Adding Regenerative medicine to your practice.

[drusso]

you cannot make an assessment of whether hyaluronidase helps the PRP with this study.

you can say that it seems that the kind may not make a great deal of difference.

It's not hyaluronidase, it's hyaluronic acid. And other studies show synergy with PRP.

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Jinlong Zhao, Hetao Huang, Guihong Liang, Ling-feng Zeng, Weiyi Yang & Jun Liu
BMC Musculoskeletal Disorders volume 21, Article number: 224 (2020) Cite this article


Abstract
Background
Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA.

Methods
The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation.

Results
Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: − 0.31; 95% confidence interval (CI): − 0.55 to − 0.06; P = 0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: − 0.54 to − 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P > 0.05).

Conclusions
Compared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.

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[Ducttape]

yes, hyaluronic acid.

and diverting from the original posted article, this meta-analysis supports that hyaluronic acid with PRP has improvements over PRP alone, for up to 12 months.

 

[drusso]

If I were a steroid KOL, I'd be pissed...

 

[MitchLevi]

How does one offer HA + PRP to a patient?

How does that work, and what's the cost?

What volume of each are you injecting?

Which PRP are you using?

 

[drusso]

How does one offer HA + PRP to a patient?

How does that work, and what's the cost?

What volume of each are you injecting?

Which PRP are you using?

Cash

Visa, Master Card, AMEX, we also do lay-a-way

2 mL for large joints

$150

Leukocyte poor, high dose/concentration.

 

[MitchLevi]

$150 total?

How is that even possible?

 

[drusso]

$150 total?

How is that even possible?

No. That's just the HA.

 

[MitchLevi]

No. That's just the HA.

So what is the total cost of this procedure, and which HA are you using? I'm assuming you're buying a bunch of it and offsetting your losses on their cost by the profits made off the PRP?

 

[drusso]

So what is the total cost of this procedure, and which HA are you using? I'm assuming you're buying a bunch of it and offsetting your losses on their cost by the profits made off the PRP?

Just take your acquisition cost and double it.

 

[Doctodd]

Did msc’s on this patient 3 years ago. She had some new sciatica which just resolved on it’s own after the MRI. I’m sure the radiologist was puzzled….he thought she had surgery lol.

 

[lobelsteve]

Did msc’s on this patient 3 years ago. She had some new sciatica which just resolved on it’s own after the MRI. I’m sure the radiologist was puzzled….he thought she had surgery lol.

View attachment 362163View attachment 362164View attachment 362165

What is the natural course?
Did you put the MSC's into the synovial cyst and rupture it? Did it rupture and disappear on its own?

 

[Doctodd]

What is the natural course?
Did you put the MSC's into the synovial cyst and rupture it? Did it rupture and disappear on its own?

most require surgery as per many on this board. The synovial cyst was almost completely filling and in the middle of the canal so i couldnt reach it very well if at all. MSC's to facets all around and epidural PRP 2 weeks later. I usually try to rupture cysts with a 22g needle....MSC's are too thick so they get placed with an 18g.

 

[MitchLevi]

Just take your acquisition cost and double it.

You continue to evade my basic questions man...

Which HA are you using?

Are you just using 2cc of HA in addition to 2cc of high concentration LP PRP?

So 4 total mL of injectate volume...

What is your total cost of the procedure?

How many times have you done this?

 

[Magnus Acus]

most require surgery as per many on this board. The synovial cyst was almost completely filling and in the middle of the canal so i couldnt reach it very well if at all. MSC's to facets all around and epidural PRP 2 weeks later. I usually try to rupture cysts with a 22g needle....MSC's are too thick so they get placed with an 18g.

Wait sorry, what’s an MSC? Mesenchymal stem cell?
So you ruptured a synovial cyst in the canal, then injected the area with MSC- which seems to have resolved the issue. That’s pretty cool. Young healthy pt or older?

 

[Doctodd]

Wait sorry, what’s an MSC? Mesenchymal stem cell?
So you ruptured a synovial cyst in the canal, then injected the area with MSC- which seems to have resolved the issue. That’s pretty cool. Young healthy pt or older?

Yes…I doubt I reached it in the canal…..65 y/o white female.

 

[drusso]

You continue to evade my basic questions man...

Which HA are you using?

Are you just using 2cc of HA in addition to 2cc of high concentration LP PRP?

So 4 total mL of injectate volume...

What is your total cost of the procedure?

How many times have you done this?

Supartz. It's total volume 4mL.

The charge "depends" because we have insurance contracts for Regen like we do everything else. Sometimes the Supartz is covered by insurance, sometimes not. Sometimes we have to use Synvisc because THAT's covered by insurance. Do you feel me?

I do it several times weekly, depending on how many referrals we get, etc.

 

[MitchLevi]

So even though Supartz is a series of injxns you just do one mixed with PRP?

In your experience, is this superior to PRP alone?

 

[drusso]

So even though Supartz is a series of injxns you just do one mixed with PRP?

In your experience, is this superior to PRP alone?

Yes.


Randomized Controlled Trial BMC Musculoskelet Disord. 2022 Nov 4;23(1):954. doi: 10.1186/s12891-022-05906-5.

Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial

Hung-Ya Huang 1 2, Chien-Wei Hsu 3 4, Guan-Chyun Lin 5, Huey-Shyan Lin 6, Yi-Jiun Chou 7, I-Hsiu Liou 1, Shu-Fen Sun 8 9
Affiliations expand
PMID: 36329428 PMCID: PMC9635114 DOI: 10.1186/s12891-022-05906-5
Free PMC article
Abstract
Background: Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA.

Methods: In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction.

Results: Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study.

Conclusions: A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results.

Trial registration: The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021.

Name of trial registry: Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis.

Level of evidence: Therapeutic Level 1.

Keywords: Hyaluronic acid; Intraarticular injection; Knee osteoarthritis; Platelet-rich plasma.

© 2022. The Author(s).

Randomized Controlled Trial

BMC Musculoskelet Disord. 2022 Sep 12;23(1):856.
doi: 10.1186/s12891-022-05787-8.

Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial​

Farshad Nouri 1, Marzieh Babaee 2, Parya Peydayesh 3, Hadi Esmaily 4, Seyed Ahmad Raeissadat 5
Affiliations expand

• PMID: 36096771
• PMCID: PMC9464606
• DOI: 10.1186/s12891-022-05787-8

Free PMC article

Abstract​

Background: Intra articular (IA) injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) are of the new methods in the management of hip osteoarthritis (OA). The aim of this study was to compare the effectiveness of IA injections of PRP, HA and their combination in patients with hip OA. HA and PRP are two IA interventions that can be used in OA in the preoperative stages. Due to the different mechanisms of action, these two are proposed to have a synergistic effect by combining.
Methods: This is a randomized clinical trial with three parallel groups. In this study, patients with grade 2 and 3 hip OA were included, and were randomly divided into three injection groups: PRP, HA and PRP + HA. In either group, two injections with 2 weeks' interval were performed into the hip joint under ultrasound guidance. Patients were assessed before the intervention, 2 months and 6 months after the second injection, using the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne questionnaires.
Results: One hundred five patients were enrolled randomly in HA, PRP and PRP + HA groups. All three groups showed significant improvement in WOMAC, VAS, and Lequesne at 2 months and 6 months compared with baseline. Comparison of the 3 groups demonstrated significant differences regarding WOMAC and Lequesne total scores and the activities of daily living (ADL) subscale of Lequesne (P = 0.041, 0.001 and 0.002, respectively), in which the observed improvement at 6th month was significantly higher in the PRP + HA and PRP groups compared to the HA group.
Conclusion: Although all 3 interventions were associated with improvement of pain and function in patients with hip OA, the therapeutic effects of PRP and PRP + HA injections lasted longer (6 months), and the effects of these two interventions on patients' performance, disability, and ADL were superior to HA in the long run. Moreover, the addition of HA to PRP was not associated with a significant increase in the therapeutic results.
Trial registration: The study was registered at Iranian Registry of Clinical Trials (IRCT) website IRCT , a WHO Primary Register setup, with the registration number of IRCT20130523013442N30 on 29/11/2019.
Keywords: Hip osteoarthritis; Hyaluronic acid; Intra-articular injections; Platelet-rich plasma; Ultrasound guided injection.

 

[drusso]

Real-world evidence study of regenerative medicine and shoulder surgery - Mayo Clinic News Network

Applying regenerative medicine to a common shoulder surgery could have an impact on the need for follow-up revision surgery in some patients, according to a Mayo Clinic study of real-world evidence.

regenerativemedicineblog.mayoclinic.org

Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair​

Bradley S. Schoch, MD [email protected], Brian C. Werner, MD, […], Shane A. Shapiro, MD, Christopher L. Camp, MD, Peter N. Chalmers, MD, and Jourdan M. Cancienne, MD, +3 -3View all authors and affiliations

https://doi.org/10.1177/23259671221127004

Abstract​

Background:​

The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy.

Purpose:​

To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) applied at the time of RCR with revision surgery rates.

Study Design:​

Cohort study; Level of evidence, 3.

Methods:​

The Mariner data set from the PearlDiver patient records repository was utilized to identify patients undergoing RCR using Current Procedural Terminology (CPT) code 29827. Patients receiving BMAC or PRP at the time of RCR were then identified using CPT coding. For comparison purposes, a matched cohort was created consisting of patients who underwent RCR without biologic augmentation in a 5:1 fashion for each biologic separately. Cases were matched according to age, sex, tobacco use, biceps tenodesis, distal clavicle excision, and subacromial decompression. All groups were then queried for revision RCR or conversion to reverse shoulder arthroplasty. Revision rates were compared utilizing a multivariate binomial logistic regression analysis. Adjusted odds ratios (ORs) and 95% CIs were calculated.

Results:​

A total of 760 patients who underwent biologic augmentation during RCR were identified, including 646 patients in the PRP group and 114 patients in the BMAC group. They were compared with 3800 matched controls without documented biologic application at the time of surgery. Compared with matched controls, patients who received BMAC at the time of surgery experienced a significantly lower incidence of revision surgery at 2 years (OR, 0.36; 95% CI, 0.15-0.82; P = .015). There was no significant difference in revision rates between PRP and matched controls (OR, 0.87; 95% CI, 0.62-1.23; P = .183).

Conclusion:​

The application of BMAC at the time of RCR was associated with a significant decrease in the incidence of revision surgery. There was no apparent effect of PRP on the incidence of revision surgery after primary RCR. Higher-level clinical studies considering surgical factors are needed to more clearly define the role of biologic adjuvants in RCR.

 

[Ducttape]

level 3 evidence. cohort study. pretty low level.

but... suggests that PRP doesnt work to prevent revision surgery.

my question - who is assessing the need for revision surgery? if it is the surgeon that put BMAC in to the RCR, i can clearly see bias. "well, i did BMAC, so im not going to do a revision, or that BMAC that the patient paid for is worth nothing."

 

[drusso]

level 3 evidence. cohort study. pretty low level.

but... suggests that PRP doesnt work to prevent revision surgery.

my question - who is assessing the need for revision surgery? if it is the surgeon that put BMAC in to the RCR, i can clearly see bias. "well, i did BMAC, so im not going to do a revision, or that BMAC that the patient paid for is worth nothing."

You're overthinking it.

 

[drusso]

level 3 evidence. cohort study. pretty low level.

but... suggests that PRP doesnt work to prevent revision surgery.

my question - who is assessing the need for revision surgery? if it is the surgeon that put BMAC in to the RCR, i can clearly see bias. "well, i did BMAC, so im not going to do a revision, or that BMAC that the patient paid for is worth nothing."

This new study at Mayo replicates a 10-year analysis from France. France. Land of socialized health care. France...

Int Orthop. 2014 Sep;38(9):1811-8.
doi: 10.1007/s00264-014-2391-1. Epub 2014 Jun 7.

Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study​

Philippe Hernigou 1, Charles Henri Flouzat Lachaniette, Jerome Delambre, Sebastien Zilber, Pascal Duffiet, Nathalie Chevallier, Helene Rouard
Affiliations expand

• PMID: 24913770
• DOI: 10.1007/s00264-014-2391-1

Abstract​

Purpose: The purpose of this study was to evaluate the efficiency of biologic augmentation of rotator cuff repair with iliac crest bone marrow-derived mesenchymal stem cells (MSCs). The prevalence of healing and prevention of re-tears were correlated with the number of MSCs received at the tendon-to-bone interface.
Methods: Forty-five patients in the study group received concentrated bone marrow-derived MSCs as an adjunct to single-row rotator cuff repair at the time of arthroscopy. The average number of MSCs returned to the patient was 51,000 ± 25,000. Outcomes of patients receiving MSCs during their repair were compared to those of a matched control group of 45 patients who did not receive MSCs. All patients underwent imaging studies of the shoulder with iterative ultrasound performed every month from the first postoperative month to the 24th month. The rotator cuff healing or re-tear was confirmed with MRI postoperatively at three and six months, one and two years and at the most recent follow up MRI (minimum ten-year follow-up).
Results: Bone marrow-derived MSC injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the quality of the repaired surface as determined by ultrasound and MRI. Forty-five (100 %) of the 45 repairs with MSC augmentation had healed by six months, versus 30 (67 %) of the 45 repairs without MSC treatment by six months. Bone marrow concentrate (BMC) injection also prevented further ruptures during the next ten years. At the most recent follow-up of ten years, intact rotator cuffs were found in 39 (87 %) of the 45 patients in the MSC-treated group, but just 20 (44 %) of the 45 patients in the control group. The number of transplanted MSCs was determined to be the most relevant to the outcome in the study group, since patients with a loss of tendon integrity at any time up to the ten-year follow-up milestone received fewer MSCs as compared with those who had maintained a successful repair during the same interval.
Conclusion: This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.

 

[Ducttape]

i guess if new you mean new in 2014, okay...

i think you posted the France study by accident, not the new Mayo one.

or were you posting that the previous study you posted in poast #1318 was a replication of this French study?

 

[drusso]

i guess if new you mean new in 2014, okay...

i think you posted the France study by accident, not the new Mayo one.

or were you posting that the previous study you posted in poast #1318 was a replication of this French study?

The Mayo study is in post 1,319

 

[drusso]

You can't Jedi-Mind-Trick a cytokine. More data supporting placebo effect of experimenting on desperate patients...

Injury. 2022 Nov 15;S0020-1383(22)00865-8. doi: 10.1016/j.injury.2022.11.036.

Online ahead of print.

Comparison of clinical outcome, cartilage turnover, and inflammatory activity following either intra-articular or a combination of intra-articular with intra-osseous platelet-rich plasma injections in osteoarthritis knee: A randomized, clinical trial

Apurba Barman 1, Debapriya Bandyopadhyay 2, Sudipta Mohakud 3, Jagannatha Sahoo 4, Rituparna Maiti 5, Somnath Mukherjee 6, Satya Prakash 6, Sankha Subhra Roy 4, Amrutha Viswanath 4
Affiliations expand
PMID: 36414504 DOI: 10.1016/j.injury.2022.11.036

Abstract
Background: The objective of the study was to determine the changes in clinical outcome (pain and knee activity) and assess bone/ cartilage biomarkers and inflammatory activity in persons with osteoarthritis (OA) knee following a single injection of intra-articular platelet-rich plasma (IA-PRP) and combination of intra-articular, intraosseous PRP (IA+IO-PRP).

Methods: This prospective, randomized, single-blind clinical trial was conducted at a tertiary care teaching hospital in India. Ninety-six persons with OA knee with a Kellgren-Lawrence score of 3 were randomized into three groups- Group-I (IA-PRP), Group-II (IA+IO-PRP)], Group-III, [intra-articular normal saline (IA-NS)]. The primary outcome was a visual analog scale (VAS) for pain. The secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), bone/ cartilage turnover biomarkers [C-telopeptide (CTX-II), N-telopeptide (NTX-I), cartilage oligomeric matrix protein (COMP), N-terminal propeptide of collagen type-IIA (PIIANP), and hyaluronic acid (HA)], ultrasonography (USG) findings of the knee joint. The outcome measures were assessed at baseline, 6, and 12 weeks of follow-up.

Results: Compared to IA-NS injection, IA-PRP and IA+IO-PRP injections significantly improved VAS-pain and KOOS scores at 6 and 12 weeks. Furthermore, both PRP groups showed a significant reduction in ESR, CRP, and CTX-II at 12 weeks following PRP injections. In addition, at 12 weeks, the IA+IO-PRP group showed a significant reduction (p=0.009) in NTX-I level. Persons in the IA+IO-PRP group reported significant reductions in the synovial-effusion and infra-patellar bursitis.

Conclusions: Significant clinical improvements were noticed following IA-PRP and IA-IO-PRP injections compared to IA-NS injections. Both PRP groups reported a significant reduction in ESR, CRP, and CTX-II levels at 12 weeks. Persons in the IA+IO-PRP group reported significant changes in u-NTX-I level and knee-USG findings.

Keywords: Biomarker; Knee; Osteoarthritis; Platelet-rich plasma.

Copyright © 2022. Published by Elsevier Ltd.

 

[Ducttape]

need to extend data far past 12 weeks.

for example, steroid injections in other studies also improve VAS and KOOS scores. however, not sustained past 12 weeks.


in terms of this study, there are some issues that i identify.

the IA+IO-PRP group all got GA and got ceftriaxone as part of their injection, the IA-PRP and IA-NS groups got local, so not blinded. the IA+IO-PRP group got 18 ml of injectate, vs the others who got 8. however, looking at the numbers, the IA-PRP group and the IA+IO-PRP group had fairly similar results, implying not that these differences may not be influential.

this is in concordance with what the authors noted:

The study had several limitations. First, each group had a significant dropout due to the breaking out of coronavirus disease (COVID-19) during the study period. Second, the study duration was limited to 12 weeks, focusing on the immediate changes in biomarkers. Third, the persons were not blinded to the intervention procedure, as it was challenging to blind those receiving IA+IO-PRP injections under GA. Fourth, persons recruited in Group-II received antibiotics, whereas the other two groups (Groups -I and -III) did not. However, there is no direct evidence that a single dose of antibiotic can cause pain relief, functional improvement, and changes in the levels of inflammatory and cartilage-turnover biomarkers at 6 and 12 weeks following injections.

 

[drusso]

Seven year long placebo effect...

Front Bioeng Biotechnol. 2022 Nov 25;10:1062371.

doi: 10.3389/fbioe.2022.1062371. eCollection 2022.

Assessment of the effectiveness and satisfaction of platelet-rich plasma compared with hyaluronic acid in knee osteoarthritis at minimum 7-year follow-up: A post hoc analysis of a randomized controlled trial​

Zhengming Wang 1 2, Rui Wang 3, Sicheng Xiang 3, Yong Gu 4, Ting Xu 3, Hengkai Jin 3, Xinbo Gu 3, Peijian Tong 5, Hongsheng Zhan 1 2, Shuaijie Lv 5

Abstract​

Background: Knee osteoarthritis (KOA) can be effectively treated conservatively using platelet-rich plasma (PRP) injections into the affected joints. While the short-term therapeutic clinical benefits were well documented, the mid-term results remain undetermined. To clarify its efficacy, the mid-term clinical outcomes of intra-articular injections of either PRP or hyaluronic acid (HA) in KOA were compared.

Methods: One hundred patients who complied with the inclusion criteria were randomized to undergo once a week 3 weeks, intra-articular injections of either PRP or HA. Patients were evaluated before the injection, at 3, 6, and a mean of 78.9 months of follow-up. Eighty-five patients reached the final evaluation. Data on survival, re-intervention, pain, function, imaging, and satisfaction were collected and analyzed.

Results: With surgery for any reason as the endpoint, the cumulative survival rate of the PRP group was 90%, while that of the HA group was 74%. There was a significant difference between the two groups in the total re-intervention rate (56.7% vs 16.2%, p < 0.05). The comparative analyses showed significant intergroup differences in the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (p < 0.01, p < 0.05, respectively) at the final follow-up. And base on the regression analyses, the type of treatment, age, and Kellgren-Lawrence (K-L) grade served as statistically an independent determinants of VAS (p < 0.001, p = 0.034, p < 0.001, respectively). Likewise, those variables independently determined WOMAC in our study. However, no difference was observed in the imaging evaluation, containing the K-L grade and Cartilage Lesion Score, between the two groups (p > 0.05). Besides, the satisfaction treated by the PRP was 78.6%, with a superiority compared with HA (55.8%, p < 0.05), and no complications were noted in the whole treatment process among patients who participated.

Conclusion: PRP was more effective than HA in survival and re-intervention rates, VAS, and WOMAC, although there were no significant differences in the imaging evaluation between the two groups. Furthermore, patients treated with PRP were associated with higher satisfaction compared with HA.

Keywords: hyaluronic acid; intra-articular injection; knee; osteoarthritis; platelet-rich plasma.

 

[lobelsteve]

Seven year long placebo effect...

Front Bioeng Biotechnol. 2022 Nov 25;10:1062371.

doi: 10.3389/fbioe.2022.1062371. eCollection 2022.

Assessment of the effectiveness and satisfaction of platelet-rich plasma compared with hyaluronic acid in knee osteoarthritis at minimum 7-year follow-up: A post hoc analysis of a randomized controlled trial​

Zhengming Wang 1 2, Rui Wang 3, Sicheng Xiang 3, Yong Gu 4, Ting Xu 3, Hengkai Jin 3, Xinbo Gu 3, Peijian Tong 5, Hongsheng Zhan 1 2, Shuaijie Lv 5

Abstract​

Background: Knee osteoarthritis (KOA) can be effectively treated conservatively using platelet-rich plasma (PRP) injections into the affected joints. While the short-term therapeutic clinical benefits were well documented, the mid-term results remain undetermined. To clarify its efficacy, the mid-term clinical outcomes of intra-articular injections of either PRP or hyaluronic acid (HA) in KOA were compared.

Methods: One hundred patients who complied with the inclusion criteria were randomized to undergo once a week 3 weeks, intra-articular injections of either PRP or HA. Patients were evaluated before the injection, at 3, 6, and a mean of 78.9 months of follow-up. Eighty-five patients reached the final evaluation. Data on survival, re-intervention, pain, function, imaging, and satisfaction were collected and analyzed.

Results: With surgery for any reason as the endpoint, the cumulative survival rate of the PRP group was 90%, while that of the HA group was 74%. There was a significant difference between the two groups in the total re-intervention rate (56.7% vs 16.2%, p < 0.05). The comparative analyses showed significant intergroup differences in the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (p < 0.01, p < 0.05, respectively) at the final follow-up. And base on the regression analyses, the type of treatment, age, and Kellgren-Lawrence (K-L) grade served as statistically an independent determinants of VAS (p < 0.001, p = 0.034, p < 0.001, respectively). Likewise, those variables independently determined WOMAC in our study. However, no difference was observed in the imaging evaluation, containing the K-L grade and Cartilage Lesion Score, between the two groups (p > 0.05). Besides, the satisfaction treated by the PRP was 78.6%, with a superiority compared with HA (55.8%, p < 0.05), and no complications were noted in the whole treatment process among patients who participated.

Conclusion: PRP was more effective than HA in survival and re-intervention rates, VAS, and WOMAC, although there were no significant differences in the imaging evaluation between the two groups. Furthermore, patients treated with PRP were associated with higher satisfaction compared with HA.

Keywords: hyaluronic acid; intra-articular injection; knee; osteoarthritis; platelet-rich plasma.

The headline is it saved lives.

" PRP was more effective than HA in survival."

 

[Analgesia108]

How are wRVU's assigned for regen procedures by hospitals to compensate providers?

 

[Doctodd]

You would think we could have reproducible studies in better journals, and outside of China.

 

[Ducttape]

generally no HOPD assigns rvus to this noncovered procedure.

interestingly, it seems certain proponents of PRP would rather have it not covered by medicare...

study not blinded to participants so there is the possibility of bias.


shows a couple of things. PRP is probably better than hyaluronidase.

the MRI imaging suggest that PRP vs hyaluronidase does not change imaging evaluation

You would think we could have reproducible studies in better journals, and outside of China.

is there something inherently wrong with data from china?

 

[lobelsteve]

generally no HOPD assigns rvus to this noncovered procedure.

interestingly, it seems certain proponents of PRP would rather have it not covered by medicare...

study not blinded to participants so there is the possibility of bias.


shows a couple of things. PRP is probably better than hyaluronidase.

the MRI imaging suggest that PRP vs hyaluronidase does not change imaging evaluation


is there something inherently wrong with data from china?

Do you trust China? Chinese government? Chinese interference with research?

 

[Ducttape]

i dont see how this study is part of the chinese government.

do you think the chinese government is so restrictive that they vet medical studies?


to that, i would retort that Big Pharma or Big Device could have as much influence on American studies.



unless a study is done at an academic institution that prohibits such influence.

in which case, we should be celebrating and encouraging academic pain medicine that sticks to these restrictions.

 

[Doctodd]

is there something inherently wrong with data from china?

is there something wrong with my request? Ive never heard of that journal. Have you?

What PRP product is big pharma involved in? Big device...maybe.

 

[lobelsteve]

i dont see how this study is part of the chinese government.

do you think the chinese government is so restrictive that they vet medical studies?


to that, i would retort that Big Pharma or Big Device could have as much influence on American studies.



unless a study is done at an academic institution that prohibits such influence.

in which case, we should be celebrating and encouraging academic pain medicine that sticks to these restrictions.

https://crsreports.congress.gov/product/pdf/IN/IN11207

University Researcher Sentenced to Prison for Lying on Grant Applications to Develop Scientific Expertise for China

An Ohio man and rheumatology professor and researcher with strong ties to China was sentenced to XX months in prison for making false statements to federal authorities as part of an immunology research fraud scheme.

www.justice.gov

Chinese government is involved in our research, do you think they are not manipulating their own?

 

[Ducttape]

is there something wrong with my request? Ive never heard of that journal. Have you?

What PRP product is big pharma involved in? Big device...maybe.

it seems that you have previously expressed anti-china sentiment, not just in research...


yes, this is a diversion, but look back at all the studies that drusso has posted, and if you are so anti china, i suggest you consider invalidating them in your own mind.

which would be most of the recent studies he has posted... only 2 of the last 10 studies he has posted have been based in the US. 5 from china. 1 france, 1 indonesia, 1 iran. should we invalidate recent PRP data because 50% is from china?

i choose to look at each study individually and consider the quality of the work done as the primary determinants. shoddy and biased work shows up not based on the journal or the location, but in the actual research and authorship.



1. he lied on applications to receive grants.
2. at present, there is nothing to suggest that he fabricated studies or lied on data.
3. however, he was working at that "school" down south. that in and of itself is question to doubt his work.

 

[cowboydoc]

it seems that you have previously expressed anti-china sentiment, not just in research...


yes, this is a diversion, but look back at all the studies that drusso has posted, and if you are so anti china, i suggest you consider invalidating them in your own mind.

which would be most of the recent studies he has posted... only 2 of the last 10 studies he has posted have been based in the US. 5 from china. 1 france, 1 indonesia, 1 iran. should we invalidate recent PRP data because 50% is from china?

i choose to look at each study individually and consider the quality of the work done as the primary determinants. shoddy and biased work shows up not based on the journal or the location, but in the actual research and authorship.



1. he lied on applications to receive grants.
2. at present, there is nothing to suggest that he fabricated studies or lied on data.
3. however, he was working at that "school" down south. that in and of itself is question to doubt his work.

Ha! If only buckeyes were a protected class!

 

[oreosandsake]

No. That's just the HA.

what brand, HMW HA?

$150 seems like a good deal in the USA. it's prob $15 in asia and africa

 

[oreosandsake]

Do you trust China? Chinese government? Chinese interference with research?

I reviewed a manuscript for a top 10 interventional pain journal re low back pain and facet injections. the paper was out of china

the entire methodology had inclusion criteria based on facet pain being reproduced with lumbar flexion. it must have been mentioned 15-20x throughout the paper. in the graphs, methods, results discussion. as part of the concerns i raised with the paper, I asked if how lumbar facet mediated pain was lumbar flexion based. and suggested that it is "classically" considered aggravated by lumbar extension.

they revised the entire paper and changed every word from flexion to extension.... didn't even mention it in their response. for some reason the manuscript made it to print.
No, it wasn't printed PP or a pay to play journal.
cutthroat countries require a lot to advance. In one country, mid career academics will need to pursue PhD if they ever expect to advance. only articles published in major journals like Lancet, NEJM, JAMA, etc are even counted towards their achievements for advancement. RAPM, Pain Medicine, journal of pain, PP, pain practice, etc don't count

 

[Ducttape]

I reviewed a manuscript for a top 10 interventional pain journal re low back pain and facet injections. the paper was out of china

the entire methodology had inclusion criteria based on facet pain being reproduced with lumbar flexion. it must have been mentioned 15-20x throughout the paper. in the graphs, methods, results discussion. as part of the concerns i raised with the paper, I asked if how lumbar facet mediated pain was lumbar flexion based. and suggested that it is "classically" considered aggravated by lumbar extension.

they revised the entire paper and changed every word from flexion to extension.... didn't even mention it in their response. for some reason the manuscript made it to print.
No, it wasn't printed PP or a pay to play journal.
cutthroat countries require a lot to advance. In one country, mid career academics will need to pursue PhD if they ever expect to advance. only articles published in major journals like Lancet, NEJM, JAMA, etc are even counted towards their achievements for advancement. RAPM, Pain Medicine, journal of pain, PP, pain practice, etc don't count

and that doesnt happen in the US?

look at our pain data. a lot of what we are allowed to do are based on what comes out of Padukah Ky. not sure the methodology from that "city" is good science.



in this case, drusso, i have rethought everything good i currently feel about PRP.

 

[Doctodd]

in this case, drusso, i have rethought everything good i currently feel about PRP.

can you be more specific?

If the study is so great, everyone will be able to reproduce it. Im not entirely biased against Chinese medicine.....i just question it. That isnt censored yet, is it?

You apparently dont understand communism. The govt may not have direct control or involvement, but communism incentivizes everyone to watch and report other people. Everyone is out to stab everyone.

 

[Ducttape]

sigh. i guess i have to spell out the obvious...


there seems to be a consensus on this thread that data from chinese scientists are not to be trusted. ergo, their data should be thrown out (because apparently some shadow chinese government official is altering the data.)

half of the past 10 studies are from chinese scientists.


so... suddenly there is much less data to show benefit from regenerative medicine.



hey, maybe someone should study PRP...

 

[lobelsteve]

sigh. i guess i have to spell out the obvious...


there seems to be a consensus on this thread that data from chinese scientists are not to be trusted. ergo, their data should be thrown out (because apparently some shadow chinese government official is altering the data.)

half of the past 10 studies are from chinese scientists.


so... suddenly there is much less data to show benefit from regenerative medicine.



hey, maybe someone should study PRP...

Maybe it’s only the acupuncture literature that they are manipulating. But every Chinese doctor, who moved here from China, as a doctor has told me that they have been influenced by the government when it comes to health care and research.

 

[lobelsteve]

it seems that you have previously expressed anti-china sentiment, not just in research...


yes, this is a diversion, but look back at all the studies that drusso has posted, and if you are so anti china, i suggest you consider invalidating them in your own mind.

which would be most of the recent studies he has posted... only 2 of the last 10 studies he has posted have been based in the US. 5 from china. 1 france, 1 indonesia, 1 iran. should we invalidate recent PRP data because 50% is from china?

i choose to look at each study individually and consider the quality of the work done as the primary determinants. shoddy and biased work shows up not based on the journal or the location, but in the actual research and authorship.



1. he lied on applications to receive grants.
2. at present, there is nothing to suggest that he fabricated studies or lied on data.
3. however, he was working at that "school" down south. that in and of itself is question to doubt his work.

China would never lie to us. I know it’s Fox.

COVID origins 'may have been tied' to China's bioweapons program: GOP report





COVID origins 'may have been tied' to China's bioweapons program: GOP report





Explore the Fox News apps that are right for you at http://www.foxnews.com/apps-products/index.html.

 

[Ducttape]

i am now several IQ points dumber for clicking on that nonsensical article.

 

[Doctodd]

“May have been”….usually tells the entire story.

 

[Ducttape]

“May have been”….usually tells the entire story.

for this, i agree.

"may have been" = "someone is paying me to write up this report, so i gotta make them feel it was worth their money."

 

[Doctodd]

My 21 y/o brother blew out his knee and had total reconstruction last year. He has been stiff and walked with a limp ever since. Ortho said he scarred poorly when he was in there. Finally able to get him into office for PRP. Next day he said it hasn’t felt this good since before surgery.

 

[drusso]

My 21 y/o brother blew out his knee and had total reconstruction last year. He has been stiff and walked with a limp ever since. Ortho said he scarred poorly when he was in there. Finally able to get him into office for PRP. Next day he said it hasn’t felt this good since surgery.View attachment 364091View attachment 364092

This is my daily life in the clinic. Same song, different verse.

 

[cowboydoc]

You guys are curing people in a day with PRP? Please publish your recipe and data!