Feb. 12, 2013
A study by researchers from Hospital for Special Surgery has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis, which is a progressive disease. The study appears online, ahead of print, in the Clinical Journal of Sports Medicine.
"This is a very positive study," said Brian Halpern, M.D., chief of the Primary Care Sports Medicine Service at Hospital for Special Surgery, New York City, and lead author of the study.
A study by researchers from Hospital for Special Surgery has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis, which is a progressive disease. The study appears online, ahead of print, in the Clinical Journal of Sports Medicine.
"This is a very positive study," said Brian Halpern, M.D., chief of the Primary Care Sports Medicine Service at Hospital for Special Surgery, New York City, and lead author of the study.
Several treatments for osteoarthritis exist, including exercise,
weight control, bracing, nonsteroidal anti-inflammatories, Tylenol,
cortisone shots and viscosupplementation, a procedure that involves
injecting a gel-like substance into the knee to supplement the natural
lubricant in the joint. A new treatment that is being studied by a small
number of doctors is PRP injections. PRP, which is produced from a
patient's own blood, delivers a high concentration of growth factors to
arthritic cartilage that can potentially enhance healing.
"You take a person's blood, you spin it down, you concentrate the
platelets, and you inject a person's knee with their own platelets in a
concentrated form," said Dr. Halpern. "This then activates growth
factors and stem cells to help repair the tissue, if possible, calm
osteoarthritic symptoms and decrease inflammation."
In the new study, researchers at Hospital for Special Surgery
enrolled patients with early osteoarthritis, gave them each an injection
of PRP (6-mL), and then monitored them for one year. Fifteen patients
underwent clinical assessments at baseline, one week, and one, three,
six, and 12 months. At these time points, clinicians used validated
tools to assess overall knee pain, stiffness and function, as well as a
patient's ability to perform various activities of daily living. At
baseline and then one year after the PRP injection, physicians also
evaluated the knee cartilage with magnetic resonance imaging (MRI),
something that has not previously been done by researchers in other PRP
studies. The radiologists reading the MRIs did not know whether the
examination was performed before or after the PRP treatment.
"The problem with a lot of the PRP studies is that most people have
just used subjective outcome instruments, such as pain and function
scores," said Hollis Potter, M.D., chief of the Division of Magnetic
Resonance Imaging at Hospital for Special Surgery, another author of the
study. "But even when patients are blinded, they know there has been
some treatment, so there is often some bias interjected into those types
of studies. When you add MRI assessment, it shows you the status of the
disease at that time, regardless of whether the patient is symptomatic
or asymptomatic or they have good or poor function in the knee. You find
out what the cartilage actually looks like. We can noninvasively assess
the matrix or the building blocks of cartilage."
While previous studies have shown that patients with osteoarthritis
can lose roughly five percent of knee cartilage per year, the HSS
investigators found that a large majority of patients in their study had
no further cartilage loss. "The knee can be divided into three
compartments, the medial compartment, the lateral compartment and the
patellofemoral compartment," said Dr. Halpern. "If we look at these
compartments individually, which we did, in at least 73% of these cases,
there was no progression of arthritis per compartment at one year. That
is very significant, because longitudinal studies suggest a four to six
percent progression of arthritis at one year."
Treatment with PRP was also useful in improving pain, stiffness and
function. The investigators found that pain, measured by a standard test
called the Western Ontario and McMaster Universities Arthritis Index,
significantly improved with a reduction of 41.7% at six months and 55.9%
at one year. On a pain scale commonly used by clinicians called the
Visual Analog Scale, pain was reduced by 56.2% at six months and 58.9%
at one year. Functional scores improved by 24.3% at one year. Activity
of Daily Living Scores also showed a significant increase at both six
months (46.8%) and one year (55.7%).
"We are entering into an era of biologic treatment, which is
incredibly ideal, where you can use your own cells to try to help repair
your other cells, rather than using a substance that is artificial,"
Dr. Halpern said. "The downside is next to zero and the upside is huge."
Dr. Halpern pointed out, however, that the study is a small case series
and PRP needs to be pitted against a traditionally treated group in a
randomized, controlled trial.
Osteoarthritis, which causes pain and joint stiffness, impacts over
27 million Americans and is a leading cause of disability. According to
statistics from the Centers for Disease Control and Prevention, overall
osteoarthritis affects 13.9% of adults aged 25 and older and 33.6% of
those older than 65. The disease is characterized by degeneration of
cartilage and its underlying bone within a joint as well as bony
overgrowth. Disease onset is gradual and usually begins after the age of
40.
Other HSS investigators involved in the study include Salma
Chaudhury, M.D., Ph.D, Scott Rodeo, M.D., Catherine Hayter, MBBS, Eric
Bogner, M.D., and Joseph Nguyen, MPH.
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