Intra-articular injection with platelet-rich plasma compared to triamcinolone hexacetonide or saline solution in knee osteoarthritis: A double blinded randomized controlled trial with one year follow-up

Abstract

Objectives To compare the effectiveness of intra-articular injection (IAI) of Platelet-Rich Plasma (PRP) with Triamcinolone Hexacetonide (TH) and Saline Solution (SS), in patients with knee osteoarthritis (OA). Design A randomized controlled trial, with blinded patients and assessor. Setting Outpatient rheumatology service. Subjects Patients with knee osteoarthritis grades II and III. Interventions Patients received IAI with PRP, 40 mg TH, or SS. Methods Patients were assessed at baseline and after 4, 8, 12 e 52 weeks with: visual analogue scale (VAS) for pain at rest and movement, WOMAC questionnaire, Timed to Up and Go test, 6-min walk test, percentage of improvement, goniometry, quality of life SF-36 questionnaire, Likert scale and Kelgreen & Lawrence (KL) radiographic scale (only at baseline and 52 weeks). Results 100 patients were studied, with a mean age of 67.13(6.56) years. The TH group was superior for: percentage of improvement (versus SS group from 4 to 52 weeks); WOMAC total and pain (versus PRP group at 4 weeks); and WOMAC stiffness (versus SS group at 12 weeks). The SS group was inferior for WOMAC function (from 8 to 52 weeks). The PRP group showed lowest radiographic progression [TH 17 (51.51%) to 24 (72.72%); SS 17 (51.51%) to 30 (90.90%); PRP 20 (58.82%) to 21 (61.76%)]. Conclusion The Triamcinolone Hexacetonide group was superior for percentage of improvement and WOMAC, pain and stiffness. For the WOMAC function, the Platelet-Rich Plasma group and Triamcinolone Hexacetonide group were superior to the Saline group. The Platelet-Rich Plasma group showed the lowest radiographic progression at 52 weeks of follow-up.

Intra-articular platelet-rich plasma vs. corticosteroid injections efficacy in knee osteoarthritis treatment: a systematic review

“…According to Nunes-Tamashiro et al . 22 , the Triamcinolone Hexacetonide group (at baseline 5.29±2.06 and 2.91±2.73 at 52 weeks), the PRP group (at baseline 5.39±1.96 and 2.57±2.52 at 52 weeks), so the Triamcinolone Hexacetonide did not differ from the PRP group. There was no difference among the three groups for the other variables assessed, including the VAS score of pain on movement.…”

“…Six 17 – 22 out of nine studies used blinding approaches, single or double. Three studies 19 , 22 , 23 used the intention-to-treat principle to analyze lost patients' results.…”

The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA‐ORBIT consensus. Part 1—Blood‐derived products (platelet‐rich plasma)

“…The questions were divided into three main topics which would represent the three sections of the question list: PRP rationale and indications (questions 1-14), PRP preparation and characterisation (questions [15][16][17][18] and PRP protocol (questions [19][20][21][22][23][24][25][26][27][28].…”

“…The remaining 10 showed similar results of PRP injections to either CS, HA, bone marrow aspirate concentrates or even saline. However, although most of the RCTs report superiority of PRP versus saline in treating knee OA [9,17,22,26,27,34], a few studies showed that in patients with symptomatic mild to moderate knee OA, intra-articular injection of PRP did not result in a significant difference in symptoms or joint structure at 12 months compared with injection of saline [6,18,20]. This has been suggested to be related to the wide heterogeneity of PRP products, variability in patient populations, the multifactoriability of knee OA and various potential biases.…”