Shu Hongxin, Huang Zhenjun, Bai Xinyan, Xia Zhiyu, Wang Nanye, Fu Xiaoling, Cheng Xigao, Zhou Bin
Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Front Surg. 2022 Jul 4;9:922637. doi: 10.3389/fsurg.2022.922637. eCollection 2022.
The clinical efficacy of platelet-rich plasma (PRP) in the treatment of total joint replacement (TJR) remains inconclusive. In this paper, systematic review and meta-analysis was adopted to assess the efficacy of using PRP for the treatment of TJR.
A comprehensive search of Medline, Embase, and Cochrane library databases for randomized controlled trial (RCT) articles recording data of PRP for TJR was conducted from inception to February 2022. Outcomes concerned were pain, range of motion (ROM), WOMAC score, length of hospital stay (LOS), hemoglobin (Hb) drop, total blood loss, wound healing rate, and wound infection. The methodological quality of the included RCTs was evaluated by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was utilized to assess the level of evidence for the outcomes. Subgroup analysis was conducted according to the type of TJR.
Ten RCTs were included in the meta-analysis. In the TKA subgroup, the available data demonstrated that there were significant differences in the outcomes of pain and Hb drop, while it was the opposite of ROM, WOMAC score, LOS, total blood loss, wound healing rate, and wound infection. In the THA subgroup, no significant differences could be seen between two groups in the outcomes of LOS and wound infection. However, the PRP group gained a higher wound healing rate in the THA subgroup.
The application of PRP did not reduce blood loss but improved the wound healing rate. However, more prospective and multicenter studies are warranted to confirm these results.
富血小板血浆（PRP）在全关节置换术（TJR）治疗中的临床疗效尚无定论。本文采用系统评价和荟萃分析来评估使用PRP治疗TJR的疗效。
对Medline、Embase和Cochrane图书馆数据库进行全面检索，以查找自数据库建立至2022年2月记录PRP用于TJR数据的随机对照试验（RCT）文章。关注的结局包括疼痛、关节活动度（ROM）、WOMAC评分、住院时间（LOS）、血红蛋白（Hb）下降、总失血量、伤口愈合率和伤口感染。使用Cochrane偏倚风险工具2.0（RoB 2.0）评估纳入的RCT的方法学质量。采用推荐分级评估、制定和评价（GRADE）方法评估结局的证据水平。根据TJR的类型进行亚组分析。
荟萃分析纳入了10项RCT。在全膝关节置换术（TKA）亚组中，现有数据表明疼痛和Hb下降结局存在显著差异，而在ROM、WOMAC评分、LOS、总失血量、伤口愈合率和伤口感染方面则相反。在全髋关节置换术（THA）亚组中，两组在LOS和伤口感染结局方面未见显著差异。然而，PRP组在THA亚组中的伤口愈合率更高。
PRP的应用并未减少失血量，但提高了伤口愈合率。然而，需要更多的前瞻性多中心研究来证实这些结果。
