Clinical Oberseration Of Intra-Knee-Articular Injection With Platelet Rich Plasma (PRP) On Knee Osteoarthritis

BACKGROUND:Osteoarthritis is one of the most common joint diseases affecting human health.There are no significant ethnic differences and regional differences.The main clinical manifestations are pain and disability.The changes of articular cartilage and subchondral bone,osteophyte formation and non bacterial synovitis were observed.In people over the age of fifty,osteoarthritis is the second leading cause of long-term disability after cardiovascular disease,with the highest incidence of knee osteoarthritis.Knee osteoarthritis(KOA)refers to the occurrence of knee cartilage primary or secondary degeneration and structural disorder,with subchondral bone sclerosis and deformity,leading to a degenerative disease of the knee joint dysfunction,is a major cause of elderly knee pain and Dysfunction.In recent years,the incidence of KOA increased year by year,about 50%of people over the age of 60 have KOA phenomenon,about 80%of people over the age of 75 have KOA phenomenon,which lead to people over the age of 50 dysfunction.One of the major diseases that cause economic losses and social development.The incidence of more factors,includes:advanced age,gender,genetics,hormones,blood supply due to reduced joint articular cartilage cell function and cartilage properties change,on cell growth factors and cytokines response changes,chronic fatigue,obesity,osteoporosis,trauma and mechanical changes,genetic factors have a Relationship.The treatment of osteoarthritis can be divided into surgical treatment(stage four and part of the three stage patients)and conservative treatment(all patients).Conservative treatment,including physical therapy,medicine,injection therapy and traditional chinese medicine treatment,symptomatic treatment.Intra-articular injection of commonly used drugs,including hormones and sodium hyaluronate acids.Hormone injection can significantly improve symptoms,but will accelerate the degeneration of the joints.So it is not recommended to use third times;Sodium hyaluronate acids are widely used in the clinical practice.There is a certain degree of symptomatic remission,but the latest evidence-based medicine guideline has no clearly evidence to support its effectiveness in the treatment of knee osteoarthritis.In 2013,American Association of Department of orthopedics physicians<Guidelines for the treatment of knee osteoarthritis>Treatment of intra-articular injection of sodium hyaluronate is not recommended.The recommended level is strong.In 2014,the International Association for the study of osteoarthritis about the KOA guidelines for conservative treatment think the effect of intra-articular injection of sodium hyaluronate is not supportde.At 2013,the American Association of Department of Orthpedics physicians<Guidelines for the treatment of knee osteoarthritis>first evaluated the therapeutic effect of platelet rich plasma(PRP)on KOA.Based on the case control study before 2012 and one term randomized controlled study,the conclusion is not in favor of and also not oppose,the recommended grade is uncertain;PRP is a kind of blood plasma with high concentration of platelets,which is prepared by separating autologous venous blood.It contains a large number of active growth factors and inflammatory regulator,and it can promote the regeneration of cartilage cells,eliminate the aseptic inflammation of Synovial joint.Theoretically,it is similar to be a cureable method to the disease of KOA.At present in china,the lack of high quality system of PRP in the treatment of KOA clinical research.In this study,we compared the clinical efficacy of PRP,sodium hyaluronate acid(HA)and PRP+HA mixtureintra-articular injection in the treatment of KOA.PART ?:Objective To observe the clinical effect of intra-knee-articular injection of PRP to treat grade ? and ? knee osteoarthritis.Methods:Total 126 qualified patients with grade II and ? knee osteoarthritis come to Weihai Municipal Hospital and Shandong Provincial hospital affiliated to Shandong university from February 2014 to May 2014 were included in this study.The patients were randomly divided into PRP group and HA group,63 cases in each group.Patients gender,age,body mass index,Kellgren-Lawrence classification and other general information in these two groups were not significant different(P>0.05).PRP group patients received 3.5ml autologous vein blood prepared PRP into the joint cavity in the day 0,day 14 and day28;HA group injection of 2 mL sodium hyaluronate in the day 0.day 7,day 14,day 21 and day28.Patients in these two groups were followed up for 12 months.The adverse reactions of two groups were recorded.The pain was evaluated by VAS score,and the joint function was assessed with IKDC score and WOMAC score.Results:58 cases in PRP group and 55 cases in HA group were followed up for 12 months.Adverse reactions occurred 40 times in 16 patients in group PRP,37 times in 14 patients in group HA.The difference was not statistically significant between the two groups(>0.05).Compared with pre-treatment,the VAS score.IKDC score and WOMAC score in the two groups were different significantly after treatment(P<0.05).The differences of those scores were not statistically significant among 1,3,6,12 months after PRP treatment(P>0.05).However,each evaluation index after 6 and 12 months in HA treatment group were better than that of 1 and 3 months(P<0.05).1 and 3 months after the treatment,the VAS score,IKDC score and WOMAC score were not significant different between PRP and HA group(P>0.05);however,6 and 12 months after treatment,the effectiveness of PRP were better than that of HA(P<0.05).Conclusion:Intra articular injection of PRP is effective and safe in the treatment of articular cartilage degeneration,which can relieve pain,improve function and improve the quality of life.There was no significant difference of short-term effects between PRP and HA,but the long-term effect of PRP was better than HA.PART ?:Background:The exact outcome of the combined use of hyaluronic acid(HA)and platelet-rich plasma(PRP)in the treatment for osteoarthritis remains unclear.The goal of this paper was to compare the efficacy of PRP+ HA with those of a cohort of patients treated with platelet-rich plasma only.Materials and methods:A total of 126 subjects with knee osteoarthritis were enrolled:63 cases in PRP plus HA group and 63 cases in PRP group.After clinical and radiographic evaluation,patients received a weekly intra-articular injection of HA added with PRP or of only PRP for 3 weeks.Follow-up was carried out at 1,3,6,and 12 months.Results:In the participants treated with PRP plus HA and with PRP only,VAS scores decreased significantly,and accordingly,knee function(WOMAC)improved,compared to the status of patients prior to treatment.Regarding to VAS and WOMAC,no significant differ-ence were observed between the two groups;however,there is a trend that could obtain better functional scores in PRP plus HA group(VAS,P = 0.392;WOMAC,P =0.082).Six failures occurred in the PRP plus HA group and 11 in PRP group.No major adverse events or complications were observed in both groups.Conclusions:The association of PRP and HA is effective and safe in the management of patients suffering from mild to moderate KOA.Although no differences in functional outcomes were shown between the groups,there is a trend that PRP plus HA could obtain relatively better functional scores.