Intra-articular Pure Platelet-Rich Plasma Combined With Open-Wedge High Tibial Osteotomy Improves Clinical Outcomes and Minimal Joint Space Width Compared With High Tibial Osteotomy Alone in Knee Osteoarthritis: A Prospective Study

Zhang, Qian; Xu, Wenxian; Wu, Kailun; Fu, Weili; Yang, Huilin; Guo, Jiong Jiong

doi:10.1016/j.arthro.2021.09.013

Cited by 27 publications

(18 citation statements)

References 37 publications

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“…Nine studies focused on injective augmentation strategies, including 513 patients (513 knees) (133 men, 295 women, 85 not available). Among these papers, one was a case series and eight were comparative studies, which were as follows: HTO + HA vs HTO [10], HTO + PRP vs HTO + HA vs HTO + saline [13], HTO + PRP vs HTO [76], HTO + MF + hyaluronic acid (HA) + BMSCs vs HTO + MF + HA [71], HTO + microfragmented adipose tissue (MF‐AT) vs HTO [47], HTO + stromal vascular fraction (SVF) vs HTO [38], HTO + platelet‐rich plasma (PRP) + SVF vs HTO + PRP [39], and HTO + adipose‐derived mesenchymal stem cells (ADMSCs) vs HTO [34] (Table 2). The analysis of the eight comparative trials [10, 13, 34, 38, 39, 47, 71, 76] included 505 patients in four comparative non‐randomized controlled trials and four RCTs.…”

Section: Resultsmentioning

confidence: 99%

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Reale

Feltri²,

Franceschini

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA). Methods A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second‐look/histological outcomes at any follow‐up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). Results Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet‐rich plasma or cell‐based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1. Conclusion There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra‐articular osteotomy augmentation. Level of evidence Level IV.

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Section: Resultsmentioning

confidence: 99%

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Reale

Feltri²,

Franceschini

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…In this context, the combination of biological procedures could stimulate post‐operative regeneration of articular cartilage or at least prevent the progression of medial OA. Cartilage restoration techniques and platelet‐rich plasma used in combination with HTO have been shown to be effective in improving function and relieving pain after surgery 35,36 . A previous literature review 35 also found that performing concomitant microfractures can potentially delay the need for TKA after HTO in the medium term.…”

Section: Discussionmentioning

confidence: 99%

“…Cartilage restoration techniques and platelet-rich plasma used in combination with HTO have been shown to be effective in improving function and relieving pain after surgery. 35,36 A previous literature review 35 also found that performing concomitant microfractures can potentially delay the need for TKA after HTO in the medium term. However, the analysis was limited by the heterogeneity of techniques used for HTO and cartilage restoration, as well as inconsistency of outcome measures in previous studies.…”

Section: Associated Proceduresmentioning

confidence: 99%

Long‐Term Survival and Predictors of Failure of Opening Wedge High Tibial Osteotomy

Guarino

Farinelli

Iacono

et al. 2023

Orthopaedic Surgery

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BackgroundThe primary aim was to evaluate the long-term survival of opening wedge high tibial osteotomy (HTO) for isolated osteoarthritis in the medial compartment of the knee. The secondary objective was to identify independent predictors of conversion to total knee arthroplasty (TKA). MethodsTwo-hundred forty-seven consecutive cases of open wedge HTO performed at the study centre were retrospectively analysed. Mean age at the operation was 42,8 years (range 15-70) and most patients were male (70%). Mean follow-up was 11.6 years (6-17). Failure was de ned as conversion to TKA.Kaplan-Meier and Cox regression analyses were performed. ResultsThirty-three of the 247 HTOs (13.4%) were converted to knee replacement, with 86.6% of the original procedures surviving at a mean 12-year follow-up. Kaplan-Meier survival estimates at 17 years for HTO were 75.5% (95% con dence interval [CI] 66.7-84.3). There was signi cant difference (p < 0.001) in the 17-year survival rate between obese (55.5%; ) and non-obese (79.7%; 95% CI 70.1-89.2) patients. The determinants of conversion to knee arthroplasty detected at multivariate Cox regression analysis were Body Mass Index, severity of cartilage degeneration in the medial compartment (Outerbridge grade), and age. ConclusionsThe long-term survival of open wedge HTO for osteoarthritis in the medial compartment of the knee is satisfactory. The risk of conversion to TKA is signi cantly increased in obese patients. Advanced age and severity of pre-existing cartilage damage may also contribute to the risk of conversion to TKA.

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“…Records of 646 patients, with average follow-up period of 60.18 months, were evaluated: (i) baseline information, including name, sex, age, treatment, BMI, CRP, IL-6, PLT count and Follow-up time; (ii) imaging data: K-L grade and Minimum joint space width (MJSW) that de ned as the minimum distance medially from the femoral condyle to the tibial plateau [26,27]. Elevation of K-L grade and decrease of MJSW more than 0.5mm were considered as KOA progression [28]; (iii) knee pain/function scores: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS).…”

Section: Discussionmentioning

confidence: 99%

Platelet-rich plasma preserves cartilage thickness and delays total knee arthroplasty in osteoarthritis with an inflammatory phenotype: a 5-year follow-up retrospective study

Chen

Wen

et al. 2022

Preprint

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Background This study aims to explore whether platelet-rich plasma (PRP) can delay the progression of disease, reduce the incidence of Total knee arthroplasty (TKA) and improve clinical symptoms in patients with typical inflammatory phenotype knee osteoarthritis (KOA) Methods This was a retrospective cohort study with 5-year follow-up. According to clinical manifestations, magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS), and serum inflammation markers C-reactive protein (CRP), we selected patients with typical inflammatory phenotype of KOA. Patients were divided into groups based on whether they had received PRP, hyaluronic acid (HA), or other conservative treatment (OCT). The Kellgren-Lawrence (K-L) grade and Minimum joint space width (MJSW) in knee X-rays were used to evaluate the progression of KOA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Knee Society scores (KSS), minimal clinically important difference (MCID) and Osteoarthritis Research Society International Set Responder Criteria Osteoarthritis Clinical Trials Revisited (OMERACT-OARSI) tool were used to evaluate the improvement of KOA symptoms. The incidence and timing of TKA was statistically analyzed. Results A total of 646 patients were finally included, including 211 received PRP, 209 received HA and 226 received OCT. PRP showed better results in K-L grade and MJSW compared with HA and OCT (The results at 12m, 24m, 36m, 48m, 60m, respectively, were as follows; K-L grade, PRP vs. HA, P = 0.957, P = 0.534, P = 0.230, P < 0.001, P < 0.001; PRP vs. OCT, P = 0.240, P = 0.012, P = 0.004, P < 0.001, P < 0.001; MJSW, PRP vs. HA, P = 0.249, P = 0.013, P < 0.001, P < 0.001, P < 0.001; PRP vs. OCT, P = 0.155, P = 0.001, P < 0.001, P < 0.001, P < 0.001). Compared with HA and OCT, PRP group exhibited significant lower TKA incidence (PRP vs. HA, P = 0.001; PRP vs. OCT, P = 0.001; HA vs OCT, P = 0.732) and delayed time to TKA (log-rank, PRP vs HA,P < 0.001, PRP vs OCT, P < 0.001, HA vs OCT, P = 0.467). The WOMAC, KSS and KSS-F in PRP group were significantly better than those in HA group and OCT group at each time point after treatment (P < 0.05). Conclusions Intra articular injection of PRP can delay progression of KOA, reduce or postpone occurrence of TKA and improve clinical symptoms in strictly screened patients with typical inflammatory phenotype KOA. Level of Evidence: III, retrospective cohort.

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Intra-articular Pure Platelet-Rich Plasma Combined With Open-Wedge High Tibial Osteotomy Improves Clinical Outcomes and Minimal Joint Space Width Compared With High Tibial Osteotomy Alone in Knee Osteoarthritis: A Prospective Study

Cited by 27 publications

References 37 publications

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Long‐Term Survival and Predictors of Failure of Opening Wedge High Tibial Osteotomy

Platelet-rich plasma preserves cartilage thickness and delays total knee arthroplasty in osteoarthritis with an inflammatory phenotype: a 5-year follow-up retrospective study

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