FUNCTIONAL OUTCOME OF SINGLE VERSUS MULTIPLE INTRAARTICULAR PLATELET RICH PLASMA (PRP) INJECTIONS FOR EARLY OSTEOARTHRITIS KNEE - A COMPARATIVE STUDY

Abstract

Osteoarthritis is a major cause of pain and disability and is detrimental to quality of life. Many non-invasive treatment options have been recommended to relieve symptoms and extend the quality of life with Osteoarthritis. Platelet-Rich Plasma (PRP) is evolving into a promising solution for various orthopaedic conditions like tendinopathies, non-union and arthritis of knee. AIM AND OBJECTIVE: To determine whether single Intra-articular Platelet-rich plasma injection when compared with multiple Intra-articular Platelet-rich plasma injections given in the early stages of osteoarthritis of the knee has better functional outcome when measured using the Western Ontario and McMaster Universities Osteoarthritis Index and for reduction in pain which is measured by Visual Analogue Scale at 6th week, 3rd month and 6th month. METHODOLOGY: The comparative study was conducted among patients diagnosed with early osteoarthritis presented to department of Orthopaedics, R. L. Jalappa Hospital & Research Centre attached to Sri Devaraj Urs Medical College Affiliated to Sri Devaraj Urs Academy of Higher Education and Research Tamaka, Kolar during the period, between January 2020 and June 2021. Patients were divided into Group I & Group II where Group 1 (34 samples) received Single Intra-articular Platelet-Rich Plasma injection (S-PRP) and patients in group II (30 samples) received Multiple (2) XX Intra-articular Platelet-Rich Plasma injections (M-PRP) on presentation and on 3rd month. Visual Analogue Scale (VAS) to measure pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Score) to assess functional status was used at first visit before intervention, on 6th week, 3rd month and 6th month after intervention. The collected data were entered in Microsoft (MS) Excel and analysed using IBM. SPSS statistics software 23.0 Version. RESULTS: The average age of the participants in the current study was 55.26 years in the S-PRP group and 51.13 years in the M-PRP group, with standard deviations of 4.8 and 7.4 years, respectively. Among the study participants, about 66 percent were females and the remaining were males. In all groups, about two-thirds of the participants felt right knee pain. Only 14% of people had problems with both knees. At the end of 6th month, the mean pain scale in S-PRP group is 4 and in M-PRP group is 5.77, this difference in mean is statistically significant (P < 0.001). Thus, multiple PRP injection have greater response in reduction of pain when compared to single PRP injection according to VAS pain scale score. The mean score by using the WOMAC Score in the S-PRP group is 45.26 and M-PRP group is 45.33 at the 6th week of follow-up. This difference of means in both groups is not statistically significant (p = 0.920) by using the independent T-test. Thus, according to the WOMAC Score, there is no statistically significant difference in the treatment response with PRP injection between S-PRP and M-PRP groups. The lowering trend was detected after S-PRP and Multiple-PRP injections at pre-injection, 6th week, 3rd month and 6th month respectively, as determined by WOMAC score. The Paired T test revealed that these differences were statistically significant. The decrease in WOMAC score is due to the fact that both therapies improved the subject’s functional XXI status by reducing pain. The significance of the correlation test between Pain and WOMAC score at pre-injection, 6th week, 3rd month and 6th month can be demonstrated. CONCLUSION: Intra-articular Platelet-rich plasma injection is a valuable and trustworthy treatment for improvement functional status and reduction in pain for Grade 1 and 2 Osteoarthritis up to 6 months post injection, and a minimum of two injections appears to be suitable.