1.
Effectiveness of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Clinical Trials
Nie LY, Zhao K, Ruan J, Xue J
Orthopaedic journal of sports medicine. 2021;9(3):2325967120973284
Abstract
BACKGROUND The effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis and the effects of leukocyte-poor PRP (LP-PRP) versus leukocyte-rich PRP (LR-PRP) are still controversial. PURPOSE To assess the effectiveness of different PRP injections through a direct and indirect meta-analysis of randomized controlled trials. STUDY DESIGN Systematic review; Level of evidence, 1. METHODS A systematic literature search of electronic databases (PubMed, Cochrane Library, and EMBASE) was performed to locate randomized controlled trials published through March 2019 that compared PRP with control treatment. A random-effects meta-analysis was conducted to synthesize the evidence, and meta-regression analyses were conducted to determine the influence of trial characteristics. An indirect comparison was performed to assess the effects of LP-PRP and LR-PRP compared with hyaluronic acid (HA). RESULTS A total of 21 trials were included. A clinically important benefit for pain relief was seen for intra-articular PRP compared with intra-articular saline (standardized mean difference [SMD] = -1.38 [95% CI, -2.07 to -0.70]; P < .0001; I (2) = 37%) and corticosteroid solution injection (SMD = -2.47 [95% CI, -3.34 to -1.61]; P < .00001; I (2) = 47%). As a result of heterogeneity (I (2) = 89%), there was no conclusive effect compared with HA, even though the pooling effect provided clinically relevant pain relief (SMD = -0.59 [95% CI, -0.97 to -0.21]; P = .003). Indirect meta-analysis showed that there was no significant difference between LR-PRP and LP-PRP. CONCLUSION PRP injections are beneficial for pain relief and functional improvement in knee osteoarthritis. Larger, randomized high-quality studies are needed to compare the effects of LP-PRP and LR-PRP.
2.
The influence of sample size and gender composition on the meta-analysis conclusion of platelet-rich plasma treatment for osteoarthritis
Zhao K, Liu YS, Nie LY, Qian LN, Nie NF, Leptihn S, Bunpetch V, Xu JQ, Zou XH, Ouyang H
J Orthop Translat. 2020;22:34-42
Abstract
Objective: The magnitude of the therapeutic effects of intra-articular injection of platelet-rich plasma (PRP) on osteoarthritis (OA) is still under debate. The goal of this study that was a systematic review of randomised controlled trials of PRP injections for the treatment of OA was to elucidate the therapeutic efficacy of PRP. Methods: Electronic databases of PubMed, CENTRAL, EMBASE, EBSCO, ClinicalTrials.gov, and International Clinical Trials Registry Platform were searched from inception to June 2018 for RCTs that compared PRP injections to controls in patients with OA. A random-effects approach was used to compile data and subgroups according to trial size (large trials versus small trials), patient profile (age and gender), and PRP preparation method was performed. Results: Thirty trials met the inclusion criteria and were analysed. All results had unexplained statistical heterogeneity. Patients treated with PRP compared with control showed statistically relevant pain relief and function improvement at short term (standardised mean difference [SMD] = -0.62, 95% confidence interval [CI]: -0.98 to -0.27, P = 0.0006, SMD = -0.74, 95% CI: -1.11 to 0.36, P = 0.0001, respectively), medium term (SMD = -0.53, 95% CI: -0.83 to -0.23, P = 0.0006, SMD = -0.50, 95% CI: -0.75 to -0.25, P = 0.0006), and long term (SMD = -0.69, 95% CI: -1.08 to -0.30, P = 0.0006, SMD = -0.68, 95% CI: -0.1.09 to -0.27, P = 0.001, respectively). A subgroup analysis of the data from large trials and from trials composed of less than 50% female patients revealed that therapeutic effects of the treatment are insignificant. Conclusions: According to the currently available data, PRP injections are beneficial for pain relief and function improvement in patients with OA. This meta-analysis, however, demonstrated that the efficacy of PRP is related to sample size and gender composition. Thus, more randomised controlled trials of high quality and larger patient size, also including gender aspects, are required to understand this phenomenon. The translational potential of this article: The translation potential of this meta-analysis is that provided another perspective to analyse the treatment effect of PRP for OA. In future research, phenotypes subpopulation and gender difference of OA patient should be considered for PRP treatment.
3.
Infected bone inactivation combined with transplantation of autologous platelet-rich plasma and bone marrow for treatment of chronic osteomyelitis
Wang JH, Zhao K, Liu HL, Zhao HM, Yang J, Sun XK
European Review for Medical & Pharmacological Sciences. 2015;19((23)):4488-93.
Abstract
OBJECTIVE Here we tested the therapeutic efficacy of infected bone inactivation combined with transplantation of autologous platelet-rich plasma and bone marrow in chronic osteomyelitis. PATIENTS AND METHODS 64 patients with chronic osteomyelitis were randomly divided into two groups. Patients in control group received conventional antibiotic and surgical treatments, while patients in the experimental treatment group underwent infected bone inactivation combined with transplantation of autologous platelet-rich plasma and bone marrow. The X-ray, histological, and biochemical (alkaline phosphatase) changes were assessed at 4, 8, 12 and 16 weeks after the treatment. RESULTS At all tested study points, X-ray and histological scores, and alkaline phosphatase levels were significantly better in patients of the experimental treatment group. CONCLUSIONS Infected bone inactivation combined with transplantation of autologous platelet-rich plasma and bone marrow achieves beneficial therapeutic results in chronic osteomyelitis.