Safety and Clinical Efficacy of Platelet Rich Growth Factors (Prgf) in Managing Knee Osteoarthritis After Failed Conservative Treatment: Evidence From Real Practices

Abstract

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.

The 36-Month Survival Analysis of Conservative Treatment Using Platelet-Rich Plasma Enhanced With Injectable Platelet-Rich Fibrin in Patients With Knee Osteoarthritis

“…49/2019). The sample size was calculated based on a related study with an alpha of 0.05 and a power of 80% [18]. The calculated sample size was 524 knees divided into 424 knees in Kellgren and Lawrence (KL) grade I to III, and 100 knees in KL grade IV groups.…”

The Role of Plasma, Platelets, and Growth Factors in Knee Osteoarthritis: The Evidence-Based Medicine 2022

“…In 2019, Turajane et al performed a clinical trial investigating the efficacy of PRGF in knee OA patients who failed conservative treatment. Their results at 3 months follow-up showed that only 5.6% of patients with KL Grade 2-3 and 10.8% of patients with KL Grade 4 needed surgical intervention (38) . In 2020, Turajane et al performed another randomized, controlled trial comparing clinical outcomes of IA-platelet plasma concentrate and growth factors and intra-articular corticosteroid injections for the treatment of knee OA.…”