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Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: a systematic review and meta-analysis

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Abstract

The effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. Previous research supports the use of intra-articular PRP injections to promote a favorable environment for joint tissue healing and to delay the progression of OA. The purpose of this review is to investigate the effectiveness of PRP in the management of hip osteoarthritis (HOA). Five electronic databases were searched from inception to May 2019: Medline (via PubMed), SportDiscus via EBSCO, ProQuest Health & Medical Complete, CINAHL, and Cochrane. Risk of bias was assessed with the Cochrane risk of bias tool. The GRADE method was used to assess the level of evidence for the studies included in this review. Clinical trials evaluate PRP injections among adult patients diagnosed with HOA according to the American College of Rheumatology criteria. At least one outcome measure for pain or function must have been reported. A total of 4 trials (334 participants, 340 hips) were included, all marked as “moderate risk of bias”. Pain and function were assessed throughout the studies with visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Harris Hip Score (HHS) tools. Intra-articular PRP injections were more effective at stages earlier than 3 months for both treatment groups with the exception of WOMAC score in one study. The superiority of PRP against comparative treatments was only reported in one study; longer-term evaluations from 4 to 12 months showed diverse results, with only one study reporting significantly better results for PRP. PRP may be beneficial and safe for patients with HOA at mid-term follow-up. However, its superiority over other procedures such as hyaluronic acid remains unclear. Further researches with high-quality designs and larger samples become imperative.

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References

  1. Buckwalter JA, Martin JA (2006) Osteoarthritis. Adv Drug Deliv Rev 58:150–167. https://doi.org/10.1016/j.addr.2006.01.006

    Article  CAS  PubMed  Google Scholar 

  2. Murphy L, Helmick CG (2012) The impact of osteoarthritis in the United States: a population-health perspective. Am J Nurs 112:S13–S19. https://doi.org/10.1097/01.NAJ.0000412646.80054.21

    Article  PubMed  Google Scholar 

  3. Murray CJL, Lopez AD, Organization WH, Bank W, Health HS of P (1996) The Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary. World Health Organization

  4. Murphy L, Helmick CG (2012) Preventing and Managing OA 112:7

  5. Peat G, McCarney R, Croft P (2001) Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 60:91–97. https://doi.org/10.1136/ard.60.2.91

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dawson J, Linsell L, Zondervan K, Rose P, Randall T, Carr A, Fitzpatrick R (2004) Epidemiology of hip and knee pain and its impact on overall health status in older adults. Rheumatology (Oxford) 43:497–504. https://doi.org/10.1093/rheumatology/keh086

    Article  CAS  Google Scholar 

  7. Zhang W, Doherty M (2006) EULAR recommendations for knee and hip osteoarthritis: a critique of the methodology. Br J Sports Med 40:664–669. https://doi.org/10.1136/bjsm.2004.016840

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wang X, Hunter D, Xu J, Ding C (2015) Metabolic triggered inflammation in osteoarthritis. Osteoarthr Cartil 23:22–30. https://doi.org/10.1016/j.joca.2014.10.002

    Article  CAS  Google Scholar 

  9. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P, American College of Rheumatology (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 64:465–474. https://doi.org/10.1002/acr.21596

    Article  CAS  Google Scholar 

  10. Bruyere O, Reginster J-Y (2007) Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging 24:573–580. https://doi.org/10.2165/00002512-200724070-00005

    Article  CAS  PubMed  Google Scholar 

  11. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM (2014) A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum 43:701–712. https://doi.org/10.1016/j.semarthrit.2013.11.012

    Article  PubMed  Google Scholar 

  12. Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S, Grasso MA, Panzani I (1987) A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artif Organs 10:47–50

    Article  CAS  PubMed  Google Scholar 

  13. Qi YY, Chen X, Jiang YZ, Cai HX, Wang LL, Song XH, Zou XH, Ouyang HW (2009) Local delivery of autologous platelet in collagen matrix simulated in situ articular cartilage repair. Cell Transplant 18:1161–1169. https://doi.org/10.3727/096368909X12483162197169

    Article  PubMed  Google Scholar 

  14. Sun Y, Feng Y, Zhang CQ, Chen SB, Cheng XG (2010) The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop 34:589–597. https://doi.org/10.1007/s00264-009-0793-2

    Article  CAS  PubMed  Google Scholar 

  15. Pereira RC, Scaranari M, Benelli R, Strada P, Reis RL, Cancedda R, Gentili C (2013) Dual effect of platelet lysate on human articular cartilage: a maintenance of chondrogenic potential and a transient proinflammatory activity followed by an inflammation resolution. Tissue Eng A 19:1476–1488. https://doi.org/10.1089/ten.TEA.2012.0225

    Article  CAS  Google Scholar 

  16. Wu C-C, Chen W-H, Zao B, Lai P-L, Lin T-C, Lo H-Y, Shieh YH, Wu CH, Deng WP (2011) Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials 32:5847–5854. https://doi.org/10.1016/j.biomaterials.2011.05.002

    Article  CAS  PubMed  Google Scholar 

  17. Akeda K, An HS, Okuma M, Attawia M, Miyamoto K, Thonar EJ-MA, Lenz ME, Sah RL, Masuda K (2006) Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthr Cartil 14:1272–1280. https://doi.org/10.1016/j.joca.2006.05.008

    Article  CAS  Google Scholar 

  18. Qureshi AH, Chaoji V, Maiguel D, Faridi MH, Barth CJ, Salem SM, Singhal M, Stoub D, Krastins B, Ogihara M, Zaki MJ, Gupta V (2009) Proteomic and phospho-proteomic profile of human platelets in basal, resting state: insights into integrin signaling. PLoS One 4:e7627. https://doi.org/10.1371/journal.pone.0007627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Pietrzak WS, Eppley BL (2005) Platelet rich plasma: biology and new technology. J Craniofac Surg 16:1043–1054

    Article  PubMed  Google Scholar 

  20. Stiles CD (1983) The molecular biology of platelet-derived growth factor. Cell 33:653–655

    Article  CAS  PubMed  Google Scholar 

  21. Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, Peng J (2013) Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthr Cartil 21:1627–1637. https://doi.org/10.1016/j.joca.2013.07.017

    Article  CAS  Google Scholar 

  22. Di Matteo B, Filardo G, Kon E, Marcacci M (2014) Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy-a systematic review. Musculoskelet Surg 99:1–9. https://doi.org/10.1007/s12306-014-0340-1

    Article  PubMed  Google Scholar 

  23. Figueroa D, Figueroa F, Calvo R, Vaisman A, Ahumada X, Arellano S (2015) Platelet-rich plasma use in anterior cruciate ligament surgery: systematic review of the literature. Arthroscopy 31:981–988. https://doi.org/10.1016/j.arthro.2014.11.022

    Article  PubMed  Google Scholar 

  24. Mostafaei S, Norooznezhad F, Mohammadi S, Norooznezhad AH (2017) Effectiveness of platelet-rich plasma therapy in wound healing of pilonidal sinus surgery: a comprehensive systematic review and meta-analysis. Wound Repair Regen 25:1002–1007. https://doi.org/10.1111/wrr.12597

    Article  PubMed  Google Scholar 

  25. Chen JX, Justicz N, Lee LN (2018) Platelet-rich plasma for the treatment of androgenic alopecia: a systematic review. Facial Plast Surg 34:631–640. https://doi.org/10.1055/s-0038-1660845

    Article  CAS  PubMed  Google Scholar 

  26. Bousnaki M, Bakopoulou A, Koidis P (2018) Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: a systematic review. Int J Oral Maxillofac Surg 47:188–198. https://doi.org/10.1016/j.ijom.2017.09.014

    Article  CAS  PubMed  Google Scholar 

  27. Bennell KL, Hunter DJ, Paterson KL (2017) Platelet-rich plasma for the management of hip and knee osteoarthritis. Curr Rheumatol Rep 19:24. https://doi.org/10.1007/s11926-017-0652-x

    Article  PubMed  Google Scholar 

  28. Tietze DC, Geissler K, Borchers J (2014) The effects of platelet-rich plasma in the treatment of large-joint osteoarthritis: a systematic review. Phys Sportsmed 42:27–37. https://doi.org/10.3810/psm.2014.05.2055

    Article  PubMed  Google Scholar 

  29. Dold AP, Zywiel MG, Taylor DW, Dwyer T, Theodoropoulos J (2014) Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med 24:31–43. https://doi.org/10.1097/01.jsm.0000432855.85143.e5

    Article  PubMed  Google Scholar 

  30. Ye Y, Zhou X, Mao S, Zhang J, Lin B (2018) Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg 53:279–287. https://doi.org/10.1016/j.ijsu.2018.03.078

    Article  PubMed  Google Scholar 

  31. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  32. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  33. N.d. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=10210 (accessed Jun 8, 2019)

  34. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D, Greenwald R, Hochberg M, Howell D, Ike R, Kapila P, Kaplan D, Koopman W, Marino C, McDonald E, McShane DJ, Medsger T, Michel B, Murphy WA, Osial T, Ramsey-Goldman R, Rothschild B, Wolfe F (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34:505–514

    Article  CAS  PubMed  Google Scholar 

  35. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  36. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926. https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  37. Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S (2013) Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 36:e1501–e1508

    Article  PubMed  Google Scholar 

  38. Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G (2016) Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med 44:664–671. https://doi.org/10.1177/0363546515620383

    Article  PubMed  Google Scholar 

  39. Di Sante L, Villani C, Santilli V, Valeo M, Bologna E, Imparato L et al (2016) Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis. Med Ultrason 18:463–468. https://doi.org/10.11152/mu-874

    Article  PubMed  Google Scholar 

  40. Doria C, Mosele GR, Caggiari G, Puddu L, Ciurlia E (2017) Treatment of early hip osteoarthritis: ultrasound-guided platelet rich plasma versus hyaluronic acid injections in a randomized clinical trial. Joints 5:152–155. https://doi.org/10.1055/s-0037-1605584

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lawson B, Putnam W, Nicol K, Archibald G, Mackillop J, Conter H, Frail D (2004) Managing osteoarthritis. Medication use among seniors in the community. Can Fam Physician 50:1664–1670

    PubMed  PubMed Central  Google Scholar 

  42. (2005) Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys Ther 85:907–971

  43. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162. https://doi.org/10.1016/j.joca.2007.12.013

    Article  CAS  Google Scholar 

  44. Chang K-V, Hung C-Y, Aliwarga F, Wang T-G, Han D-S, Chen W-S (2014) Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil 95:562–575. https://doi.org/10.1016/j.apmr.2013.11.006

    Article  PubMed  Google Scholar 

  45. Wehling P, Evans C, Wehling J, Maixner W (2017) Effectiveness of intra-articular therapies in osteoarthritis: a literature review. Ther Adv Musculoskelet Dis 9:183–196. https://doi.org/10.1177/1759720X17712695

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors would like to acknowledge Patricia Alvarez-Juarez for her valuable contribution at the initial stages of this study.

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Authors and Affiliations

  1. Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain

    Ivan Medina-Porqueres & Miguel Ortega-Castillo

  2. Department of Nursing and Physical Therapy, Faculty of Health Sciences, University of Alcala, Alcala, Spain

    Miguel Ortega-Castillo & Alfonso Muriel-Garcia

  3. Medical Services, Malaga Football Club, Malaga, Spain

    Ivan Medina-Porqueres

  4. Ramon and Cajal Hospital IRYCIS, CIBERESP, Madrid, Spain

    Alfonso Muriel-Garcia

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  1. Ivan Medina-Porqueres
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Correspondence to Ivan Medina-Porqueres.

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Medina-Porqueres, I., Ortega-Castillo, M. & Muriel-Garcia, A. Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 40, 53–64 (2021). https://doi.org/10.1007/s10067-020-05241-x

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