Efficacy of platelet-rich plasma combined with arthroscopic debridement for treatment of knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2018.03.006

Abstract

Abstract:

Objective

To investigate the clinical effects of platelet-rich plasma (PRP) in combination with arthroscopic debridement for moderate knee osteoarthritis.

Methods

A total of 25 patients with grade two or grade three knee osteoarthritis according to K-L classification, numerical rating scal (NRS) over five, failed treatment with non-operative methods for more than three months were allocated in the treatment group(n=12) or the control group(n=13). In the treatment group, two times of 5 ml of PRP intra-articular injection were performed with four weeks interval. The first time of PRP intra-articular injection was performed during arthroscopy after arthroscopic debridement. In the control group, the patients were only treated with knee arthroscopic debridement. The outcomes were assessed with NRS, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the Hospital for Special Surgery (HSS) scores, the short form-36 questionnaire of health survey (SF-36) scores at baseline and six months, one year and two years after treatment. Statistical analysis was performed using the SPSS version 17.0. Data of Gaussian distribution were analyzed by ttest (data between treatment and control groups) or analysis of variance (data within group). Categorized data were analyzed using the Chi-square test.

Results

The scores of NRS and WOMAC of the treatment group at six months, one year and two years after treatment were lower than the control group; the scores of HSS and SF-36 of the treatment group were higher than the control group. In the treatment group, the scores of NRS and WOMAC at six months after treatment decreased from (7.1±1.0), (74.4±11.1) at baseline to (1.3±0.6)(t=13.415, P<0.01), (19.2±4.1)(t=17.994, P<0.01) respectively; the scores of HSS and SF-36 increased from (33.2±6.0), (63.2±12.0) at baseline to (79.2±8.1)( t=-14.175, P<0.01) and (109.8±10.5)(t=-44.557, P<0.01)respectively. The four scores at one year and the scores of NRS and HSS at two years had no statistically significant difference compared to the scores at six months (P>0.05), while the scores of WOMAC and SF-36 at two years after treatment were (21.7±2.7)(t=15.517, P<0.01) and (98.6±8.7)(t=-10.454, P<0.01) respectively, which were worse than the scores at six months, but still better than the scores at baseline (P<0.05). In the control group, the scores of NRS and WOMAC decreased from (6.8±0.9), (73.7±8.3) at baseline to (2.8±1.3) (t=18.623, P<0.01), (32.5±4.5)(t=25.059, P<0.01) at six months after treatment respectively. The scores of HSS and SF-36 increased from (34.0±9.1), (62.2±7.2) at baseline to (63.8±10.4) (t=-18.553, P<0.05), (85.6±4.3)( t=-13.632, P<0.05) at six months after treatment respectively. The scores of HSS at one year decreased to (39.8±8.8) compared to six months (P<0.05), but still higher than the scores at baseline (t=-2.448, P<0.05). The scores of HSS at two years decreased to (29.8±7.7), lower than the scores at baseline (t=1.732, P<0.05). The scores of NRS, WOMAC and SF-36 at one and two years had no significant difference statistically compared to the scores at baseline (P>0.05).

Conclusions

Both the PRP and arthroscopic debridement could reduce pain, restore knee function and improve the life quality of patients with knee osteoarthritis of K-L grade two and three. The PRP combined with arthroscopic debridement may have better and long-term effects of pain reduction, knee function restoration and life quality improvement within two years compared to arthroscopic debridement alone. The effects of the arthroscopic debridement could maintain for only six months.

Key words: Platelet-rich plasma, Arthroscopy, Osteoarthritis, Knee, Treatment outcome

Shandong Huang, Zhijun Fei, Xiaoliang Zhao, Peng Xin, Kai Xu, Ningling Xie, Huai Lin, Wei Wang. Efficacy of platelet-rich plasma combined with arthroscopic debridement for treatment of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 332-337.

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References 17

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?	例数	女/男(例)	K-L分级2级/3级(例)	年龄[岁，(±s)]	BMI[kg/m²，( ±s)]
治疗组	12	9/3	4/8	60.3±8.0	28.5±2.7
对照组	13	9/4	5/8	61.8±6.7	27.7±4.0
统计值	?	χ²＝0.103	χ²＝0.071	t＝－0.485	t＝0.646
P值	?	>0.05	>0.05	>0.05	>0.05

?	例数	女/男(例)	K-L分级2级/3级(例)	年龄[岁，(±s)]	BMI[kg/m²，( ±s)]
治疗组	12	9/3	4/8	60.3±8.0	28.5±2.7
对照组	13	9/4	5/8	61.8±6.7	27.7±4.0
统计值	?	χ²＝0.103	χ²＝0.071	t＝－0.485	t＝0.646
P值	?	>0.05	>0.05	>0.05	>0.05

?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后6个月	治疗组	12	1.3±0.6	19.2±4.1	79.2±8.1	109.8± 10.5
	对照组	13	2.8±1.3	32.5±4.5	63.8±10.4	85.6±4.3
	t值	?	－3.53	－7.637	4.106	7.681
	P值	?	<0.01	<0.01	<0.01	<0.01
?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后1年	治疗组	12	1.1±0.7	18.7±3.0	81.5±9.1	112.1±8.2
	对照组	13	6.6±0.9	70.5±9.3	39.8±8.8	62.5±7.2
	t值	?	－17.716	－18.45	11.885	16.082
	P值	?	<0.01	<0.01	<0.01	<0.01
?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后2年	治疗组	12	1.2±0.4	21.7±2.7	77.4± 9.8	98.6±8.7
	对照组	13	6.8±0.7	71.8±8.1	29.8±7.7	61.4±7.6
	t值	?	－23.768	－20.348	13.559	11.386
	P值	?	<0.01	<0.01	<0.01	<0.01

?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后6个月	治疗组	12	1.3±0.6	19.2±4.1	79.2±8.1	109.8± 10.5
	对照组	13	2.8±1.3	32.5±4.5	63.8±10.4	85.6±4.3
	t值	?	－3.53	－7.637	4.106	7.681
	P值	?	<0.01	<0.01	<0.01	<0.01
?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后1年	治疗组	12	1.1±0.7	18.7±3.0	81.5±9.1	112.1±8.2
	对照组	13	6.6±0.9	70.5±9.3	39.8±8.8	62.5±7.2
	t值	?	－17.716	－18.45	11.885	16.082
	P值	?	<0.01	<0.01	<0.01	<0.01
?	分组	例数	NRS	WOMAC	HSS	SF-36
治疗后2年	治疗组	12	1.2±0.4	21.7±2.7	77.4± 9.8	98.6±8.7
	对照组	13	6.8±0.7	71.8±8.1	29.8±7.7	61.4±7.6
	t值	?	－23.768	－20.348	13.559	11.386
	P值	?	<0.01	<0.01	<0.01	<0.01

?	NRS		WOMAC		HSS		SF-36
?	F值	P值	F值	P值	F值	P值	F值	P值
治疗前/治疗后6个月	179.969	<0.01	271.973	<0.01	181.006	<0.01	1987.097	<0.01
治疗前/治疗后1年	198.000	<0.01	235.473	<0.01	184.655	<0.01	322.658	<0.01
治疗前/2年	423.290	<0.01	194.774	<0.01	159.610	<0.01	109.295	<0.01
治疗后6个月/治疗后1年	3.667	>0.05	0.287	>0.05	4.389	>0.05	1.201	>0.05
治疗后6个月/治疗后2年	1.000	>0.05	5.612	<0.05	0.683	>0.05	15.212	<0.01
治疗后1年/治疗后2年	0.186	>0.05	28.2868	<0.01	2.143	>0.05	79.396	<0.01

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