Assessment of the role of platelet rich plasma (PRP) in mild to moderate osteoarthritis knee joint using VAS and WOMAC score
Journal Title: International Journal of Medical and Health Research - Year 2018, Vol 4, Issue 10
Abstract
Introduction: Osteoarthritis is the most common form of arthritis afflicting mankind specially the elderly population. One of the most affected joints is the knee. Characteristic features of osteoarthritis are pain, swelling, and stiffness with the decline in physical function such as walking, climbing stairs and getting in and out of the chair. There is a large population of young and active people with early osteoarthritis who have not yet developed the classical signs of OA. But, who are strong candidates to an increased risk for accelerated development of joint degeneration. Approximately 27 million Americans over the age of 25 currently suffer from OA. This number is predicted to increase by 2030 to a staggering 67million. The number of total hip replacement and total knee replacement operations is expected to reach 572,000 and 3,480,000, respectively by 2030. At present, there are numerous, non-invasive treatment modalities like physical therapy, analgesic, non-steroid anti-inflammatory drugs, glucosamine/chondroitin supplementation, intra-articular injection of hyaluronic acid (HA), intra-articular steroid injection and Platelet Rich Plasma. In almost all published studies, PRP has been shown to have a strong positive effect on chondrocyte proliferation in vitro. Platelet rich plasma (PRP) therapy is a simple, low cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration. This therapy is widely experimented in different fields of medicine to test its potential to enhance tissue regeneration. Aims and Objectives: The aim of the study is to assess the role of PRP in active patients with symptomatic Osteoarthritis knee and to compare the clinical outcome of PRP treatment by using WOMAC and VAS scoring system at different time interval. Materials and Methods: The study was conducted in the Department of Orthopaedics at Santosh hospital Ghaziabad over a period of 24 months (October 2013 to October 2015). Subjects were recruited randomly from patients presenting with pain in knee joint in Orthopaedics OPD, and diagnosed as a case of primary Osteoarthritis Knee after Clinical and Radiological evaluation and satisfying inclusion criteria which includes patients above 35-75 years age with Unilateral or Bilateral Osteoarthritis Knee involvements, history of chronic knee pain or swelling equal to or more than four months, radiological (X-ray) finding of articular cartilage degeneration, including Kellgren-Lawrence (KL) Grade II and III. Patients who signed written informed consent and the patients were excluded following the exclusion criteria viz. systemic disorders like Gouty Arthritis, Rheumatoid Arthritis Diabetic mellitus, any bleeding disorder, metabolic disease or cardiovascular disease, immunosuppressed patients and those receiving anticoagulation therapy, platelets values of <150,000/mmc. Pregnancy, late stages of Osteoarthritis Knee, KL Grade IV. Results: In our study, it was observed that the age distribution of the cases ranged from 35 years to above 65 years, with a maximum number of cases i.e. 58 (53.70%) in the age group of 35-45 years. The mean age of the cases was 49.82 ± 8.62 years. In our study we observed a female preponderance, with 62 out of 108 (57.40%) cases being females. This was in accordance with the study conducted by Sandeep et al, which also had a female preponderance. In the present study the maximum number of patients were homemakers, being 56 (51.85%) cases, followed by labourers 15 (13.88%), maximum number of patients 75 (69.44%) cases had complaints of pain for less than a year while 33 (30.55%) cases had complaints of Pain more than 1 year. In our study 80 out of 108 cases (74.07%) had grade II disease status as per the Kellgren-Lawrence grading scale and 28 out of 108 cases i.e. 25.92% had grade III disease status. This finding differed from that of Gobbi et al who had approximately equal number of cases with KL Grade II and III. However the VAS score in our study showed an improvement at 24 weeks which was 4.29±2.10 and the WOMAC score showed a significant improvement at all follow ups decreasing to 44.55±20.47 at the final follow up of 24 weeks. Conclusion: The hypothesis of this study was that PRP reduces pain and leads to a more effective and lasting functional recovery in mild to moderate osteoarthritis knee patients. Our objective was to assess the efficacy of PRP IAI for relieving pain and improving knee function in Grade 1 and 2 OA Knee using WOMAC and VAS Scoring methods. Total 108 patients diagnosed with osteoarthritis, were included in our study. All patients were given 3 intra articular injections of PRP at 0, 3 and 6 weeks and followed up at 6, 12 and 24 weeks and found better improvement in activities of daily living post PRP therapy. We demonstrated that PRP IAI is potentially safe, simple, and low-cost method to improve articular joint healing, with promising results.
Authors and Affiliations
Ashok Kumar, Amit Dwivedi, Tushar Sachdev
Keywords
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