EVALUATION OF FUNCTIONAL OUTCOME OF INTRA-ARTICULAR PLATELET RICH PLASMA (PRP) INJECTION FOR EARLY OSTEOARTHRITIS OF KNEE: A COMPARISON BETWEEN SINGLE VERSUS DOUBLE SPINNING TECHNIQUE

Abstract

BACKGROUND:Osteoarthritis (OA) is the most common type of arthritis in both developed and developing countries.It is a chronic progressive musculoskeletal disorder characterized by gradual loss of cartilage in joints, with a prevalence of 22% to 39% in India. OA is more common in women than men, 45% of women over the age of 65 years have symptoms while 70% of those over 65 years show radiological evidence of OA, by 2050 people aged over 60 will account for OA more than 20% of the world’s population. Treatment of knee OA is difficult due to the avascular and aneural nature of adult knee cartilage, which results in a low regenerative capacity, and thus limited healing potential for the joints. The joint destruction arising from OA occurs as a result of an imbalance in the equilibrium between the breakdown and repair of the joint tissue while a combination of cellular changes and biomechanical stresses causes several secondary changes in the joint. PRP is a simple and minimally invasive method to obtain a high concentrate of autologous GFs in physiological proportions, which can be easily and safely placed directly into the lesion site. Moreover, the risk of allergy or infection is negligible, due to the autologous nature of the platelet extract. PRP concentrations have been reported to range widely, and the numerous preparation methods present many other different variables, such as the presence of other cells, activation and storage modalities, and many other aspects that are not of secondary importance for determining PRP properties and clinical efficacy. Platelet concentration is one of the most topical factors in PRP treatment. XIV Platelet concentration in the published literature on knee OA has been variable and not consistently reported. Some authors suggest that the PRP platelet concentration should be at least two times the whole blood platelet concentration; however, concentrations up to eight times that of blood levels have been reported with good results. Single-spinning centrifugation results in platelets up to three times that of baseline level whereas double-spinning centrifugation results in platelets up to eight times the baseline level with a high leucocyte content. However, there are very few studies which compare the use of the two techniques of preparation of PRP in early OA knee. The aim of this study is to explore this novel biological treatment for degenerative lesions of articular cartilage and OA by comparing two products, already used in clinical practice, which are based on different preparation approaches: single- versus double-spinning procedures. MATERIAL AND METHODS: It is a prospective, comparative, observational, time bound, hospital-based study conducted from November 2018 to May 2019, after obtaining institutional Ethical committee approval. 68 patients were included in the study following the inclusion and exclusion criteria. The patients were randomized into 2 groups using a standard randomization technique (odd and even number method). Group A (odd numbers) received single spin PRP injection and group B (even numbers) received double spin PRP injection. Out of the 68 patients, 4 patients were lost to follow-up, which gave a final sample size of 64 patients.Patients were selected from R L Jalappa Hospital and Research centre, Department of Orthopaedics, Kolar, on outpatient and in-patient basis who meets inclusion criteria. XV After clinical examination & radiographs of the knee joint in standing position (antero-posterior views and lateral views) were taken, blood sample of the patient was collected and PRP prepared in Blood bank. Infiltration was done in the operation theatre under strict aseptic conditions. Patients were assessed with “VAS” (visual analogue scale) for pain, “WOMAC” (Western Ontario McMaster Universities Arthritis Index) scoring, and Oxford knee scoring, before giving the PRP injection & after giving the injection at periods of 1 month, 3 & 6 months. The decrease in WOMAC score & VAS score and increase in Oxford knee scores was suggestive of improvement in patient’s condition. RESULTS: The mean age was 57.63 ± 7.4 in SS-PRP and it was 50.75 ± 7.33 in DSPRP. The participants in both groups are above 40 years of age. The mean pre-injection VAS score was 8.25 ± 0.62 in SS-PRP, it was 8 ± 0.51 in DSPRP. The mean VAS score at 1 month was 6.28 ± 0.73 in SS-PRP, it was 5.88 ± 0.61 in DS-PRP. The mean VAS score at 3 months was 5.16 ± 0.57 in SS-PRP, it was 4.63 ± 0.61 in DS-PRP. The mean VAS score at 6 months was 4.28 ± 0.58 in SS-PRP, it was 3.34 ± 0.65 in DS-PRP. From above observations it can be deduced that PRP injections helps in reduction of pain in osteoarthritis over a period of 6 months which is evident by reduced VAS scores. Another observation that can be made from above results of present study is that the reduction in VAS scores is slightly higher for group injected with double spin PRP at 1,3 and 6 months follow up. The mean pre-injection WOMAC score was 76.75 ± 3.62 in SS-PRP, it was 74.84 ± 3.02 in DS-PRP. The mean WOMAC score at1 month was 67.28 ± 4.46 in SS-PRP, it was 61.25 ± 2.75 in DS-PRP. The mean WOMAC score at 3 months was 60.66 ± XVI 5.38 in SS-PRP, it was 52.72 ± 3.09 in DS-PRP. The mean WOMAC score at 6 months was 54.78 ± 5.95 in SS-PRP, it was 44.53 ± 3.03 in DS-PRP. The difference in WOMAC scores between single spin PRP and double spin PRP groups was again similar to VAS scores. There was slightly higher reduction in WOMAC scores in DSPRP group than in SS-PRP group. The median pre-injection Oxford knee score was 20 in SS-PRP, it was 19 in DS-PRP. The median Oxford knee score at 1 month was 24 in SS-PRP, it was 24 in DS-PRP. The median Oxford knee score at 3 months was 26.5 in SS-PRP, it was 27.5 in DSPRP. The median Oxford knee score at 6 months was 29 in SS-PRP, it was 30 in DSPRP. From above observations it can be deduced that improvement was noted in knee scores for both single spin and double spin PRP groups with slightly better outcomes in the double spin group.