Double-Blind Randomised Controlled Trial Comparing Platelet-Rich Plasma (PRP injection) With Intra-Articular Corticosteroid Injections in Patients With Bilateral Knee Osteoarthritis
Platelet-rich plasma (PRP) joint injections have gained increasing more popularity and are suggested to be more effective and longer lasting than corticosteroid or visco-supplementation injection therapy.
There are studies comparing PRP with corticosteroid injections, but this recent November 2022 doubled blinded study looks to compare PRP in patients with bilateral knee osteoarthritis with the patient acting as their own control.
The treatment of knee arthritis starts with conservative treatments in most cases - self physical therapy, topical and oral anti inflammatory medicines, physical therapy, and weight loss. As the disease progresses, other therapeutic methods become very important such as intra-articular injections, which include corticosteroids, hyaluronic acid, and PRP. Steroid injections often just provide short term benefit, whereas HA and PRP provide better long term benefits. However, there is still ongoing controversy regarding which injection is the most effective treatment modality.
A recent systematic review performed comparing intra-articular PRP and steroid injections for the management of knee arthritis identified that PRP has an overall greater efficacy compared to corticosteroid injections over 12 months with follow-up, this comparing 8 studies. The beneficial effect was statistically significant from 3 months onward and is most pronounced at 6 month follow-up. PRP showed greater efficacy in reducing pain while also improving stiffness and general physical function.
Joint corticosteroid injections are widely used to reduce pain and limitation of joint movement in knee OA, particularly in the presence of inflammation and swelling. But certain study reviews on the use of corticosteroid injections for knee OA found that the beneficial effect of was only significant short term (at one week), with minimal benefit after a 6 week period. PRP injection has been shown to be a safe treatment option with no serious complications. Minor side effects may include discomfort and swelling.
It has been suggested that PRP will have a better response in the earlier stages of disease progression due to its ability to restore and protect cartilage. It has been suggested that multiple PRP injections are likely have a better outcome than single PRP injections, which could possibly have resulted in further improved outcome measures if multiple PRP injections were compared to a single corticosteroid injection.
This double blinded study concluded that both PRP and corticosteroid injections are effective in improving pain, stiffness, and function in patients with bilateral knee arthritis. The PRP group scored better at six months’ follow-up.
It is worth noting again that this study only compares the benefit of one injection per treatment. In clinical practice it is generally recommended to do a course of 3 PRP injection treatments approximately one month apart. This is to gain full therapeutic affect. Also in clinical practice, repeated administration of steroid injection has been shown to provide poor outcomes. It is also worth noting that PRP has a protective influence on cartilage, at the same time is being used to reduce inflammation and stimulate a repair/healing process. On the other hand, steroid has been shown to be toxic for cartilage, speeding up the degenerative process.
Study can be found here
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