Zhang Edmund Jia Xi, Sim Craigven Hao Sheng, Ow Zachariah Gene Wing, Lie Edward Vincentius, Rasu Krishmen, Wong Keng Lin
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
J Clin Orthop Trauma. 2024 Dec 31;62:102901. doi: 10.1016/j.jcot.2024.102901. eCollection 2025 Mar.
Autologous peripheral blood-derived orthobiologics like platelet-rich plasma (PRP) have been gaining in popularity in symptomatic relief of knee osteoarthritis (OA). Autologous protein solution (APS) that is derived from PRP offers higher levels of growth factors and anti-inflammatory cytokines, reducing inflammation and improve cartilage quality. Additionally, hyaluronic acid (HA) has shown efficacy in relieving OA symptoms. This study aims to assess the clinical outcomes of combined APS and HA therapy, particularly a presence of pathological site pain (PSP) during injection as a predictive sign for clinical response.
Patients with early-stage OA received APS and HA injections. Patients were evaluated pre-injection and at 1-year follow-up. Patient-reported outcomes were assessed with WOMAC, KOOS, VAS pain score, and SF-36 survey. The OMERACT-OARSI criteria determined treatment effects. Satisfaction and expectation fulfillment were also recorded.
32 patients were included in the final analysis. Statistically significant improvements were observed in all outcome scores at 1 year. The responder rate per OMERACT-OARSI criteria was 65.6 %, with 96.9 % of patients reporting satisfaction and expectation fulfillment. When comparing responder-rates and improvement in patient-reported outcome measures with other studies, combined therapy does not appear to confer additional therapeutic benefit over APS monotherapy at the 1-year mark. No severe adverse events related to the injections were reported. Patients with PSP had significantly better outcomes in terms of pain, stiffness, symptoms, activities of daily living, quality of life, as well as statistically significantly higher satisfaction rates of expectation fulfilment.
At 1-year post-injection, the APS and HA combination significantly improved WOMAC, KOOS, SF-36 PCS, and VAS scores, with a high rate of patient satisfaction. PSP during injection could possibly be predictive of better outcomes and expectation fulfilment.
Level III.
自体外周血来源的生物制剂如富血小板血浆（PRP）在缓解膝关节骨关节炎（OA）症状方面越来越受欢迎。源自PRP的自体蛋白溶液（APS）含有更高水平的生长因子和抗炎细胞因子，可减轻炎症并改善软骨质量。此外，透明质酸（HA）已显示出缓解OA症状的功效。本研究旨在评估APS和HA联合治疗的临床效果，特别是注射期间病理性部位疼痛（PSP）的存在作为临床反应的预测指标。
早期OA患者接受APS和HA注射。在注射前和1年随访时对患者进行评估。通过WOMAC、KOOS、视觉模拟评分（VAS）疼痛评分和SF-36调查评估患者报告的结局。采用OMERACT-OARSI标准确定治疗效果。还记录了满意度和期望达成情况。
32例患者纳入最终分析。在1年时所有结局评分均观察到具有统计学意义的改善。根据OMERACT-OARSI标准，缓解率为65.6%，96.9%的患者报告满意度和期望达成。与其他研究比较反应率和患者报告结局指标的改善情况时，联合治疗在1年时似乎并不比APS单药治疗具有额外的治疗益处。未报告与注射相关的严重不良事件。有PSP的患者在疼痛、僵硬、症状、日常生活活动、生活质量方面有明显更好的结局，以及在期望达成满意度方面有统计学意义的更高比率。
注射后1年，APS和HA联合治疗显著改善了WOMAC、KOOS、SF-36生理健康评分（PCS）和VAS评分，患者满意度高。注射期间的PSP可能预示更好的结局和期望达成。
三级。
