Background The concentrated platelets found in Platelet Rich Plasma (PRP) include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration.
Objectives To evaluate the assess the duration of effectiveness of 4 intra-articular injection: two infiltration of platelet gel followed by two ultrasound guided infiltration of hyaluronic acid under ultrasound (US) guidance in symptomatic osteoarthritis of the hip.
Methods We treated 46 patients (aged between 45 and 65 years) with symptomatic hip osteoarthritis (radiological grade II/III, Kellgren-Lawrence scale), excluding cases with concomitant rheumatic diseases.
15 Patients were treated with a cycle of 4 intra-articular injections (one every three weeks) under ultrasound guidance of platelet gel obtained by peripheral blood of the patient and performed at basal evaluation and at 1-3-6 months.15 Patients were treated with a cycle of 4 intra-articular injections under ultrasound guidance of ialuronan (Highly Cross-Linked HA – molecular weight approximately 6 million D.)
16 Patients were treated with a cycle of 4 intra-articular injections under ultrasound guidance, but, two infiltration of platelet gel followed by two ultrasound guided infiltration of hyaluronic acid (Highly Cross-Linked HA – molecular weight approximately 6 million D.) under ultrasound (US) guidance. Primary efficacy endpoint was the change of the profile articular cartilage, any fibrillation, erosions and reduction thickness of the center point of the joint space coxofemoral a 6 and 12 months through the ' ultrasound examination. Primary safety endpoint was the nature, incidence and severity of local and systemic events, acute inflammatory reactions and laboratory evaluations. Secondary endpoints included changes in the thickness of the cartilage coxo femoral total and the width of the joint space measured by X-ray examination, and VAS pain.
Results A significant improvement in all the evaluated parameters has been observed from baseline to one year after the end of therapy (p<0.0005); a reduction in VAS score of 50% was observed in 62.5% (n=29), 87.5% (n=40) and 93.7% of patients (n=43) after the 1st, 2nd and 3rd injection, respectively.
At the end of the therapy 62.5% of patients (n=29) had a further reduction of VAS score of 70%. Patients observed after one year treated with sequential therapy have maintained a greater reduction in VAS score than patients treated with ialuronan or platelet gel alone and the average reduction in NSAID consumption correlated with the evolution of the VAS score. was associated with a statistically significant and dose-dependent improvement in the total thickness of the hip joint and cartilage volume, and joint space narrowing
Conclusions The ultrasound-guided intra-articular treatment with platelet gel and after ialuronan in patients with symptomatic hip osteoarthritis demonstrates in almost all the treated patients (93.7% of cases) a significant reduction of subjective pain (on a VAS scores) and consumption of NSAIDs greater than the ialuronan or platelet gel alone
These are preliminary data that need further confirmation in a larger number of patients.
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Disclosure of Interest None declared