scholarly journals Comparison of the clinical effect of intra-articular injection of platelet-rich plasma and methylprednisolone in primary osteoarthritis of knee: a randomized controlled trial

2019 ◽  
Vol 6 (6) ◽  
pp. 1842
Author(s):  
Darendrajit S. Longjam ◽  
Joy S. Akoijam ◽  
Meina S. Ahongshangbam ◽  
Nilachandra S. Longjam
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Osteoarthritis Of The Knee ◽  
Womac Pain ◽  
Osteoarthritis Of Knee ◽  
Primary Osteoarthritis ◽  
Steroid Group

Background: Osteoarthritis of knee is one of the commonest musculoskeletal disorder causing mobility impairment affecting 3.3% in urban areas and 5.5% in rural areas. Intra-articular injection of Platelet-Rich Plasma (PRP) delivers activated platelets that may reduce inflammation, provide pain relief, improve function and stimulate possible cartilage regeneration at the site of worn cartilage area of the knee.Methods: Eighty patients with primary osteoarthritis of the knee fulfilling inclusion and exclusion criteria were recruited in the study conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal from October 2014 to September 2017. Six ml of PRP prepared by conventional bench top centrifugation system was injected intra-articularly, two weeks apart in the PRP group. Steroid group received 80mg of methylprednisolone, two weeks apart by the same technique. The outcome variables (VAS and WOMAC score) were measured before starting intervention (baseline) and at 8 and 24-weeks post-intervention follow up.Results: Significant improvement seen in VAS, WOMAC-pain, stiffness and physical function and total scores in both the groups at 8- and 24-weeks follow-ups (p˂0.001). Steroid group showed better result than the PRP group in VAS (2.78±0.76 vs 3.58±1.03) and WOMAC-total (30.42±6.85 vs 36.25±10.87) scores at 8 weeks respectively (p˂0.001). But at 24 weeks follow-up, PRP showed significantly more effective than the steroid group in reducing pain (2.0±.0.87 vs 2.45±0.78) and disability (22.95±3.78 vs 25.25±6.67) respectively (p˂0.001).Conclusions: Intra-articular injection of methylprednisolone was found to be more effective in reducing pain and disability in primary knee osteoarthritis of KL grade 2 and 3 at the end of 8 weeks whereas 2 doses of PRP intra-articular injection 2 weeks apart was significantly more effective than methylprednisolone at the end of 24 weeks. However, the long-term benefit of PRP is to be determined by studies with a larger sample size and longer duration of follow-up.

scholarly journals Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shu-Fen Sun ◽  
Guan-Chyun Lin ◽  
Chien-Wei Hsu ◽  
Huey-Shyan Lin ◽  
I.-H.siu Liou ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Pain Reduction ◽  
Womac Pain ◽  
Knee Oa ◽  
Lequesne Index ◽  
Injection Group ◽  
The One

AbstractIntraarticular hyaluronan or platelet-rich plasma (PRP) is widely used in the treatment of knee osteoarthritis (OA). The efficacy of combined hyaluronan with PRP remained inconclusive. This study aimed to investigate the efficacy of combined a single crosslinked hyaluronan (HYAJOINT Plus) and a single PRP versus a single PRP in patients with knee OA. In a prospective randomized-controlled trial, 85 patients with knee OA (Kellgren-Lawrence 2) were randomized to receive a single intraarticular injection of HYAJOINT Plus (3 ml, 20 mg/ml) followed by 3 ml PRP (the combined-injection group, N = 43) or a single injection of 3 ml PRP (the one-injection group, N = 42). The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0–00 mm) at 6 months. Secondary outcomes included The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert Scale), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patient satisfaction at 1, 3 and 6 months. Seventy-eight patients were available for the intention-to-treat analysis at 6 months. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at each follow-up visit (p < 0.001). Patients receiving a single PRP experienced significantly greater improvements in VAS pain than patients receiving combined injections at 1-month follow-up (adjusted mean difference: − 5.6; p = 0.017). There were no significant between-group differences in several of the second outcomes at each follow-up visit, except the WOMAC-pain and WOMAC-stiffness scores favoring the one-injection group at 1 month (p = 0.025 and p = 0.011). However, at 6-month follow-up, the combined-injection group achieved significantly better VAS pain reduction (p = 0.020). No serious adverse events occurred following injections. In conclusion, either combined injections of HYAJOINT Plus and PRP or a single PRP alone was safe and effective for 6 months in patients with Kellgren-Lawrence 2 knee OA. Combined injections of HYAJOINT Plus and PRP achieved better VAS pain reduction than a single PRP at 6 months. The results indicating a long term benefit effect of a combination of HYAJOINT Plus and PRP in a particular subset of patients with moderate knee OA need to be replicated in larger trials.ClinicalTrials.gov number NCT04315103.

scholarly journals Comparison between 25% dextrose prolotherapy and single dose of platelet rich plasma in the management of pain and improvement of functional outcome in patients suffering from primary knee osteoarthritis: a randomized controlled trial

2020 ◽  
Vol 7 (11) ◽  
pp. 1717
Author(s):  
Debasish Deb ◽  
Yumnam Nandabir Singh ◽  
Naorem Bimol Singh
Keyword(s):  
Single Dose ◽  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Womac Score ◽  
Osteoarthritis Of Knee ◽  
Primary Osteoarthritis ◽  
Strengthening Exercise

Background:  One of the most prevalent and disabling diseases worldwide, which decreases patients' quality of life (QoL) is knee osteoarthritis. However, pharmacological and non-pharmacological treatments, apart from complications, could not desirably control the disease. Limited studies are available in management of primary osteoarthritis of knee with prolotherapy with 25% dextrose and platelet rich plasma (PRP). Objective was to compare between 25% dextrose prolotherapy and single dose of PRP injection in the management of pain and improvement of functional outcome in patients suffering from primary knee osteoarthritis.Methods: A comparative study was conducted to see the effectiveness of 25% dextrose prolotherapy and PRP in primary osteoarthritis (OA) of knee in the management of pain and improvement of functional outcome in sixty-six patients in age group of 50 to 70 years attending PMR department OPD, RIMS, Imphal between october2018 to April 2020. The first group received 6 ml injections of 25% dextrose 3 times at baseline, 1 month and 4th month, whereas the 2nd group received single dose of 5ml PRP at baseline.Results: In both the groups 50 mg of tramadol tablet and isometric strengthening exercise of quadriceps was given. Assessment was done at baseline, at 1, 4 and 8 months by visual analogue scale (VAS) and western Ontario and McMaster university arthritis (WOMAC) index. Statistically significant improvement was noted in VAS (5.91±0.82 to 2.65±0.94) and WOMAC score (45.25±6.68 to 20.25±7.67) at end of 8 month in first group.Conclusion: It was concluded that 25% dextrose was more effective than in management of primary osteoarthritis of knee.

Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up

2021 ◽  
Vol 49 (4) ◽  
pp. 873-882
Author(s):  
Bart W. Oudelaar ◽  
Rianne Huis In ‘t Veld ◽  
Edwin M. Ooms ◽  
Relinde Schepers-Bok ◽  
Rob G.H.H. Nelissen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Rotator Cuff ◽  
Mixed Model ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Needle Aspiration ◽  
Randomized Controlled ◽  
Clinical Scores ◽  
Calcific Deposits

Background: Needle aspiration of calcific deposits (NACD) is a frequently used treatment for rotator cuff calcific tendinitis (RCCT). However, a substantial number of patients experience recurrent or persisting shoulder symptoms after NACD. Purpose: To compare the effects of adjuvant application of platelet-rich plasma (PRP) after NACD (NACP+PRP) with those of conventional NACD with corticosteroids (NACD+corticosteroids) on pain, shoulder function, and quality of life (QoL). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a single-center, double-blinded, randomized controlled trial, 80 adults with symptomatic RCCT were randomly allocated to receive NACD+corticosteroids or NACD+PRP. Pain, shoulder function, and QoL were assessed at baseline; 6 weeks; and 3, 6, 12, and 24 months after treatment using a numeric rating scale for pain (NRS); the Constant-Murley score (CMS); the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH); the Oxford Shoulder Score (OSS); and the EuroQol 5-dimension scale (EQ-5D). Additionally, resorption of calcific deposits and the integrity of rotator cuff tendons were assessed by using standard radiographs and ultrasound examination, respectively. The results were analyzed using noninferiority analysis for NRS scores and a mixed model for repeated measures. Results: Eighty patients were included (48 female; mean age, 49 ± 6 years; 41 patients in the NACD+PRP group). Both groups showed improvement of clinical scores at the 2-year follow-up ( P < .001 for all clinical scores). NACD+PRP was found to be noninferior to NACD+corticosteroids with regard to the mean decrease of NRS scores (4.34 vs 3.56; P = .003). Mixed-model analysis showed a significant difference in favor of NACD+PRP (CMS, P < .001; DASH, P = .002; OSS, P = .010; EQ-5D, P < .001). However, clinically relevant differences in favor of NACD+PRP were only seen at the 6-month follow-up for NRS and CMS scores, whereas at the 6-week follow-up a clinically relevant difference in favor of NACD+corticosteroids was found for all clinical scores except for the NRS. Full resorption of calcific deposits was present in 84% of the NACD+PRP group compared with 66% in the NACD+corticosteroids group ( P = .081). In the NACD+PRP group, 10 (24%) patients required a second NACD procedure compared with 19 (49%) patients in the NACD+corticosteroids group ( P = .036). Six complications, of which 5 were frozen shoulders, occurred in the NACD+PRP group compared with 1 complication in the NACD+corticosteroids group ( P = .11). Conclusion: NACD+PRP resulted in worse clinical scores at the 6-week follow-up but better clinical scores at the 6-month follow-up compared with NACD+corticosteroids. At the 1- and 2-year follow-ups, the results were comparable between groups. Furthermore, PRP seemed to reduce the need for additional treatments but was associated with more complications. In conclusion, NACD+corticosteroids had a favorable early effect on pain and function combined with low comorbidity. Thus, it remains the treatment of choice for patients with RCCT. Registration: NCT02173743 (ClinicalTrials.gov identifier).

An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

2021 ◽  
pp. 089719002110002
Author(s):  
David Rhys Axon ◽  
Melissa Johnson ◽  
Brittany Abeln ◽  
Stephanie Forbes ◽  
Elizabeth J. Anderson ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Program Effectiveness ◽  
Small Town ◽  
The United States ◽  
Small Towns ◽  
Academic Community ◽  
Service Needs ◽  
Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

Follow-up of Children With Trait in a Rural Setting

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 876-877
Author(s):  
Herman Harris
Keyword(s):  
Sickle Cell ◽  
Rural Areas ◽  
Urban Areas ◽  
Cost Effective ◽  
Rural Setting ◽  
Urban Centers ◽  
Hb S ◽  
The Individual ◽  
Limited Testing

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located. The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results. Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states. Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring. To do this, we must first look at the problems facing us.

scholarly journals Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5–9 years

2019 ◽  
Vol 14 (9) ◽  
pp. 831-840 ◽  
Author(s):  
Jennifer Cheng ◽  
Kristen A Santiago ◽  
Joseph T Nguyen ◽  
Jennifer L Solomon ◽  
Gregory E Lutz
Keyword(s):  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Intervertebral Discs ◽  
Discogenic Pain ◽  
Autologous Platelet Rich Plasma ◽  
Clinically Significant ◽  
And Function ◽  
Pain Patients ◽  
Autologous Platelet

Aim: This study assessed pain and function at 5–9 years postinjection in a subset of patients who received intradiscal platelet-rich plasma (PRP) injections for moderate-to-severe lumbar discogenic pain. Patients & methods: All patients received injections of intradiscal PRP in a previous randomized controlled trial. Data on pain, function, satisfaction, and need for surgery were collected at one time point of 5–9 years postinjection and compiled with existing data. Results: In comparison to baseline, there were statistically significant improvements in pain and function (p < 0.001). All improvements were clinically significant. Six patients had undergone surgery during the follow-up period. Conclusion: This subset of patients demonstrated statistically and clinically significant improvements in pain and function at 5–9 years postinjection.

Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

2019 ◽  
Vol 47 (5) ◽  
pp. 1130-1137 ◽  
Author(s):  
Jane Fitzpatrick ◽  
Max K. Bulsara ◽  
John O’Donnell ◽  
Ming Hao Zheng
Keyword(s):  
Randomized Controlled Trial ◽  
Ultrasound Guidance ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Harris Hip Score ◽  
Randomized Controlled ◽  
Gluteal Tendinopathy ◽  
To Receive

Background: A previously published trial showed that patients with chronic gluteal tendinopathy achieved greater clinical improvement at 12 weeks when treated with a single platelet-rich plasma (PRP) injection than those treated with a single corticosteroid injection (CSI). Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS. Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) ( P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks ( P < .0001). Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks. Registration: ACTRN12613000677707 (Australian New Zealand Clinical Trials identifier).

scholarly journals Effectiveness of Platelet Rich Plasma for the Management of Knee Osteoarthritis

2021 ◽  
Vol 15 (7) ◽  
pp. 1553-1556
Author(s):  
Adnan Qamar ◽  
Saima Naz Mohsin ◽  
Uzma Nasim Siddiqui ◽  
Sana Naz ◽  
Sana Danish
Keyword(s):  
Knee Osteoarthritis ◽  
Normal Saline ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Saline Group ◽  
Control Group ◽  
Plasma Therapy ◽  
Vas Score ◽  
To Receive

Aim: To determine impact of platelet rich plasma therapy for the management of knee osteoarthritis. Study design: Prospective double-blinded, add –on randomized, placebo-controlled trial Place and duration of study: Department of Orthopedics, Shaikh Zayed Hospital Lahore from 1st January 2019 to 30th June 2019 Methodology: Fifty volunteer participants fulfilling inclusion criteria were enrolled. One hundred knees of patients were randomly allocated into two groups. Knees were assigned either of the two groups. Platelet rich plasma group which was assigned to receive 5ml of platelet rich plasma and normal saline (NS) group which was assigned to receive 5ml of NS labeled as control group. All patients given 3 successive intra-articular injections of 5 mL of autologous platelet rich plasma or 5ml of normal saline was given at weekly intervals. Patients were blinded and subjected to a standardized injection protocol and the intensity of pain was assessed on visual analog scale (VAS) for pain. Results: The VAS scores decreased from 50.9±14.7 at baseline assessment to 43.6±16.2 at 1-month follow-up after completion of therapy for PRP group (p<0.0203). The improvement was maintained from the end of the therapy to 3 and 6 months’ follow-up, as measure of VAS score as 30.54±11.8 and 20.2±8.6 respectively (p<0.0001). In normal saline group, there was very slight decrease in VAS score from baseline i.e. 49.8±19.5 to 48±22.7, 44±16.6, and 42±21.7 at 1, 3 and 6 months interval. Conclusion: Platelet rich plasma therapy can provide effective pain control up to 6 months post injection in knee osteoarthritis. Key words: Platelet rich plasma (PRP), Knee osteoarthritis (OA), Pain score

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