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Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial
被引:15
作者:
Szwedowski, Dawid
[1
,2
]
Mobasheri, Ali
[3
,4
,5
,6
,7
]
Moniuszko, Andrzej
[8
]
Zabrzynski, Jan
[9
]
Jeka, Slawomir
[10
]
机构:
[1] Orthoped Arthroscop Surg Int OASI Biores Fdn, I-20133 Milan, Italy
[2] Prov Polyclin Hosp, Dept Orthopaed & Trauma Surg, PL-87100 Torun, Poland
[3] Univ Oulu, Res Unit Med Imaging Phys & Technol, Fac Med, FI-90014 Oulu, Finland
[4] State Res Inst Ctr Innovat Med, Dept Regenerat Med, Santariskiu 5, LT-08406 Vilnius, Lithuania
[5] Univ Med Ctr Utrecht, Dept Orthoped, NL-3508 GA Utrecht, Netherlands
[6] Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, NL-3508 GA Utrecht, Netherlands
[7] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Joint Surg, Guangzhou 510080, Peoples R China
[8] Cent Clin Hosp, Dept Internal Med & Gastroenterol, Inflammatory Bowel Dis Unit, Minist Interior & Adm, PL-02507 Warsaw, Poland
[9] Univ Med Sci, Dept Gen Orthoped Musculoskeletal Oncol & Trauma, PL-61701 Poznan, Poland
[10] Coll Med UMK, Univ Hosp 2, Dept & Clin Rheumatol & Connect Tissue Dis, PL-85168 Bydgoszcz, Poland
关键词:
knee osteoarthritis;
injections;
intra-articular;
osteoarthritis;
platelet-rich plasma;
viscosupplementation;
glucocorticosteroids;
DOUBLE-BLIND;
CORTICOSTEROID INJECTIONS;
PRACTICE GUIDELINES;
PLACEBO;
OUTCOMES;
D O I:
10.3390/biomedicines10050991
中图分类号:
Q5 [生物化学];
Q7 [分子生物学];
学科分类号:
071010 ;
081704 ;
摘要:
Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections.
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