EFFICACY OF PLATELETRICH PLASMA INJECTIONS IN OSTEOARTHRITIS CAPSTONE

EFFICACY OF PLATELET-RICH PLASMA INJECTIONS IN OSTEOARTHRITIS CAPSTONE PROJECT, MPAS 218 SPRING 2020 CHELSEA BREKKE APRIL 3, 2020

DISCLOSURES SLIDE I have no actual or potential conflict of interest in relation to this presentation. No financial support was received for this presentation. No animals or plants were harmed during this production.

PICOT QUESTION In adults with joint pain due to osteoarthritis and degenerative joint disorders (P), does intra articular platelet rich plasma injections (I) versus intra articular steroid injections (C) offer any benefits in increasing function and decreasing pain (O) after completing treatment (T).

LEARNING OBJECTIVES Review osteoarthritis pathophysiology Describe the science behind Platelet-rich plasma Discuss the potential role Platelet-rich plasma has in treating osteoarthritis Review the available evidence and research

BACKGROUND OA common complaint in primary care OA pathophysiology refresher Conventional treatment options New emerging treatments

WHAT THE HECK IS PRP? ! What is it? How do we get it? What is in it? How does it work?

EVIDENCE #1 The Study – Is PRP effective and safe? 57 total participants in three groups Strengths Follow-up Randomized control trial VAS and WOMAC scores Compared efficacy of PRP directly to steroid Lequensne The Evidence VAS showed greatest improve in the 3 -PRP injection group at 2 month mark WOMAC scores better in PRP groups Concluded PRP was effective and safe Limitations Small sample size Brief Follow up time Lack of placebo group

EVIDENCE #2 The Study – Is PRP effective and feasible? 12 participants Strengths Multiple PRP injections Used objective forms to quantify pain improvement Follow-up Limited exclusion criteria The Evidence ICOAP, EQ-VAS, and patient specific goals improved 29% reduction of pain Limitations Very small size No control group

EVIDENCE #3 The Study – Efficacy and durability of PRP 90 participants Follow-up Strengths Longest follow-up time study found Measures used – IKDC, EQ-VAS scores The Evidence IKDC scores 67%. At 12 month, 59% at 24 months Max improvement around 9 months Limitations Lack of control group Omission of knee functional assessments

EVIDENCE #4 The Study – PRP vs hyaluronic acid Meta-analysis – 3 prospective, 10 RCT Total of 1, 520 participants WOMAC and VAS scores The Evidence PRP was shown to be more beneficial to HA but was not statistically significant – could be due to multiple measures used across studies Strengths Meta-analysis – 1, 500+ participants Head to head comparison of PRP vs. HA Limitations Heterogenicity of calculations from all studies

EVIDENCE #5 The Study – Can a single PRP IA be effective vs steroid Prospective randomized, double-blinded clinical trial 65 participants – PRP vs. steroid VAS, KOOS, SF-36 Follow-up Strengths Studied advanced OA patients Prospective, double blind RCT Multiple measures for pain, function, and quality of life The Evidence VAS scores decreased but not significantly more in PRP KOOS and SF-36 scores were better in PRP group Limitations Sample size

EVIDENCE #6 The Study – PRP for discogenic low back pain Specific inclusion criteria 14 participants Strengths Quality of measures used Inclusion criteria – younger patients VAS scores/RDQ The Evidence 71% of patients saw at least a 50% reduction in VAS scores after just one injections Minor side effects Limitations Small sample size

EVIDENCE #7 The Study Measures used – VAS, MODQ scores, SLRT, Neuro exams 10 patients, 3 months The Evidence All VAS scores were under five in three months MOFQ reduced by 30% SLRT improved by 70 degrees Sustained for six. months Strengths Specific inclusion and exclusion criteria Limitations Small sample size No control group

EVIDENCE SUMMARY Overall Consensus Evidence is still very preliminary PRP is superior to HA and steroid injections in small studies PRP is effective in: Overall strengths Every single study showed some improvement in either pain or function, or both Overall limitations SAMPLE SIZE Reducing pain No standardization of administering PRP Improving function No standardization of concentration or mixture to Improving quality of life be used in injections

CONCLUSION PRP is a viable treatment option for treating osteoarthritis Evidence supports that it can help reduce pain and improve a patient’s quality life More research is needed to explore possible PRP combinations, concentrations, and injection regimes

PRACTICE IMPLICATIONS Preliminary studies suggest PRP can be a viable treatment option, however more research is needed. Cost, time, and supplies Delaying unnecessary surgeries Keeping patients active longer

KNOWLEDGE GAPS Are specific growth factors or enzymes better than others in PRP? Is there a concentration, dose or frequency of injections that is more effective? How long do the benefits last? Are there any long term side effects?

FUTURE RESEARCH Larger studies Different stages of OA Different concentrations, doses, and number of injections of PRP

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