1.
The efficacy of intraoperative autologous platelet gel in total knee arthroplasty: a meta-analysis
Kuang MJ, Han C, Ma JX, Li F, Zhao J, Fu L, Ma XL
International Journal of Surgery (London, England). 2016;36((Pt A):):56-65
Abstract
PURPOSE Autologous platelet gel, developed from fresh autologous blood, is a breakthrough in the promotion and acceleration of soft tissue and bone repair. The application of autologous platelet gel has been reported to improve haemostasis and promote function recovery. We screened the randomized controlled trials and controlled clinical trials of high quality to investigate whether autologous platelet gel makes a better performance for postoperative bleeding and functional recovery in patients after total knee arthroplasty. METHOD The Web of Science, the Cochrane Library, EMBASE, and PubMed databases were comprehensively searched. A total of 1234 patients with 1333 knees were included in the twelve studies. The PRISMA guidelines and Cochrane Handbook were applied to appraise the results published in all included studies. Review Manager 5.3 for Windows was used to analyse the extracted data. RESULTS Compared with the placebo group, the autologous platelet gel group showed a significant decrease in visual analogue scale. No significant differences were found in the drop of haemoglobin, knee society score, Western ontario mcmaster osteoarthritis index, length of hospital stay, postoperative narcotics, and range of motion during post-operative follow-up. CONCLUSIONS Compared with placebo, APG offers superior pain control after total knee arthroplasties. However, APG has no advantage in blood loss, functional recovery, postoperative narcotics and length of stay. The use of autologous platelet gel is not worthy of being recommended as a bioactive autologous material to improve the clinical outcomes in total knee arthroplasty patients.
2.
No positive effect of autologous platelet gel after total knee arthroplasty: a double-blind randomized controlled trial: 102 patients with a 3-month follow-up
Peerbooms JC, De Wolf GS, Colaris JW, Bruijn DJ, Verhaar JAN
Acta Orthopaedica. 2009;80((5):):557-62.
Abstract
Background and purpose: Activated platelets release a cocktail of growth factors, some of which are thought to stimulate repair. We investigated whether the use of autologous platelet gel (PG) in total knee arthroplasty (TKA) would improve wound healing and knee function, and reduce blood loss and the use of analgesics. Patients and methods: 102 patients undergoing TKA were randomly assigned to a PG group (n 50) or to a control (C) group (n 52). The primary analysis was based on 73 participants (PG: 32; C: 41) with comparison of postoperative wound scores, VAS, WOMAC, knee function, use of analgesics, and the pre- and postoperative hemoglobin values after a follow-up of 3 months. 29 participants were excluded due to insufficient data. Results: The characteristics of the protocol-compliant patients were similar to those of the patients who were excluded. Analysis was per protocol and focused on the remaining 73 patients. At baseline and after 3 months of follow-up, there were no statistically significant differences between both groups regarding age, height, weight, sex, side of operation, platelet count, hemoglobin values, severity of complaints (WOMAC), and level of pain. Interpretation In our patients undergoing TKA, application of PG to the wound site did not promote wound healing. Also, we found that PG had no effect on pain, knee function, or hemoglobin values. copyright 2009 Nordic Orthopedic Federation. Copyright © 2011 Elsevier B. V. , Amsterdam. All Rights Reserved.
3.
Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty
Zavadil DP, Satterlee CC, Costigan JM, Holt DW, Shostrom VK
The Journal of Extra-Corporeal Technology. 2007;39((3):):177-82.
Abstract
The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by activating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postoperatively. After Institutional Review Board (IRB) approval, 40 patients undergoing TSA at our institution were prospectively enrolled in our study. They were randomized into either a control (n = 20) or study (n = 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measurements, and postoperative lengths of stay were recorded for each group. The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4. 64 +/- 4. 46 vs. 1. 88 +/- 2. 44, p < . 05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84. 54 +/- 5. 32 vs. 79. 87 +/- 8. 73) and 72 hours (87. 46 +/- 16. 03 vs. 76. 70 vs. 5. 96), but neither difference reached statistical significance. The treatment group had significantly lower pain scores (p = . 007) and total fentanyl requirements (p < . 05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative internal rotation index) was significantly higher in the treatment group vs. the control group (p < . 05). Although it did not reach statistical significance, the treatment group was discharged almost 9 hours earlier than the control group (64. 44 +/- 15. 23 vs. 73. 39 +/- 15. 37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively.