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Serial Platelet-Rich Plasma Intra-articular Injections in Kellgren and Lawrence Grade IV Knee Joint Osteoarthritis: A Prospective Blinded Placebo-Controlled Interventional Study

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Abstract

Purpose

The purpose of this study was to evaluate whether serial intra-articular (IA) Platelet-Rich Plasma (PRP) injections improve pain and function in patients of Kellgren–Lawrence (K–L) Grade IV primary knee osteoarthritis (KOA), not willing for arthroplasty or having relative contraindications to surgery.

Methods

90 patients (84 available at final follow-up) of Grade IV KOA were given 3 PRP or Normal Saline injections at 1-month interval. Pain and functional assessment was done with Visual analog scale (VAS) and Western Ontario and McMaster universities osteoarthritis index (WOMAC) respectively, at baseline and then at three and six months of follow-up. Both groups were homogenous with similar baseline characteristics.

Results

Both groups showed statistically significant improvements in the outcome scores but only PRP showed minimal clinically important difference (25% in WOMAC and > 2 cm difference of mean in VAS at follow-up). For inter-group comparison, PRP showed better results as there was statistically significant difference in WOMAC at 3 months (Difference =  − 9.220, 95% CI =  − 13.1945 to − 5.2455, P < 0.0001) and at 6 months (Difference =  − 10.360, 95% CI =  − 14.5358 to − 6.1842, P < 0.0001). Similar results were seen for VAS also (Difference =  − 0.580, 95% CI =  − 1.1412 to − 0.0188, P = 0.04 at 3 months, Difference =  − 0.870, 95% CI − 1.3993 to − 0.3407, P = 0.001 at 6 months). Outcome scores significantly correlated with age and sex but not with body mass index (BMI).

Conclusion

Serial Intra-articular Injections of autologous PRP mildly improve short-term subjective pain and knee function scores in patients of Grade IV KOA without any major complications.

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Acknowledgements

We appreciate the help from the technical manager in our Hospital Laboratory as well as laboratory haematologist for their immense cooperation and for providing us with laboratory equipment needed for the study.

Funding

We did not receive any funding from anywhere for this study.

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Authors and Affiliations

  1. Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India

    Amit Saraf, Altaf Hussain, Sandeep Bishnoi, Goushul Azam & Hamza Habib

  2. Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Hospital Building, H.O.D Office, Delhi Road, 4th Floor, Uttar Pradesh, 244001, Moradabad, India

    Altaf Hussain

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  1. Amit Saraf
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Correspondence to Altaf Hussain.

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The study was conducted only after obtaining permission from the institutional review board (IRB) and the authors have maintained conformity to the ethical guidelines of the Helsinki declaration (as revised in Tokyo 2004).

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Consent was taken from all the patients included in the study for the intervention as well as for publication of data. We have not made any studying advertisement and neither any remuneration was offered.

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Saraf, A., Hussain, A., Bishnoi, S. et al. Serial Platelet-Rich Plasma Intra-articular Injections in Kellgren and Lawrence Grade IV Knee Joint Osteoarthritis: A Prospective Blinded Placebo-Controlled Interventional Study. JOIO 56, 1722–1728 (2022). https://doi.org/10.1007/s43465-022-00730-4

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