Elsevier

The Journal of Arthroplasty

Volume 37, Issue 11, November 2022, Pages 2282-2290.e2
The Journal of Arthroplasty

Systematic Review and Meta-Analysis
The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.arth.2022.05.014Get rights and content

Abstract

Background

Platelet-rich plasma (PRP) usage in orthopedics continues to rise, despite guidelines suggesting non-superiority to comparative cohorts. Therefore, we performed a systematic review and meta-analysis on PRP efficacy using two clinical assessments: (1) Visual Analog Scale and (2) Western Ontario and McMaster Universities Osteoarthritis Index. We assessed consistency and clinical relevancy by determining study heterogeneity (eg, sample sizes, ages, body mass index, arthritic severities, etc.). Comparative cohorts were: (A) hyaluronic acid (HA); (B) corticosteroid (CS); (C) normal saline (NS); and (D) exercise therapy. We performed sub-analyses of structural changes assessed on ultrasound, radiograph, or magnetic resonance imaging .

Methods

We utilized PubMed, Cochrane Library, and Embase databases up to December 1, 2021, according to Preferred Reporting Items for Systematic-Reviews and Meta-Analyses guidelines. Twenty-four studies met criteria, with comparisons to: HA (n = 11); CS (n = 6); NS (n = 5); and exercise therapy (n = 3). Seven studies assessed structural changes. Evaluations utilized a methodological scoring system. I2 statistics and forest plots pooled analyses and delineated study results.

Results

PRP led to Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index improvements in most studies when compared to HA, CS, and NS (P ≤ .05). Comparison to exercise therapy resulted in inconclusive findings (P ≥ .05). However, substantial heterogeneity (I2 ≥ 76%) was reported due to study variability. No differences were found when assessing structural changes or cartilage thickness by magnetic resonance imaging (standardized mean difference −0.01 [−0.19, 0.18], P = .91).

Conclusions

PRP may be associated with pain and functional improvements but was not clinically relevant (inconsistent study- and patient-metrics). In addition, PRP did not confer superiority when assessing knee-related structural changes.

Section snippets

Methods

We utilized PubMed, Cochrane Library, and Embase databases up to December 1, 2021, according to Preferred Reporting Items for Systematic-Reviews and Meta-Analyses guidelines. Prior to data collection, we registered this study with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022296909).

PRP versus HA

A total of 11 studies (46%) compared the efficacy of PRP to HA [18,[29], [30], [31], [32], [33], [34], [35], [36], [37], [38]] (Table 2). Seven studies had “fair” methodology scores, while the remaining four had “good” scores. Cohorts ranged from 25 to 77 patients, with a mean age range of 53-66 years and a mean body mass index (BMI) range of 25-32. All but three studies reported follow-up beyond 6 months.

Seven of these studies reported VAS scores with most demonstrating reduced pain at final

Discussion

Use of PRP to treat knee OA has rapidly expanded over the last decade with global estimated growth of up to 4.5 billion dollars over the next several years [10,45]. However, reports remain inconclusive and continue to demonstrate PRP’s non-superiority [8,[13], [14], [15]]. Knee structural changes have also been recently evaluated in high level reports, though a comprehensive review of this literature is lacking. In our review, many of the included studies evaluated the efficacy of PRP and

Conclusions

The use of PRP compared to CS, HA, NS, and exercise therapy is favored in most studies, but their clinical relevance remains non-superior due to substantially inconsistent study- and patient-metrics. Knee structural changes following PRP administration are also no different than comparative cohorts. These studies remain inconclusive for multiple reasons: varying levels of methodology scores; small samples sizes; and inconsistent study durations. Despite the rapid rise of PRP use in orthopedic

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.05.014.

    Source of Funding: No source of funding was sought for this study.

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