SAFETY AND CLINICAL EFFICACY OF PLATELET RICH GROWTH FACTORS (PRGF) IN MANAGING KNEE OSTEOARTHRITIS AFTER FAILED CONSERVATIVE TREATMENT: EVIDENCE FROM REAL PRACTICES
DOI:
https://doi.org/10.55374/jseamed.v3i1.43Keywords:
Osteoarthritis, Platelet rich plasma, Platelet rich growth factor, Knee arthroplasty, Total knee arthroplasty, Kellgren-Lawrence, Surgical interventionAbstract
Background: Platelet rich growth factors (PRGF) comprise a biological treatment of knee osteoarthritis (OA). Due to its limitation concerning the articular cartilage lesions’ healing potential, chondrocyte differentiation and external environment factors, clinical improvement of knee OA using PRGF treatment depends on preparation techniques.
Objectives: The study aimed to demonstrate clinical outcomes of PRGF treatment in real practices.
Methods: A prospective cohort study was conducted from February 2018 to 2019 at the Biomedical Technology Research and Development Center, Police General Hospital, Bangkok, Thailand. We enrolled patients above 60 years old with knee OA that failed conservative treatment. The exclusion criteria included meniscus and ligament injury and knee deformity of the tibiofemoral angle more than 5 degrees. The primary endpoint was safe PRGF while secondary endpoints included changes of weight bearing pain and delayed surgery until an appropriate time for intervention.
Results: A total of 240 patients with knee OA, Kellgren-Lawrence (KL) grades II, III or IV were enrolled including 90 males and 150 females. The average age was 68 (60-81) years. Mode of conservative treatment failure included 140 cases of oral medication, 60 cases of oral medication and steroid injection and 40 cases of oral medication, steroid and intra-articular hyaluronic injections (IA-HA). Based on the KL system, 194 were classified as grades II-III, and 46 patients were grade IV. The PRGF was collected according to the protocol. The average initial platelet concentration before and after centrifugation was 165x103 cells/µL (140-195x103 cells/µL) and 990x103 cells/µL (825-1,650x103 cells/µL), respectively. At average of 3.3 (3-8) months follow-up, no major complications were observed, but 17 cases (7.9%) had minor complications. Average VAS (visual-analog-scale for pain: 0-100) scores before and after injection were 71 (65-80) and 52 (50-72, respectively. Surgical intervention in KL II-III totaled 11 cases (5.6%) and KL IV totaled 5 cases (10.8%).
Conclusion: Our technique of adjusting platelet concentration, fibrin concentration, leukocyte population and activator status improved clinical efficacy of PRGF treatment. PRGF is a safe, simple and effective treatment for patients with knee OA experiencing conservative treatment failure.
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