Background: Platelet rich growth factors (PRGF) comprise a biological treatment of knee osteoarthritis (OA). Due to its limitation concerning the articular cartilage lesions’ healing potential, chondrocyte differentiation and external environment factors, clinical improvement of knee OA using PRGF treatment depends on preparation techniques. Objectives: The study aimed to demonstrate clinical outcomes of PRGF treatment in real practices. Methods: A prospective cohort study was conducted from February 2018 to 2019 at the Biomedical Technology Research and Development Center, Police General Hospital, Bangkok, Thailand. We enrolled patients above 60 years old with knee OA that failed conservative treatment. The exclusion criteria included meniscus and ligament injury and knee deformity of the tibiofemoral angle more than 5 degrees. The primary endpoint was safe PRGF while secondary endpoints included changes of weight bearing pain and delayed surgery until an appropriate time for intervention. Results: A total of 240 patients with knee OA, Kellgren-Lawrence (KL) grades II, III or IV were enrolled including 90 males and 150 females. The average age was 68 (60-81) years. Mode of conservative treatment failure included 140 cases of oral medication, 60 cases of oral medication and steroid injection and 40 cases of oral medication, steroid and intra-articular hyaluronic injections (IA-HA). Based on the KL system, 194 were classified as grades II-III, and 46 patients were grade IV. The PRGF was collected according to the protocol. The average initial platelet concentration before and after centrifugation was 165x103 cells/µL (140-195x103 cells/µL) and 990x103 cells/µL (825-1,650x103 cells/µL), respectively. At average of 3.3 (3-8) months follow-up, no major complications were observed, but 17 cases (7.9%) had minor complications. Average VAS (visual-analog-scale for pain: 0-100) scores before and after injection were 71 (65-80) and 52 (50-72, respectively. Surgical intervention in KL II-III totaled 11 cases (5.6%) and KL IV totaled 5 cases (10.8%). Conclusion: Our technique of adjusting platelet concentration, fibrin concentration, leukocyte population and activator status improved clinical efficacy of PRGF treatment. PRGF is a safe, simple and effective treatment for patients with knee OA experiencing conservative treatment failure.
To compare and evaluate the efficacy of intraarticular platelet-rich growth factor (PRGF) versus intraarticular steroid injections. MATERIAL AND METHODS: A prospective, blinded, randomized controlled trial was conducted by enrolling 650 patients with knee osteoarthritis (OA) who did not respond to the combination of oral medication and physiotherapy. After computer-based randomization and exclusion, the number of patients in our study was 557. Patients were divided into 2 groups. Group 1 (310 patients) received intraarticular PRGF injection and group 2 (247 patients) received intraarticular injection of 40-mg triamcinolone solution. The post-trial follow-up period ranged from 12 to 18.5 months. The primary endpoints were the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and the secondary endpoints were the Visual Analog Scale (VAS) pain scores. RESULT: The IKDC scores were measured at baseline, 2-, 4-, 6-, and 12-month follow-up after the injection. The IKDC scores of group 1 (PRGF treatment)
Introduction: Platelet-rich plasma (PRP) has gained increasing popularity in the orthopedic field. There has been still no consensus on PRP preparation technique, thus providing a variety of final PRP products. Different preparation techniques lead to different compositions of PRP, which include platelet concentration, the number of leukocytes, and their subtypes. Here, we studied those compositions of PRP compared to whole blood samples. Methods: There were 335 participants who met the inclusion and exclusion criteria. Each participant underwent a blood drawing process to prepare PRP for their knee osteoarthritis treatment. We categorized baseline platelet concentration in whole blood samples into three groups: less than 2 x 10 5 /µL (Group 1), between 2 x 10 5 /µL and 2.99 x 10 5 /µL (Group 2), and greater than 2.99 x 10 5 /µL (Group 3). The primary outcome was reported as the platelet concentration in PRP and the ratio of platelet concentration in PRP compared to baseline whole blood samples. The secondary outcome was reported as the ratios of leukocyte, lymphocyte, and neutrophil in PRP compared to the baseline whole blood samples.Results: The average platelet concentration in PRP was 1.26 x 10 6 /µL (6.3 times higher compared to baseline whole blood samples). The mean platelet concentration of PRP in Group 1, Group 2, and Group 3 was 1.08 x 10 6 /µL, 1.38 x 10 6 /µL, and 1.71 x 10 6 /µL, respectively (p-value = 0.0001). The platelet concentration ratio of PRP condition to the baseline whole blood was 6.9, 5.8, and 4.2 in Group 1, Group 2, and Group 3, respectively (p-value = 0.0018). The average ratio of leukocytes in PRP to whole blood was 1.5. The average ratio of lymphocytes and neutrophils in PRP to whole blood was 2.0 and 0.5, respectively. Conclusion: Different baseline platelet concentrations in whole blood samples provided significantly different platelet concentrations in PRP. The baseline platelet concentration in whole blood also provided an inverse relation to the fold change of the platelet concentration in PRP. Subtypes of leukocytes changed from neutrophil-predominated in the baseline whole blood samples to lymphocyte-predominated in PRP.
Background: The application of platelet, plasma and growth factors (PP&GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&GF has yet to be well established. Objectives: This study aimed to report the survival analysis of 24-month follow-up treatment using PP&GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score. Methods: A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed. Results: A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&GF products contained 6-10 times higher platelet concentration than those in the peripheral blood. Conclusion: Intra-articular injection of PP&GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.
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