Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2022; 13(10): 911-920
Published online Oct 18, 2022. doi: 10.5312/wjo.v13.i10.911
Adjunctive platelet-rich plasma and hyaluronic acid injection after arthroscopic debridement in Kellgren-Lawrence grade 3 and 4 knee osteoarthritis
Henry Tirtosuharto, I Gede Eka Wiratnaya, Putu Astawa
Henry Tirtosuharto, I Gede Eka Wiratnaya, Putu Astawa, Department of Orthopaedic and Traumatology, Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar 80113, Bali, Indonesia
Author contributions: Tirtosuharto H designed and conceived the study, collected the data, conducted the data analyses, and drafted the manuscript; Wiratnaya IGE and Astawa P designed and conceived the study, and revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Faculty of Medicine Udayana University/Sanglah Hospital (Ethical Clearance No. 1847/UN14.2.2.VII.14/LT/2021).
Informed consent statement: Informed consent was not required due to the retrospective nature of the study and anonymized nature of the data.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data supporting the findings of this study are not available to be shared publicly due to legal/ethical restrictions.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: I Gede Eka Wiratnaya, Doctor, Consultant Physician-Scientist, Department of Orthopaedic and Traumatology, Faculty of Medicine Udayana University/ Sanglah Hospital, Jalan Diponegoro, Dauh Puri Klod, Denpasar 80113, Bali, Indonesia. igewiratnaya@gmail.com
Received: June 7, 2022
Peer-review started: June 7, 2022
First decision: August 4, 2022
Revised: August 18, 2022
Accepted: September 12, 2022
Article in press: September 12, 2022
Published online: October 18, 2022
Processing time: 132 Days and 4.2 Hours
Abstract
BACKGROUND

Osteoarthritis (OA) is the most common cause of pain and disability, predominantly affecting the knee. The current management of knee OA falls short of completely stopping disease progression, particularly in Kellgren-Lawrence (KL) grade 3 and 4 knee OA. As such, joint replacement is often recommended, although only 15%-33% of candidates accept it. Alternative therapeutic options are still needed to prevent the progression of joint damage and delay the need for knee arthroplasty.

AIM

To investigate the effect of adjunctive platelet rich plasma (PRP) and hyaluronic acid (HA) after arthroscopic debridement in KL grade 3 and 4 knee OA.

METHODS

This retrospective cohort study used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and WOMAC sub-scores (pain, stiffness, and function) to assess 21 patients, grouped according to medical record data of treatment received: Arthroscopic debridement (n = 7); arthroscopic debridement with PRP (n = 7); or arthroscopic debridement with HA (n = 7). WOMAC scores and sub-scores at baseline and at 3 mo and 5 mo posttreatment were recorded. The three-group data were statistically analyzed using the tests of paired t, one-way analysis of variance, and post hoc least significant difference.

RESULTS

All three treatment groups showed significant improvements in WOMAC score and sub-scores from before treatment to 3 mo and 5 mo after treatment. However, the arthroscopic debridement with PRP treatment group, in particular, showed a significantly lower WOMAC pain score than the group who received arthroscopic debridement alone at 5 mo after the procedure (P = 0.03).

CONCLUSION

Compared to arthroscopic debridement alone, adjunctive PRP after arthroscopic debridement significantly lessened the patients’ pain symptom.

Keywords: Arthroscopic debridement; Hyaluronic acid; Osteoarthritis; Platelet-rich plasma; Western Ontario and McMaster Universities Osteoarthritis Index; WOMAC score

Core Tip: This manuscript highlights the alternative approaches in managing knee osteoarthritis of Kellgren-Lawrence grade 3 and 4. Outcomes of arthroscopic debridement, arthroscopic debridement with platelet-rich plasma (PRP), or arthroscopic debridement with hyaluronic acid were evaluated prior to treatment and at 3 mo and 5 mo after the procedure. According to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and sub-scores (pain, stiffness, function), arthroscopic debridement with PRP provided significantly lower pain than arthroscopic debridement after treatment, however neither treatment was superior in the ability to improve total WOMAC score.