Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study

Aggarwal, Aditya; Shashikanth, V. S.; Marwaha, Neelam

doi:10.1007/s00264-013-2136-6

Cited by 46 publications

(57 citation statements)

References 21 publications

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“…The multimolecular preparations, obtained from autologous blood, provide clinical benefits by modulating the early healing response through secretion of an array of signaling cytokines that influence inflammation and angiogenesis concurrently and influence cell migration and proliferation [10,13,23,24]. Plateletrich plasma affects healing, both physiologically and pathologically, and is currently used not only in surgery [2,16], but also as an injectable to treat pathological conditions such as osteoarthritis (OA) and tendinopathies [5,6,14], in which the disordered vascularization and deleterious neoinnervation are associated with reduced healing capability and increased vulnerability to chronic injuries.…”

Section: Introductionmentioning

confidence: 99%

Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

Andı́a

Rubio‐Azpeitia

Maffulli

2015

Clinical Orthopaedics &Amp; Related Research

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Background Platelet-rich plasma therapies for tendinopathy appear to provide moderate pain reduction. However, the biological mechanisms behind the observed clinical effects remain poorly characterized. Questions/purposes The purpose of this study was to explore whether platelet-rich plasma modifies the inflammatory/angiogenic status of already inflamed tenocytes by examining (1) gene expression; (2) modulation of chemokine and interleukin secretion; and (3) differences between healthy and tendinopathic tenocytes. Methods Cells from both healthy and tendinopathic tendons were exposed to interleukin (IL)-1ß and after treated with platelet-rich plasma. Modifications in the expression of selected genes were assessed by real-time reverse transcription-polymerase chain reaction and changes in secretion of angiogenic/inflammatory molecules by enzyme-linked immunosorbent assay. Platelet-rich plasmainduced changes in tendinopathic cells were compared with normal after normalizing platelet-rich plasma data against IL-1ß status in each specific sample. Results In IL-1ß-exposed cells, platelet-rich plasma downregulates expression of IL-6/CXCL-6 (mean, 0.015; 95% confidence interval [CI], 0.005-0.025; p = 0.026), IL-6R (mean, 0.61; 95% CI, 0.27-0.95; p = 0.029), and IL-8/CXCL-8 (mean, 0.02; 95% CI, 0.007-0.023; p = 0.026). Secretion of IL-6/CXCL6, 0.35 (95% CI, 0.3-0.4; p = 0.002), IL-8/CXCL8, 0.55 (95% CI, 0.5-0.7; p = 0.01), and monocyte chemoattractant protein-1/CCL2, 0.40 (95% CI, 0.2-0.6; p = 0.001) was reduced by platelet-rich plasma, whereas vascular endothelial growth factor increased by twofold, (95% CI, 1.7-2.3; p \ 0.001). RANTES/CCL5 increased by10-fold (95% CI, 4-17) and hepatocyte growth factor by 21-fold (95% CI, 0.2-42) in tendinopathic and by 2.3-fold (95% CI, 2-3) and threefold (95% CI, 1-5) in normal cells (p = 0.005 for both). Conclusions Platelet-rich plasma induces an immunomodulatory and proangiogenic phenotype consistent with healing mechanisms with few differences between tendinopathic and normal cells. Clinical Relevance Platelet-rich plasma injections in pathological and nearby tissue might help to recover tendon homeostasis.

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Section: Introductionmentioning

confidence: 99%

Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

Andı́a

Rubio‐Azpeitia

Maffulli

2015

Clinical Orthopaedics &Amp; Related Research

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“…Some authors recommended pre-operative blood donation [14], correction of preoperative anaemia [15], autologous donation and retransfusion systems [10,[16][17][18][19][20][21][22][23], supplementation of erythropoietin or iron [24,25], pharmacologic agents like tranexamic acid [26,27], plasmapheresis, normovolaemic haemodilution [28][29][30][31] and post-operative red blood cell salvage [32].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Hawi

Kendoff

Hessling

et al. 2014

International Orthopaedics (SICOT)

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Purpose The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions. Methods Between January 2011 and December 2011, patients being treated with revision THA were included (n=411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m 2 ), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre-and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded. Results In both the cemented and non-cemented revision THA groups, there was no significant difference between pre-and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p=0.0042, odds ratio=2.035).Conclusions Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.

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“…With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. We believe that in non-anaemic patients other factors can influence significant reduction of blood loss: good surgical techniques, regional anaesthesia, post-operative autotransfusion, oral iron therapy and maybe tranexamic acid [24] or platelet-rich plasma [25]. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion.…”

Section: Resultsmentioning

confidence: 99%

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

Blazekovic

Bićanić

Hrabač

et al. 2013

International Orthopaedics (SICOT)

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Purpose During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients. Methods Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and postoperative blood loss were measured and compared. Results With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion. Conclusions Results of our study showed that PABD in nonanaemic patients is not justified and is not economically feasible.

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Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study

Abstract: PRP has significant effect in preventing blood loss, postoperative pain and need for narcotics after TKA and has a positive effect on short-term clinical outcome.

Cited by 46 publications

References 21 publications

Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

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