A study of the role of Platelet rich plasma in the treatment of knee osteoarthritis.

Seran, M (2016) A study of the role of Platelet rich plasma in the treatment of knee osteoarthritis. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Increased physical activities and prolonged life expectancies, coupled with biomechanical, metabolic, and biological changes of articular cartilage, have led to a significant rise in osteoarthritis. Unfortunately, cartilage lesions are difficult to treat because of their inherit limit of adequate blood and nerve supplies, which decreases healing potential. There are numerous, non-invasive treatment approaches with emphasis on pain management, improvement in function, and hindering the disease progress. But most of them are of short-term success with significant side effects, and do not address the biological pathology The complex OA process involves an interplay of several growth factors needed in joint homeostasis and cartilage metabolism. Autologous platelet-rich plasma (PRP), which contains a pool of growth factors, appears to offer an easy solution for delivering multiple growth factors needed for tissue repair. RATIONALE: Osteoarthritis is a clinically heterogenous condition due to uncoupling of balance between cartilage degeneration and regeneration.PRP delivers high concentrations of autologous growthfactors contained in the alpha granules of platelets.among these (i) TGF-B is involved in phenotype expression,chondrogenic differentiation,matrix deposition . (ii) PDGF promotes maintenance of hyaline like phenotype,chondrocyte proliferation and proteoglycan synthesis. (iii) IGF stimulates proteoglycan production OBJECTIVES OF THE STUDY : Primary: To assess the efficacy of platelet rich plasma in reducing joint pain from baseline ,measured using WOMAC subscale Secondary: Changes in joint stiffness and physical function and global WOMAC METHODS : Hundred patients ,who satisfy the inclusion criteria are chosen.Fifty receive PRP and fifty receive normal saline .Randomization is done while selecting the patients .Those who attended the O.P on Tuesdays receive Platelet Rich Plasma and those patients who attend the O.P on Fridays receive Normal saline The primary outcomes of pain reduction and symptoms and function improvements are compared using WOMAC score,VAS score at pre injection and at 6 weeks,3 months and 6 months after injection MATERIALS: The Department of Transfusion Medicine ,GSH &SMC,Chennai, has gracefully consented to prepare platelet rich plasma from the subjects own blood RESULTS: The primary efficacy criterion was change from baseline in joint pain, measured using the WOMAC subscale. Secondary efficacy variables included change in joint stiffness, physical function The WOMAC parameters were measured before injection and at 6 weeks, 3 months, and 6 months after injection. Patients were also assessed for pain by VAS and for satisfaction (satisfied, partly satisfied, not satisfied) at the end of 6 monthS. DISCUSSION: The Efficacy of Platelet Rich Plasma in reducing pain ,stiffness and physical function were assessed and scored on WOMAC index for both study and control group.The Results were analysed using unpaired t-test and chi-square test. Age distribution revealed mean age in group I to be 49.92 and the mean age in Group II was 54.16.The p-value derived using unpaired t-test is 0.1120, rendering age factor insignificant. Gender distribution were comparable on both groups with 80 % being male 20% being female. The p-valve using chi square test is 0.0833 .The Gender factor was insignificant. The mean height in group I was 159.66 and the mean height in Group II was 159.68.The p-valve using unpaired t test turned insignificant (0.9895). The mean weight, in group I was 68.62 and group II was 67.66 with p-valve of 0.4777(insignificant). The mean BMI was 26.97 in group I and 26.64 in Group II. The p-valve is 0.5507(insignificant). Thus the study ensured that all patients were comparable on baseline characters. The Global WOMAC showed a mean of 74.2 at pre injection period which decreased to 62.46 at 6 weeks follow up and 47.68 at 3 months and declining to 33.40 at 6 months. The study showed a significant decrease in global WOMAC score, which was also consistent throughout the study period. The Individual variables such as pain, stiffness and physical function were assessed. Mean score for pain showed a decrease from 16.58 to 11.32 at 6 weeks post injection .At the end of 6 months follow up, the mean was 5.34. The mean score for pain in group II showed a marginal decreased from 16.30 to 13.74 at 6 weeks but returned to 15.46 at 6 months follow up. The p-value using unpaired t-test showed significant improvement. Secondary variable stiffness showed significance difference at 3 months follow up and 6 months follow up. The mean of Physical function decreased from a pre injection score of 52.12 to 24.62 at 6 months follow up in Group I. Group II showed a marginal dip in mean scores from 48.30 to 45.80 and to 44.38 at 3 months .the scores leveled at 46.20 at the end of 6 months follow up. Visual analog score showed a decrease in mean of 7.22 to 3.06 which denoted a change of patient’s perception of pain from intense, dreadful, horrible pain to mild annoying pain in Group I. Group II showed a marginal dip from 6.86 to 4. 98 on mean, showing insignificant change in pain. CONCLUSION: Our study relied on injecting a highly concentrated mix of platelets into joint cavity and observing the patients for reduction in symptoms of pain, stiffness and improvement in physical function .our study has revealed a consistent reduction in pain and stiffness and a clear improvement in lifestyle of the patients. Our study has thrown up an interesting choice of treatment modality using Platelet Rich Plasma in the treatment of Knee Osteoarthritis and it has proved efficacious in the observation period of six months.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Platelet rich plasma ; knee osteoarthritis ; Randomized controlled trial.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:02
Last Modified: 16 Sep 2017 15:02
URI: http://repository-tnmgrmu.ac.in/id/eprint/3194

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