 semanas y un seguimiento de la escala EVA y WOMAC hasta los 24 meses.
Resultados: Todos los pacientes presentaron mejoría en las escalas EVA y WOMAC tras cada una de las inyecciones de PRP, siendo estadísticamente significativa en la semana 9 (3ª inyección). Objetivamos que, de manera estadísticamente significativa, los pacientes obesos tienen una peor evolución del resultado del tratamiento. Se produjo un cambio en la distribución porcentual de las modalidades de tratamiento analgésico, aunque este cambio no alcanzó significación estadística. La duración del efecto del tratamiento tuvo una mediana de 8 meses [P25: 4 meses; P75: 13 meses] (IC 95 % de la media = 6,78 a 11,61) después de la última infiltración.
Conclusiones: El tratamiento con PRP en los pacientes con artrosis de rodilla resulta eficaz en la disminución del dolor objetivado con las escalas EVA, WOMAC y la disminución en la ingesta de analgésicos. La obesidad es un factor predictor de peor resultado en los pacientes tratados con PRP.
Nuevo comentario
Comentarios
No comments in this article
Bibliografía
1. Migliorini F, Driessen A, Quack V, Sippel N, Cooper B, Mansy YE, et al. Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis. Arch Orthop Trauma Surg. 2021;141(9):1473-90.
2. Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol. 2019;29(4):947-55.
3. Migliorini F, Eschweiler J, Tingart M, Rath B. Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: A meta-analysis of clinical trials. Eur J Orthop Surg Traumatol. 2019;29(4):937-46.
4. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59.
5. Migliorini F, Eschweiler J, Trivellas A, Rath B, Driessen A, Tingart M, et al. Implant positioning among the surgical approaches for total hip arthroplasty: A Bayesian network meta-analysis. Arch Orthop Trauma Surg. 2020;140(8):1115-24.
6. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323-30.
7. Vannabouathong C, del Fabbro G, Sales B, Smith C, Li CS, Yardley D, et al. Intra-articular injections in the treatment of symptoms from ankle arthritis: A systematic review. Foot Ankle Int. 2018;39(10):1141-50.
8. Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: A randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):958-65.
9. Bossert M, Boublil D, Parisaux JM, Bozgan AM, Richelme E, Conrozier T. Imaging guidance improves the results of viscosupplementation with HANOX-M-XL in patients with ankle osteoarthritis: Results of a clinical survey in 50 patients treated in daily practice. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:195-9.
10. Chang KV, Hsiao MY, Chen WS, Wang TG, Chien KL. Effectiveness of intra-articular hyaluronic acid for ankle osteoarthritis treatment: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(5):951-60.
11. Sucuoglu H, Ustunsoy S. The short-term effect of PRP on chronic pain in knee osteoarthritis. Agri. 2019;31(2):63-9.
12. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137-62.
13. Nakazawa F, Matsuno H, Yudoh K, Watanabe Y, Katayama R, Kimura T. Corticosteroid treatment induces chondrocyte apoptosis in an experimental arthritis model and in chondrocyte cultures. Clin Exp Rheumatol. 2002;20(6):773-81.
14. Ostergaard M, Halberg P. Intra-articular corticosteroids in arthritic disease: A guide to treatment. BioDrugs. 1998;9(2):95-103.
15. Mladenovic Z, Saurel AS, Berenbaum F, Jacques C. Potential role of hyaluronic acid on bone in osteoarthritis: matrix metalloproteinases, aggrecanases, and RANKL expression are partially prevented by hyaluronic acid in interleukin 1-stimulated osteoblasts. J Rheumatol. 2014;41(5):945-54.
16. Mongkhon JM, Thach M, Shi Q, Fernandes JC, Fahmi H, Benderdour M. Sorbitol-modified hyaluronic acid reduces oxidative stress, apoptosis and mediators of inflammation and catabolism in human osteoarthritic chondrocytes. Inflamm Res. 2014;63(8):691-701.
17. Filardo G, Kon E, Buda R, Timoncini A, di Martino A, Cenacchi A, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):528-35.
18. Filardo G, Kon E, di Martino A, di Matteo B, Merli ML, Cenacchi A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: Study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:229.
19. Grogan SP, D'Lima DD. Joint aging and chondrocyte cell death. Int J Clin Rheumtol. 2010;5(2):199-214.
20. Shen L, Yuan T, Chen S, Xie X, Zhang C. 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. 2017;12(1):16.
21. Smyth NA, Murawski CD, Fortier LA, Cole BJ, Kennedy JG. Platelet-rich plasma in the pathologic processes of cartilage: review of basic science evidence. Arthroscopy. 2013;29(8):1399-409.
22. Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthritis Cartilage. 2013;21(11):1627-37.
23. Paget LDA, Reurink G, de Vos RJ, Weir A, Moen MH, Bierma-Zeinstra SMA, et al. Effect of platelet-rich plasma injections vs placebo on ankle symptoms and function in patients with ankle osteoarthritis: A randomized clinical trial. JAMA. 2021;326(16):1595-605.
24. Hsu WK, Mishra A, Rodeo SR, Fu F, Terry MA, Randelli P, et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013;21(12):739-48.
25. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014;16(1):204.
26. Filardo G, Kon E, Roffi A, di Matteo B, Merli ML, Marcacci M. Platelet-rich plasma: Why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2459-74.
27. Raeissadat SA, Ghorbani E, Sanei Taheri M, Soleimani R, Rayegani SM, Babaee M, et al. MRI changes after platelet rich plasma injection in knee osteoarthritis (randomized clinical trial). J Pain Res. 2020;13:65-73.
28. Chen S, Sun X, Zhou G, Jin J, Li Z. Association between sensitivity to thyroid hormone indices and the risk of osteoarthritis: an NHANES study. Eur J Med Res. 2022;27(1):114.
29. Raeissadat SA, Ghazi Hosseini P, Bahrami MH, Salman Roghani R, Fathi M, Gharooee Ahangar A, et al. The comparison effects of intra-articular injection of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factor (PRGF), Hyaluronic Acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC Musculoskelet Disord. 2021;22(1):134.
30. Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: A prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017;45(2):339-46.
Artículos relacionados
Pain: a "hotchpotch"
Rev. Soc. Esp. Dolor. 2020; 27(4): 278-280 / DOI: 10.20986/resed.2016.3507/2016