American Society of Regional Anesthesia and Pain Medicine May 2017 - 37
Platelet-Rich Plasma Injections for Knee Osteoarthritis:
How Long Do the Benefits Last?
THE CHALLENGING PROBLEM OF KNEE OSTEOARTHRITIS
Osteoarthritis (OA) is a common condition, typically discovered in
middle age. The prevalence of symptomatic knee OA is as high
as 13% in women and 10% in men older than 60 years.1 It is
significantly higher in the population 65 years and older and is one
of the top five causes of disability.1 Direct healthcare costs of knee
OA are significant. For example, estimated hospital expenditures
for total knee joint replacements are around $10 billion a year in
the United States alone.2 However, this figure likely represents
only a small portion of the economic impact of this condition:
Likely to increase this cost estimate substantially are the global
economic impact of knee OA on work performance, absenteeism,
required assistance within households, and the negative impact
of decreased physical activity on mental health as well as
cardiovascular, endocrine, and other organ systems.3
Current evidence suggests that managing pain and other
problems associated with knee OA via physical rehabilitation,
manipulation therapy, and pharmacotherapy remain unsatisfactory.4
Corticosteroids and hyaluronic acid are the most commonly
used agents for intra-articular knee injections.4 Despite their
widespread use, corticosteroid injections appear to be appropriate
predominantly for knee OA with synovitis.4 The duration of clinical
effects for corticosteroid injections is usually only a few weeks,
according to the majority of studies.4 Viscosupplementation with
hyaluronic acid has been
considered a safe and useful
treatment for symptomatic
knee OA in many studies,
including a recent systematic
review of high-quality, placebocontrolled trials.5 However,
other systematic reviews
have reported contradictory
conclusions, including that
viscosupplementation has no or
minimal benefit, any benefits that occur last for less than 6 months
after injection, and the therapy is associated with adverse effects.6
Dmitri Souzdalnitski, MD, PhD
Heritage College of Osteopathic
Medicine, Ohio University
Center for Pain Medicine, Western
Reserve Hospital
Cuyahoga Falls, Ohio
Imanuel R. Lerman, MD, MS
Department of Anesthesiology,
University of California
San Diego, California
Section Editor: Magdalena Anitescu, MD
Analgesic outcomes of arthroscopic surgery for knee OA are
unclear and, even if present, last less than 2 years.7 The definitive
treatment for knee OA remains knee replacement, which is not
without its own adverse effects and limitations.4 The current
published causes of death secondary to knee OA do not include
the complications of treatment with opioids, nonsteroidal antiinflammatory drugs (NSAIDs), or other drugs used to treat knee OA.4
Platelet-rich plasma (PRP) therapy involves the use of a patient's
own growth factors contained in platelet alpha-granules in
supraphysiologic concentrations.9 Experimental studies have
suggested that PRP injections may stimulate regeneration of the
bone, cartilage, and synovia. Initial clinical studies assessing
the feasibility of using PRP
injections for knee pathology,
published more than 7 years
ago, showed that PRP might
be a viable treatment option to
address the pain and functional
disability accompanying
knee OA.10 The number of
publications in this area has
grown significantly since the
initial investigations. Various
reviews have assessed pain, function, and quality of life for knee
OA patients treated with PRP. More recent studies and reviews
of the clinical evidence suggest that PRP could be a reasonable
management option for temporarily alleviating pain and improving
function as well as improving quality of life. However, the current
literature does not systematically assess the duration of clinical
benefit of PRP and recounted autologous products. We have
recently reviewed these studies with our colleagues, Dr. Samer
Narouze and Dr. Aaron Calodney, in an attempt to answer this
important question.10
A SEARCH FOR NOVEL MANAGEMENT TOOLS
Disappointing treatment outcomes have prompted a rigorous
search for agents that will result in restorative reactions in the
knee while maintaining a balance between degenerative and
regenerative processes in the joint tissues.4,7,8
PLATELET-RICH PLASMA INJECTIONS FOR KNEE OSTEOARTHRITIS:
DURATION OF CLINICAL EFFECT
Using a systematic review approach, we analyzed published clinical
reports on the duration of therapeutic effect of PRP in patients
with knee OA. We searched primarily for randomized controlled
"Regenerative medicine agents are
used with the intention of shifting the
balance toward reparative processes
in the knee joint affected by the
degenerative process or injury."
American Society of Regional Anesthesia and Pain Medicine
2017
37
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