Treating Severe Knee Osteoarthritis with Combination of Intra-Osseous and Intra-Articular Infiltrations of Platelet-Rich Plasma: An Observational Study

Abstract

Objective Assessing the therapeutic effects of a combination of intra-articular and intra-osseous infiltrations of platelet-rich plasma (PRP) to treat severe knee osteoarthritis (KOA) using intra-articular injections of PRP as the control group. Design In this observational study, 60 patients suffering from severe KOA were treated with intra-articular infiltrations of PRP (IA group) or with a combination of intra-osseous and intra-articular infiltrations of PRP (IO group). Both groups were matched for sex, age, body mass index, and radiographic severity (III and IV degree according to Ahlbäck scale). Clinical outcome was evaluated at 2, 6, and 12 months, using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. Results At 2, 6 and 12 months after treatment, IO group had a significant improvement in all KOOS and WOMAC subscales ( P < 0.05). On the contrary, patients of the IA group did not improve in any of the scores. Sixteen out of 30 IO group patients showed minimal clinically important improvement (MCII) whereas 8 out of 30 IA group patients showed this response at 6 months (26.7%; 95% CI -0.4 to 49.9; P = 0.037). At 12 months, 14 patients of IO group and 5 patients of the IA group showed MCII (30%; 95% CI 4.3 to 51.9; P = 0.013). No differences between groups were observed at 2 months. Conclusions PRP intra-articular injections in severe KOA were not effective and did not provide any benefit. Combination of intra-articular and intra-osseous infiltrations of PRP was not clinically superior at 2 months, but it showed superior clinical outcomes at 6 and 12 months when compared with intra-articular injections of PRP.

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

“…We identified four prospective studies 11,49,57,58 and two retrospective studies. 6,9 Their methodological quality was assessed by the level of evidence using the criteria by Wright et al 62 and Slobogean and Bhandari 63 as shown in ►Table 1.…”

“…11 The remaining studies had a prospective design and appraised the application of intraarticular and intraosseous injections of PRP in patients with knee OA. The studies by Su et al, 58 Sánchez et al 2018, 57 and Sánchez et al 2016 49 were graded as levels II-IV of evidence, respectively. We limited our analysis of these studies to the patients from the subchondral intraosseous injection group (group A) from the study by Su et al, 58 as well as those from the subchondral intraosseous injection group from Sánchez et al 2018.…”

“…We limited our analysis of these studies to the patients from the subchondral intraosseous injection group (group A) from the study by Su et al, 58 as well as those from the subchondral intraosseous injection group from Sánchez et al 2018. 57…”

“…Recent studies have suggested possible benefits from different subchondral intraosseous injections. 6,9,11,49,57,58 Therefore, the purpose of this study was to systematically review the current literature and examine the evidence appraising the efficacy and safety of subchondral injections in the clinical treatment of knee OA.…”

Enhanced Subchondroplasty Treatment for Post‐Traumatic Cartilage and Subchondral Bone Marrow Lesions in a Canine Model

“…In a 2018 observational study by Sánchez et al, they compared IA PRP alone versus IO + IA PRP for severe knee OA in 60 patients. At 2, 6, and 12 months after treatment, the IO + IA group had a significant improvement in all KOOS and WOMAC subscales ( p < 0.05), while the IA group did not improve in any of the scores . Finally, in 2018, Su et al compared IA PRP, IA + IO PRP, and IA hyaluronic acid injections and found the combination of IA + IO PRP resulted in sustained lower VAS and WOMAC scores and improvement in the quality of life at 18 months.…”