Department of Surgery, Welfare District of Forssa, Forssa, Finland.
The University of Turku, Turku, Finland.
Scand J Surg. 2019 Dec;108(4):329-337. doi: 10.1177/1457496918812218. Epub 2018 Nov 25.
Intra-articular injections of viscosupplements have been an option in the treatment of knee osteoarthritis. Platelet-rich plasma is an experimental treatment in osteoarthritis. Previous studies have shown that platelet-rich plasma reduces osteoarthritis symptoms in similar proportions as viscosupplements. The aim of this study was to compare platelet-rich plasma versus viscosupplements in terms of symptoms' relief and time to arthroplasty.
A total of 190 patients included in this retrospective study received either intra-articular injections of platelet-rich plasma (94 patients) or hyaluronic acid (86 patients) between January 2014 and October 2017. Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, and range of motion were measured before injection, at 15 days, 6 months, 12 months, and at last follow-up. We compared outcomes between these two groups using propensity score analysis for risk adjustment in multivariate analysis and for one-to-one matching.
Hyaluronic acid-treated patients experienced a higher arthroplasty rate (36.0% vs 5.3%, p < 0.001), lower range of motion, worse Visual Analogue Scale and Western Ontario and McMaster Universities Osteoarthritis Index scores, and increased risk of any arthroplasty occurrence (log-rank < 0.001) than platelet-rich plasma patients. Cox proportional hazards analysis revealed a tendency to decrease the risk of knee arthroplasty for the patients treated by platelet-rich plasma (hazard ratio = 0.23, 95% confidence interval, 0.05-1.05, p = 0.058). When the treatment method was adjusted for propensity score in the propensity score-matched pairs (n = 78), we found that platelet-rich plasma group still showed significant improvement over the hyaluronic acid group in arthroplasty rate (12.8% vs 41.0%, p = 0.010), Visual Analogue Scale and Western Ontario and McMaster Universities Osteoarthritis Index scores, but not in the range of motion, during the mean follow-up of 16.7 months.
Intra-articular injections of platelet-rich plasma associated with better outcomes than hyaluronic acid in knee osteoarthritis. Platelet-rich plasma might prolong the time to arthroplasty and provide a valid therapeutic option in selected patients with knee osteoarthritis not responding to conventional treatments. Further larger studies are needed to validate this promising treatment modality.
关节内注射黏弹性补充剂一直是治疗膝骨关节炎的一种选择。富含血小板的血浆是骨关节炎的一种实验性治疗方法。先前的研究表明，富含血小板的血浆可减轻骨关节炎症状，其比例与黏弹性补充剂相似。本研究旨在比较富含血小板的血浆与黏弹性补充剂在缓解症状和关节置换时间方面的差异。
本回顾性研究共纳入 190 例患者，于 2014 年 1 月至 2017 年 10 月期间分别接受富含血小板的血浆（94 例）或透明质酸（86 例）关节内注射。在注射前、注射后 15 天、6 个月、12 个月和最后随访时，测量 Western Ontario 和 McMaster 大学骨关节炎指数、视觉模拟评分和活动范围。我们使用倾向评分分析进行风险调整，在多变量分析和一对一匹配中比较这两组之间的结果。
与富含血小板的血浆组相比，接受透明质酸治疗的患者关节置换率更高（36.0% vs. 5.3%，p<0.001），活动范围更小，视觉模拟评分和 Western Ontario 和 McMaster 大学骨关节炎指数评分更差，且任何关节置换发生的风险增加（对数秩检验<0.001）。Cox 比例风险分析显示，富含血小板的血浆治疗患者的膝关节置换风险有降低趋势（风险比=0.23，95%置信区间 0.05-1.05，p=0.058）。当在倾向评分匹配的对（n=78）中调整治疗方法的倾向评分时，我们发现富含血小板的血浆组在关节置换率（12.8% vs. 41.0%，p=0.010）、视觉模拟评分和 Western Ontario 和 McMaster 大学骨关节炎指数评分方面仍显著优于透明质酸组，但在平均 16.7 个月的随访中，活动范围无差异。
富含血小板的血浆关节内注射在膝骨关节炎患者中优于透明质酸，可获得更好的结果。富含血小板的血浆可能会延长关节置换时间，并为对常规治疗无反应的膝关节骨关节炎患者提供有效的治疗选择。需要进一步开展更大规模的研究来验证这种有前途的治疗方式。
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