Efficacy of platelet-rich plasma for clinical outcomes after total knee arthroplasty: a systematic review and meta-analysis

Objective: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs were to evaluate the effect of platelet-rich plasma (PRP) versus placebo on the patients receiving total knee arthroplasty (TKA). Methods: In April 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews and Chinese Wanfang database. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the range of motion (ROM), which represents the function after TKA. The Western Ontario McMaster Universities Osteoarthritis Index Bellamy (WOMAC), pain at 24 h, 48 h and 7 day and hemoglobin (Hb) at 24 h after TKA were also to assess the effect of PRP on the function and pain after TKA. The complications of infection were also compiled to assess the safety of PRP. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. Results: Ten clinical trials with 1001 patients were included in the meta-analysis. The pooled results indicated that administration of PRP significantly increase ROM at third day (mean difference (MD) = 4.05, 95% CI = 1.58-6.52; P = 0.001) and 3 month postoperatively (MD = 3.12, 95% CI = 0.94-5.29; P = 0.005). There is no statistically difference between the two groups in terms of WOMAC questionnaire score at 3 month, pain intensity at 24 h, 48 h and 7 day and Hb at 24 h after TKA. There is no statistically significant difference between the PRP versus placebo in terms of the occurrence of infection (relative risk (RR) = 0.64, 95% CI = 0.19-2.14, P = 0.464). Conclusion: Based on the current meta-analysis, PRP can limitedly increase the ROM after TKA in short and long period. What's more, PRP has no effects on the WOMAC score, pain scores and the occurrence of infection. More RCTs and high quality studies are still needed to identify the efficacy and safety of PRP after TKA.