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Jeyaraman M, Pai SN, Filippo M, Jeyaraman N, Venkatasalam R, Nallakumarasamy A, Khanna M, Patro BP, Sharma S, Rangarajan RV. Informed consent form for platelet rich plasma injections: evidence-based and legally guide for orthopaedic surgeons. Eur J Med Res 2024; 29:422. [PMID: 39152486 PMCID: PMC11330123 DOI: 10.1186/s40001-024-02019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, 600077, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, 201310, India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Regenerative Medicine, Mother Cell Regenerative Centre, Tiruchirappalli, Tamil Nadu, 620017, India
- Department of Regenerative Medicine, Orange Health Care, Chennai, Tamil Nadu, 600040, India
| | - Satvik N Pai
- Department of Orthopaedics, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, 560083, India
| | - Migliorini Filippo
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy.
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, 600077, India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Regenerative Medicine, Mother Cell Regenerative Centre, Tiruchirappalli, Tamil Nadu, 620017, India
| | | | - Arulkumar Nallakumarasamy
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Regenerative Medicine, Mother Cell Regenerative Centre, Tiruchirappalli, Tamil Nadu, 620017, India
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal, Puducherry, 609602, India
| | - Manish Khanna
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
| | - Bishnu Prasad Patro
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Orthopaedics, All Indian Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Shilpa Sharma
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ravi Velamor Rangarajan
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Regenerative Medicine, Mother Cell Regenerative Centre, Tiruchirappalli, Tamil Nadu, 620017, India
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Harding D, Cameron L, Monga A, Winter S. Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis. Musculoskeletal Care 2024; 22:e1892. [PMID: 38777616 DOI: 10.1002/msc.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). AIM To investigate the efficacy of SWT on pain and function in the management of GTPS. METHODS A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow-up were considered for inclusion. Meta-analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Twelve articles (n = 1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non-RCTs. No statistical differences were observed for pain over time f(1,5) = 1.349 (p = 0.298) or between SWT and control f(1,5) = 1.782 (p = 0.238). No significant differences in functional outcomes in short- (H = 2.591, p = 0.181) and medium-term follow-up (H = 0.189, p = 0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges-G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow-up time-points in SWT groups compared to control. CONCLUSION Moderate-quality evidence demonstrated no statistically significant improvements in pain and function post-SWT compared to control. Low-quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta-analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.
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Affiliation(s)
- Dan Harding
- Aneurin Bevan University Health Board, Caerleon, UK
| | - Lee Cameron
- Aneurin Bevan University Health Board, Caerleon, UK
| | - Aastha Monga
- School of Allied Health Professions, Keele University, Keele, UK
| | - Sara Winter
- School of Allied Health Professions, Keele University, Keele, UK
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Atilano L, Martin N, Ignacio Martin J, Iglesias G, Mendiola J, Bully P, Aiyegbusi A, Manuel Rodriguez-Palomo J, Andia I. Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671241249123. [PMID: 38751852 PMCID: PMC11095191 DOI: 10.1177/23259671241249123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 05/18/2024] Open
Abstract
Background Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space. Purpose To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment. Results Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027). Conclusion Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group. Registration NCT04231357 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Leire Atilano
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Nerea Martin
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Orthopaedic Surgery Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Jose Ignacio Martin
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Gotzon Iglesias
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Josu Mendiola
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Bizkaia, Spain
| | - Ayoola Aiyegbusi
- Department of Physiotherapy, Faculty of Clinical Sciences College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jose Manuel Rodriguez-Palomo
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Orthopaedic Surgery Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Isabel Andia
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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Disantis A, Andrade AJ, Baillou A, Bonin N, Byrd T, Campbell A, Domb B, Doyle H, Enseki K, Getz B, Gosling L, Grant L, M. Ilizaliturri Jr. V, Kohlrieser D, Laskovski J, Lifshitz L, P. McGovern R, Monnington K, O’Donnell J, Takla A, Tyler T, Voight M, Wuerz T, Martin RL. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. J Hip Preserv Surg 2023; 10:48-56. [PMID: 37275836 PMCID: PMC10234389 DOI: 10.1093/jhps/hnac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/19/2022] [Accepted: 11/22/2022] [Indexed: 11/12/2023] Open
Abstract
The 2022 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS) was intended to present a physiotherapy consensus on the assessment and surgical and non-surgical physiotherapy management of patients with GTPS. The panel consisted of 15 physiotherapists and eight orthopaedic surgeons. Currently, there is a lack of high-quality literature supporting non-operative and operative physiotherapy management. Therefore, a group of physiotherapists who specialize in the treatment of non-arthritic hip pathology created this consensus statement regarding physiotherapy management of GTPS. The consensus was conducted using a modified Delphi technique to guide physiotherapy-related decisions according to the current knowledge and expertise regarding the following: (i) evaluation of GTPS, (ii) non-surgical physiotherapy management, (iii) use of corticosteroids and orthobiologics and (iv) surgical indications and post-operative physiotherapy management.
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Affiliation(s)
- Ashley Disantis
- Adolescent and Young Adult Hip Preservation Program, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Ave, Pittsburgh, PA 15282, USA
| | - Antonio J Andrade
- Reading Orthopaedic Centre, Circle Reading Hospital, Reading RG2 0NE, UK
- Trauma and Orthopaedic Department, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Alexander Baillou
- Physiotherapy, Physio-Baillou,Praterstrasse, 60/1/3, A-1020, Vienna, AT
| | - Nicolas Bonin
- Orthopaedic Surgery, Lyon Ortho Clinic, 29B Avenue des Sources, Lyon 69009, FR
| | - Thomas Byrd
- Orthopaedic Surgery, Nashville Sports Medicine Foundation, 100, 2011 Church Street, Nashville, TN 37203, USA
| | - Ashley Campbell
- Physical Therapy, Performance One Physical Therapy and Wellness, 400 Franklin Road, Franklin TN 37069, USA
| | - Benjamin Domb
- Orthopaedic Surgery, American Hip Institute, 999 E Touhy, Des Plaines, Chicago IL 60018, USA
| | - Holly Doyle
- Integrum Physiotherapy, 94 Ridge Rd, London N8 9NR, UK
| | - Keelan Enseki
- Centers for Rehab Services/University of Pittsburgh Medical Center, Rooney Sports Complex, 3200 S. Water St, Pittsburgh, PA 15203, USA
| | - Barry Getz
- Physiotherapy, The Centre for Sports Medicine and Orthopaedics, 9 Sturdee Ave, Johannesburg, Rosebank 2196, SA
| | - Lucie Gosling
- Young Adult Hip Service, The Royal National Orthopaedic Hospital, 519 Briston Rd S, Birmingham B31 2AP, UK
| | - Louise Grant
- Physiotherapy, PhysioCure, Cookridge Lane, Leeds S16 7NL, UK
| | - Victor M. Ilizaliturri Jr.
- Adult Joint Reconstruction, National Rehabilitation Institute of Mexico, Calz Mexico-Xochimilco 289, Coapa, Guadalupe Tlalpan, Tlalpan, 14389 Cuidad de Mexico, CDMS, MX
| | - Dave Kohlrieser
- Physiotherapy, Orthopedic One, 4605 Sawmill Road, Columbus OH 43220, USA
| | - Jovan Laskovski
- Orthopedic Surgery, Crystal Clinic Orthopedic Center, Hip Preservation, 1622 SR 619, Ste 200, Akron, OH, USA
| | - Liran Lifshitz
- Physiotherapy, Physio & More, 27 Shabtai Yaacov, Tel Aviv- Yafo 6962806, IL
| | - Ryan P. McGovern
- Sports Medicine Research, Texas Health Orthopedic Specialists, 6301 Harris Parkway, #200 Dallas/Fort Worth, TX 76132, USA
| | - Katie Monnington
- Young Adult Hip Service, The Royal National Orthopaedic Hospital, 519 Briston Rd S, Birmingham B31 2AP, UK
| | - John O’Donnell
- Hip Arthroscopy Australia, 21 Erin Street, Richmond VIC 3121, AU
- Orthopaedics, St. Vincent’s Melbourne, East Melbourne, VIC 3065, AU
| | - Amir Takla
- Hip Arthroscopy Australia, 21 Erin Street, Richmond VIC 3121, AU
- Swinburne University of Technology, Hawthorn Campus, John Street, Hawthorn, Victoria 3122, AS
- Australian Sports Physiotherapy, Ivanhoe 3079, Australia
| | - Tim Tyler
- Physiotherapy, NISMAT, 130 E 77th St, New York, NY 10075, USA
- Professional Physical Therapy, New York, NY 10010, USA
| | - Mike Voight
- Physical Therapy, Performance One Physical Therapy and Wellness, 400 Franklin Road, Franklin TN 37069, USA
- School of Physical Therapy, Belmont University, 1900 Belmont Boulevard, Nashville, TN, US
| | - Thomas Wuerz
- Orthopaedic Surgery, New England Baptist Hospital, 40 Allied Drive, Dedham, MA 02026, USA
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Ave, Pittsburgh, PA 15282, USA
- Centers for Rehab Services/University of Pittsburgh Medical Center, Rooney Sports Complex, 3200 S. Water St, Pittsburgh, PA 15203, USA
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Migliorini F, Eschweiler J, Goetze C, Pastor T, Giorgino R, Hildebrand F, Maffulli N. Cell therapies for chondral defects of the talus: a systematic review. J Orthop Surg Res 2022; 17:308. [PMID: 35690865 PMCID: PMC9188715 DOI: 10.1186/s13018-022-03203-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background This systematic review investigated the efficacy and safety of surgical procedures augmented with cell therapies for chondral defects of the talus. Methods The present systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus databases were accessed in March 2022. All the clinical trials investigating surgical procedures for talar chondral defects augmented with cell therapies were accessed. The outcomes of interest were to investigate whether surgical procedures augmented with cell therapies promoted improvement in patients reported outcomes measures (PROMs) with a tolerable rate of complications. Results Data from 477 procedures were retrieved. At a mean follow-up of 34.8 ± 9.7 months, the Visual Analogic Scale (VAS) improved of 4.4/10 (P = 0.002) and the American Orthopaedic Foot and Ankle Score (AOFAS) of 31.1/100 (P = 0.0001) points. No improvement was found in Tegner score (P = 0.4). Few articles reported data on complications. At last follow-up, the rate of reoperation and failure were 0.06% and 0.03%, respectively. No graft delamination or hypertrophy was observed. Conclusion The current evidence suggests that cell therapies may be effective and safe to enhance surgical procedures for chondral defects of the talus. These results should be considered within the limitations of the present study. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Goetze
- Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany
| | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital, 6000, Lucerne, Switzerland
| | - Riccardo Giorgino
- IRCCS Istituto Ortopedico Galeazzi, University of Milan, 20161, Milan, Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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