Skip to main content
SpringerLink
Log in

Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The biological action of platelet-rich plasma (PRP) could slow down the osteoarthritis progression, resulting in a delay of joint replacement. This work aims to evaluate the ability of PRP to postpone and even avoid knee replacement in patients with knee osteoarthritis (KOA) analyzing, on the one hand, the time of delay and on the other hand the percentage of patients without undergoing total knee arthroplasty (TKA).

Methods

A retrospective analysis and a survival analysis were conducted. KOA patients who underwent knee replacement between 2014 and 2019 and previously received PRP infiltrations were included in the retrospective analysis. Regarding survival analysis, KOA patients who received PRP treatment during 2014 and with follow-up until 2019 were included. The dates of PRP treatment and TKA, KOA severity, age of the patients, number of PRP cycles, and administration route were analyzed.

Results

This work included 1084 patients of which 667 met the inclusion criteria. 74.1% of the patients in the retrospective study achieved a delay in the TKA of more than 1.5 years, with a median delay of 5.3 years. The survival analysis showed that 85.7% of the patients did not undergo TKA during the five year follow-up. The severity degree, age, PRP cycles, and administration route had a statistically significant influence on the efficacy of PRP in delaying surgery.

Conclusion

These data suggest that the application of PRP in KOA patients is a treatment that could delay TKA, although further studies are needed to understand and improve this therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Not applicable.

References

  1. O’Neill TW, McCabe PS, McBeth J (2018) Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Practice & Research. Clin Rheumatol 32(2):312–326. https://doi.org/10.1016/j.berh.2018.10.007

    Article  Google Scholar 

  2. Woodell-May JE, Sommerfeld SD (2020) Role of inflammation and the immune system in the progression of osteoarthritis. J Orthop Res 38(2):253–257. https://doi.org/10.1002/jor.24457

    Article  PubMed  Google Scholar 

  3. Romanini E, Decarolis F, Luzi I, Zanoli G, Venosa M, Laricchiuta P, Carrani E, Torre M (2019) Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty. Int Orthop 43(1):133–138. https://doi.org/10.1007/s00264-018-4165-7

    Article  PubMed  Google Scholar 

  4. Adeyemi A, Trueman P (2019) Economic burden of surgical site infections within the episode of care following joint replacement. J Orthop Surg Res 14(1):196. https://doi.org/10.1186/s13018-019-1224-8

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lohmander LS, Roos EM (2007) Clinical update: treating osteoarthritis. Lancet. 370(9605):2082–2084. https://doi.org/10.1016/S0140-6736(07)61879-0

    Article  PubMed  Google Scholar 

  6. O'Connell B, Wragg NM, Wilson SL (2019) The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res 376(2):143–152. https://doi.org/10.1007/s00441-019-02996-x

    Article  PubMed  Google Scholar 

  7. Sánchez M, Beitia M, Pompei O et al (2019) Isolation, activation, and mechanism of action of platelet-rich plasma and its applications for joint repair. Regen Med IntechOpen. https://doi.org/10.5772/intechopen.90543

  8. Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC (2020) Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med:363546520909397. https://doi.org/10.1177/0363546520909397

  9. Sánchez M, Fiz N, Guadilla J, Padilla S, Anitua E, Sánchez P et al (2014) Intraosseous infiltration of platelet-rich plasma for severe knee osteoarthritis. Arthrosc Tech 3(6):e713–e717. https://doi.org/10.1016/j.eats.2014.09.006

    Article  PubMed  PubMed Central  Google Scholar 

  10. Vilchez-Cavazos F, Millán-Alanís JM, Blázquez-Saldaña J, Álvarez-Villalobos N, Peña-Martínez VM, Acosta-Olivo CA et al (2019) Comparison of the clinical effectiveness of single versus multiple injections of platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Orthop J Sports Med 7(12):2325967119887116. https://doi.org/10.1177/2325967119887116

    Article  PubMed  PubMed Central  Google Scholar 

  11. Altman R, Fredericson M, Bhattacharyya SK, Bisson B, Abbott T, Yadalam S et al (2016) Association between hyaluronic acid injections and time-to-total knee replacement surgery. J Knee Surg 29(7):564–570. https://doi.org/10.1055/s-0035-1568992

    Article  PubMed  Google Scholar 

  12. Delbarre A, Amor B, Bardoulat I, Tetafort A, Pelletier-Fleury N (2017) Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - a Cox model analysis. PLoS One 12(11):e0187227. https://doi.org/10.1371/journal.pone.0187227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ong KL, Anderson AF, Niazi F, Fierlinger AL, Kurtz SM, Altman RD (2016) Hyaluronic acid injections in medicare knee osteoarthritis patients are associated with longer time to knee arthroplasty. J Arthroplast 31(8):1667–1673. https://doi.org/10.1016/j.arth.2016.01.038

    Article  Google Scholar 

  14. Boutefnouchet T, Puranik G, Holmes E, Bell KM (2017) Hylan GF-20 viscosupplementation in the treatment of symptomatic osteoarthritis of the knee: clinical effect survivorship at 5 years. Knee Surg Relat Res 29(2):129–136. https://doi.org/10.5792/ksrr.16.061

    Article  PubMed  PubMed Central  Google Scholar 

  15. Waddell DD, Joseph B (2016) Delayed total knee replacement with Hylan G-F 20. J Knee Surg. 29(2):159–168. https://doi.org/10.1055/s-0034-1395281

    Article  PubMed  Google Scholar 

  16. Larsson A, Carlsson L, Gordh T, Lind AL, Thulin M, Kamali-Moghaddam M (2015) The effects of age and gender on plasma levels of 63 cytokines. J Immunol Methods 425:58–61. https://doi.org/10.1016/j.jim.2015.06.009

    Article  CAS  PubMed  Google Scholar 

  17. Stowe RP, Peek MK, Cutchin MP, Goodwin JS (2010) Plasma cytokine levels in a population-based study: relation to age and ethnicity. J Gerontol A Biol Sci Med Sci 65A(4):429–433. https://doi.org/10.1093/gerona/glp198

    Article  CAS  Google Scholar 

  18. Delgado D, Garate A, Sánchez P, Bilbao AM, García Del Caño G, Salles J et al (2020) Biological and structural effects after intraosseous infiltrations of age-dependent platelet-rich plasma: an in vivo study. J Orthop Res. https://doi.org/10.1002/jor.24646

  19. Xu Z, Yin W, Zhang Y, Qi X, Chen Y, Xie X et al (2017) Comparative evaluation of leukocyte- and platelet-rich plasma and pure platelet-rich plasma for cartilage regeneration. Sci Rep 7:43301. https://doi.org/10.1038/srep43301

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rossi LA, Murray IR, Chu CR, Muschler GF, Rodeo S, Piuzzi NS (2019) Classification systems for platelet-rich plasma. Bone Joint J 101-B(8):891–896. https://doi.org/10.1302/0301-620X

    Article  CAS  PubMed  Google Scholar 

  21. Vaquerizo V, Padilla S, Aguirre JJ, Begoña L, Orive G, Anitua E (2018) Two cycles of plasma rich in growth factors (PRGF-Endoret) intra-articular injections improve stiffness and activities of daily living but not pain compared to one cycle on patients with symptomatic knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(9):2615–2621. https://doi.org/10.1007/s00167-017-4565-z

    Article  PubMed  Google Scholar 

  22. Gobbi A, Lad D, Karnatzikos G (2015) The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 23(8):2170–2177. https://doi.org/10.1007/s00167-014-2987-4

    Article  PubMed  Google Scholar 

  23. Chen Z, Wang C, You D, Zhao S, Zhu Z, Xu M (2020) Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Medicine (Baltimore) 99(11):e19388. https://doi.org/10.1097/MD.0000000000019388

    Article  CAS  Google Scholar 

  24. Chouhan DK, Dhillon MS, Patel S, Bansal T, Bhatia A, Kanwat H (2019) Multiple platelet-rich plasma injections versus single platelet-rich plasma injection in early osteoarthritis of the knee: an experimental study in a guinea pig model of early knee osteoarthritis. Am J Sports Med 47(10):2300–2307. https://doi.org/10.1177/0363546519856605

    Article  PubMed  Google Scholar 

  25. Sánchez M, Anitua E, Delgado D, Sanchez P, Prado R, Goiriena JJ et al (2016) A new strategy to tackle severe knee osteoarthritis: combination of intra-articular and intraosseous injections of platelet-rich plasma. Expert Opin Biol Ther 16(5):627–643. https://doi.org/10.1517/14712598.2016.1157162

    Article  CAS  PubMed  Google Scholar 

  26. Delgado D, Garate A, Vincent H, Bilbao AM, Patel R, Fiz N et al (2019) Current concepts in intraosseous platelet-rich plasma injections for knee osteoarthritis. J Clin Orthop Trauma 10(1):36–41. https://doi.org/10.1016/j.jcot.2018.09.017

    Article  PubMed  Google Scholar 

  27. Altman RD, Devji T, Bhandari M, Fierlinger A, Niazi F, Christensen R (2016) Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: a systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum 46:151–159. https://doi.org/10.1016/j.semarthrit.2016.04.003

    Article  CAS  PubMed  Google Scholar 

  28. Previtali D, Merli G, Di Laura FG, Candrian C, Zaffagnini S, Filardo G (2020) The long-lasting effects of “placebo injections” in knee osteoarthritis: a meta-analysis. Cartilage. 1947603520906597. https://doi.org/10.1177/1947603520906597

  29. Hastie G, Soufi M, Wilson J, Roy B (2018) Platelet-rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention. J Orthop 15(1):239–241. https://doi.org/10.1016/j.jor.2018.01.046

    Article  PubMed  PubMed Central  Google Scholar 

  30. Repetto I, Biti B, Cerruti P, Trentini R, Felli L (2017) Conservative treatment of ankle osteoarthritis: can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg 56(2):362–365. https://doi.org/10.1053/j.jfas.2016.11.015

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Arthroscopic Surgery Unit, Hospital Vithas San José, Beato Tomás de Zumarraga 10, 01008, Vitoria-Gasteiz, Spain

    Mikel Sánchez, Beatriz García-Cano, Jorge Guadilla & Diego Delgado

  2. Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain

    Mikel Sánchez, Cristina Jorquera, Pello Sánchez, Maider Beitia & Diego Delgado

Authors
  1. Mikel Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Jorquera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pello Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maider Beitia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Beatriz García-Cano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorge Guadilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Diego Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors equally contributed to this paper, in terms of the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

Corresponding author

Correspondence to Diego Delgado.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The present study was carried out in accordance with the international standard on clinical studies: Declaration of Helsinki in its latest revised version (Fortaleza, Brazil; 2013), and Good Clinical Practice Regulations (International Conference for Harmonization). Ethical approval for this study was obtained from the Ethics Committee of the Basque Country.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sánchez, M., Jorquera, C., Sánchez, P. et al. Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. International Orthopaedics (SICOT) 45, 401–410 (2021). https://doi.org/10.1007/s00264-020-04669-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04669-9

Keywords

Search

Navigation