Prospective comparative study of the use PRP and viscoelastic sodium hyaluronate gel in patients with grade ii knee osteoarthritis
The development of an effective and safe methods of conservative treatment of knee osteoarthritis of the has a priority in modern orthopaedics.
Objective: to compare results of Platelet-Rich Plasma — PRP and PRP in combination with 2 % viscoelastic sodium hyaluronate gel (proFLEX INTRA) in patients with the II grade knee osteoarthritis.
Methods: from 2018 to 2019 prospective randomized comparative study of the efficiency of using PRP therapy (group I) and PRP in combination with a 2 % viscoelastic sodium hyaluronate gel (proFLEX INTRA) (group II) was conducted in 50 patients with II grade knee osteoarthritis (aged between 48 and 73 years). Patients were assessed before treatment, 1, 3, and 6 months after treatment with the help of VAS while walking, WOMAC, and OKS scales. Laboratory assesment of inflammation markers in serum and synovial fluid were performed before treatment and 4 weeks after. Synovial fluid was examined by using clinical-microscopic and biochemical methods according to the following markers: cytosis, percentage of neutrophils, lymphocytes, synoviocytes and macrophages, protein, hyaluronic acid. In blood serum were determined: total protein, glycoproteins, chondroitin sulfates, alkaline phosphatase activity.
Results: in II group was noted a statistically significant improvement according to VAS and WOMAC scale comparing with I group 6 months after treatment. The content of glycoproteins and chondroitin sulfates in blood serum of patients in the II group, also the protein content in synovial fluid, 4 weeks after treatment was lower (p < 0.05) comparing with the I group. However, the content of HA was higher (p < 0.05) in the II group of patients.
Conclusions: both methods, PRP; PRP and HA allowed to reduce VAS pain score while walking and to improve joint function according to WOMAC and OKS scales in patients with the II stage knee osteoarthritis, six months after treatment. While, in the group of combined use PRP and 2 % viscoelastic sodium hyaluronate gel the results of treatment according to VAS and WOMAC scales were statistically significantly better and the inflammatory-dystrophic degree of changes in the knee was less comparing with the I group.
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McAlindon, T., Bannuru, R., Sullivan, M., Arden, N., Berenbaum, F., Bierma-Zeinstra, S., & Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22 (3), 363–388. doi:10.1016/j.joca.2014.01.003
Bruyère, O., Cooper, C., Pelletier, J., Branco, J., Luisa Brandi, M., Guillemin, F., & Reginster, J. (2014). An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 44 (3), 253–263. doi:10.1016/j.semarthrit.2014.05.014
Treatment of Osteoarthritis (OA) of the Knee [web source]. Evidence-based guideline. 2nd ed. (2013). Retrieved from: http://www.aaos.org/cc_files/aaosorg/research/guidelines/treatmentofosteoarthritisofthekneeguideline.pdf.
Michael, J. W., Schlüter-Brust, K. U., & Eysel, P. (2010). The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Aerzteblatt Online, 107 (9), 152–162. doi:10.3238/arztebl.2010.0152
Bennell, K. L., Hunter, D. J., & Paterson, K. L. (2017). Platelet-rich plasma for the management of hip and knee osteoarthritis. Current Rheumatology Reports, 19 (5). doi:10.1007/s11926-017-0652-x
Bellamy, N., Campbell, J., Robinson, V., Gee, T., Bourne, R., & Wells, G. (2005). Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2, CD005321 doi:10.1002/14651858.cd005321
Gigante, A., & Callegari, L. (2010). The role of intra-articular hyaluronan (Sinovial®) in the treatment of osteoarthritis. Rheumatology International, 31 (4), 427–444. doi:10.1007/s00296-010-1660-6
Bannuru, R., Natov, N., Dasi, U., Schmid, C., & McAlindon, T. (2011). Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis. Osteoarthritis and Cartilage, 19 (6), 611–619. doi:10.1016/j.joca.2010.09.014
Bannuru, R. R., Vaysbrot, E. E., Sullivan, M. C., & McAlindon, T. E. (2014). Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 43 (5), 593–599. doi:10.1016/j.semarthrit.2013.10.002
Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., & Rettig, A. C. (2014). Efficacy of platelet-rich plasma for chronic tennis elbow. The American Journal of Sports Medicine, 42 (2), 463–471. doi:10.1177/0363546513494359
Patel, S., Dhillon, M. S., Aggarwal, S., Marwaha, N., & Jain, A. (2013). Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis. The American Journal of Sports Medicine, 41 (2), 356–364. doi:10.1177/0363546512471299
Kon, E., Mandelbaum, B., Buda, R., Filardo, G., Delcogliano, M., Timoncini, A., & Marcacci, M. (2011). Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 27 (11), 1490–1501. doi:10.1016/j.arthro.2011.05.011
Spaková, T., Rosocha, J., Lacko, M., Harvanová, D., & Gharaibeh, A. (2012). Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. American Journal of Physical Medicine & Rehabilitation, 91 (5), 411–417. doi:10.1097/phm.0b013e3182aab72
Anitua, E., Sanchez, M., Nurden, A. T., Zalduendo, M. M., De la Fuente, M., Azofra, J., & Andia, I. (2007). Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology, 46 (12), 1769–1772. doi:10.1093/rheumatology/kem234
Lana, J. F., Weglein, A., Sampson, S. E. & [et al.] (2016). Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. Stem Cells in Regenerative Medicine, 12 (2), 69–78.
Yu, W., Xu, P., Huang, G., & Liu, L. (2018). Clinical therapy of hyaluronic acid combined with platelet-rich plasma for the treatment of knee osteoarthritis. Experimental and Therapeutic Medicine, 16 (3), 2119–2125 doi:10.3892/etm.2018.6412
Korzh, A. A., Kovalenko, V. N., & Korzh, N. A. (1998). Diagnosis and conservative treatment of diseases and injuries of the musculoskeletal system. Book third. Kharkov: Osnova. (in Russian)
Morozenko, D. V., & Leontуeva, F. S. (2016). Methods of research of connective tissue metabolism markers in clinical and experimental medicine. Young scientist, 2, 29, 168–172. (in Ukrainian)
Goryachkovsky, A. M. (2005). Clinical biochemistry in laboratory diagnostics (3rd eds.). Odessa: Ecology. (in Russian)
Simental-Mendía, M., Vílchez-Cavazos, J. F., Peña-Martínez, V. M., Said-Fernández, S., Lara-Arias, J., & Martínez-Rodríguez, H. G. (2016). Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Archives of Orthopaedic and Trauma Surgery, 136 (12), 1723–1732. doi:10.1007/s00402-016-2545-2
Menshikov, V. V. (Eds.). (1997). Encyclopedia of clinical laboratory tests. Moscow: Labinform. Encyclopedia of Clinical Laboratory Tests: Translation Edition Moscow: Labinform. (in Russian)
Omelyanenko, N. P., Slutsky, L. I., & Mironova, S. P. (2010). Connective tissue: (histophysiology and biochemistry)., Vol. 2. Moscow: Izvestia. (in Russian)
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