Platelet-rich plasma for the reduction of blood loss after total knee arthroplasty: a clinical trial

Mochizuki, Takeshi; Yano, Koichiro; Ikari, Katsunori; Hiroshima, Ryo; Kawakami, Kosei; Koenuma, Naoko; Ishibashi, Mina; Shirahata, Toshikatsu; Momohara, Shigeki

doi:10.1007/s00590-016-1821-8

Cited by 20 publications

(30 citation statements)

References 28 publications

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“…Sample size of the studies was 21 to 315 patients. All of the trials involved primary unilateral TKA, and all patients were diagnosed with knee osteoarthritis except one study, [22] which included the patients with rheumatoid arthritis. All of the included studies were compared with blank control.…”

Section: Resultsmentioning

confidence: 99%

“…A pneumatic tourniquet was applied in all the included studies except one study, [21] which did not report the use of a tourniquet. Two studies [14,22] reported use of a drain during TKA, and no postoperative drains were applied in the other 4 studies. Two studies [5,21] described an indication for transfusion associated with a fall in hemoglobin level or hematocrit and clinical symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…Thromboembolic complications such as deep vein thrombosis, pulmonary embolism, and venous thrombus embolism were reported in all studies except 1 study. [22] Outcome of units transfused was reported in 1 study, [5] which was not analyzed owing to insufficient data.…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, 2 included studies [21,23] were randomized by randomization table or computer-generated numbers, and the remaining studies did not report the method of random sequence generation. All studies reported allocation concealment using sealed envelope except 2 studies [22,23] . We used the GRADE criteria to measure the strength of recommendations.…”

Section: Resultsmentioning

confidence: 99%

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The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty

Sun

Guo

et al. 2017

Medicine

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Background:Efficacy and safety of platelet-rich plasma (PRP) compared with control for preventing postoperative bleeding after total knee arthroplasty (TKA) is controversial. We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether PRP might reduce blood loss and improve function following TKA.Methods:PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify RCTs comparing PRP with control for patients undergoing unilateral TKA. The mean difference (MD) of total blood loss, hemoglobin (Hb) level, Hb drop, drain volume, range of motion (ROM), Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores, length of hospital stay (LOS), and odds ratios of transfusion rate and postoperative complications in the PRP and control groups were pooled throughout the study. Relevant data were meta-analyzed using RevMan v5.3.Results:Six RCTs involving 529 patients were included (208 PRP vs. 321 controls). The application of PRP in TKA had a significantly less calculated total blood loss (MD = −98.11; 95% confidence interval [CI]: −153.63 to −42.59, P = .0005) and lower Hb drop (MD = −0.34; 95% CI: −0.59 to −0.09, P = .008) than the control in the early postoperative period while decreasing the LOS (MD = −2.12; 95% CI: −3.47 to −0.76, P = .002). No significant differences were seen in drain volume, Hb level, transfusion rate, ROM, WOMAC scores, and complications between the 2 groups (P > .05).Conclusions:Our meta-analysis suggests that PRP appears to be effective in reducing postoperative blood loss and lowering Hb drop without increasing the risks of postoperative complications after TKA. However, owing to the variation of included studies, no firm conclusions can be drawn.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty

Sun

Guo

et al. 2017

Medicine

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“…Treatment with PRP delivers high concentration of platelets and growth factors directly to the wound site, which initiates and enhances wound healing. However, the effect of PRP is a function of many variables, including platelet concentration, procedures for concentration, platelet activation and the number of infiltrations, to date some of them [43]. The use of a standardized protocol for PRP elaboration is a great strength of our study.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Fernández-Cuadros¹,

Albaladejo-Florín²,

Algarra-López³

et al. 2017

Divers Equal Health Care

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Objective: 1) to determine the efficiency of PRP compared to Ozone Infiltrations on pain, function and quality of life (QoL) in patients with Patellofemoral Pain Syndrome (PFPS) and Chondromalacia. Material and methods:Prospective non-randomized controlled-trial, comparing two treatment protocols in parallel design, on 48 patients (24 in each group), with PFPS and Chondromalacia , who were treated at Santa Cristina's University Hospital, from January 2014 to May 2017. The PRP-protocol consisted of 3 sessions (1 session/week) of platelet-rich plasma (PRP), by an intra-articular infiltration of 3 ml. To obtain PRP, a kit device from EXACTECH (Accelerate Concentration System Device and Drucker Centrifuge was used.The Ozone-protocol consisted of 4 sessions (1 per week) of a medical mixture of Oxygen-Ozone (95%-5%) 20 ml, at a 20 ug/ml concentration, infiltrated intra-articularly. Pain, function, stiffness and Quality of Life were measured by Western Ontario and Mc Master Universities Index for Osteoarthritis (WOMAC) and Visual Analogical Scale (VAS) at baseline/end of treatment.Results: At baseline, age, sex, ratio male to female, clinical chondromalacia grades and symptom severity such as pain, stiffness and function were similar between groups of treatment. In both groups, the most common grade of chondromalacia was 2º grade (41.8% in PRP, 50% in Ozone), followed by 3º (37.6% in PRP, 33.4% in Ozone) and 4º (16.6% in both PRP and Ozone). When treatment protocols are analyzed separately, both PRP and Ozone were capable to produce pain relief (measured by VAS and WOMAC pain subscale), and improvement in function and rigidity (measured by WOMAC subscales), with a significant statistical level (p<0.05). In the case of pain, Ozone is even more effective than PRP (1.46 points on VAS scale and 2.95 points on WOMAC pain subscale) (p<0.05).Conclusion: PRP and ozone produce pain relief, function recovery and quality of life improvement in PFPS and chondromalacia, measured by WOMAC and VAS scores. In the case of pain severity, ozone produces even greater pain relief. PRP and Ozone are safe and effective modalities for the management of PFPS and chondromalacia.

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Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial

Gobbi

Dallo

D’Ambrosi

2022

Eur J Orthop Surg Traumatol

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Purpose The purpose of this prospective randomized clinical trial is to compare the clinical outcomes of three injections of leucocyte-poor platelet-rich plasma (LP-PRP) and hyaluronic acid (HA) to a single dose of autologous microfragmented adipose tissue (AMAT) in patients with mild osteoarthritis at a two-year follow-up. Methods Eighty symptomatic knees in fifty patients (mean age: 62.38 ± 11.88 years) with Kellgren-Lawrence grade 0 to 2 osteoarthritis were non blinded, randomly allocated into two equal groups. Group 1 consisted of 40 knees that received autologous LP-PRP + HA; Group 2 consisted of 40 knees treated with a single dose of AMAT injection. The outcomes were measured by Tegner, Marx, Visual Analogue Scale (VAS) for pain, International Knee Documentation Committee, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 (T1), 12 (T2), and 24 (T3) months. Adverse events were recorded at each follow-up timepoint. To assess score differences among subjects of the same gender and age, a subgroup analysis was performed. Results Both groups had significant clinical and functional improvement at 6, 12, and 24 months (p < 0.05). Comparing the two groups, the AMAT groups showed significantly higher pre-operative Marx score (3.35 ± 4.91 vs. 1.78 ± 3.91) and VAS score (5.03 ± 2.02 vs. 3.85 ± 1.68) (p < 0.05), higher VAS (3.89 ± 2.51 vs. 2.64 ± 2.00) at T2 and KOOS-ADL (79.60 ± 20.20 vs. 65.68 ± 23.62), and lower KOOS-Sports (50.30 ± 30.15 vs. 68.35 ± 30.39) at T3 (p < 0.05). No patient from either group had experienced major adverse effects. In the LP-PRP group 12 (30%) patients presented swelling, redness, and mild pain for one day after injection and two patients had synovitis for two days and required paracetamol and local ice. In AMAT group 5 (12.5%) patients had ecchymosis and bruising at the fat aspiration site for three days. Conclusion AMAT did not show significant superior clinical improvement compared with three LP-PRP combined with HA injections in terms of functional improvement at different follow-up points. Both procedures were safe with no major complications reporting good results at mid-term follow-up, improving knee function, pain, and quality of live regardless of age and gender. Level of evidence Level I—Prospective Randomized Clinical Trial.

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Platelet-rich plasma for the reduction of blood loss after total knee arthroplasty: a clinical trial

Abstract: In this prospective randomized study, those that received PRP after TKA had significantly less postoperative blood loss and change in Hb level. PRP appears to be effective in reducing postoperative bleeding in TKA.

Cited by 20 publications

References 28 publications

The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty

The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial

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