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Zhu X, Zhao L, Riva N, Yu Z, Jiang M, Zhou F, Gatt A, Giannoudis PV, Guo JJ. Allogeneic platelet-rich plasma for knee osteoarthritis in patients with primary immune thrombocytopenia: A randomized clinical trial. iScience 2024; 27:109664. [PMID: 38646173 PMCID: PMC11031822 DOI: 10.1016/j.isci.2024.109664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
The treatment of painful KOA in adult patients with ITP has not been well studied yet. We conducted a prospective, double-blind, randomized, placebo-controlled trial to evaluate the efficacy of intra-articular allogeneic PRP injections on symptoms and joint structure in patients with KOA and ITP. 80 participants were randomly allocated in a 1:1 ratio to allogeneic PRP group or saline group. The primary outcome was the WOMAC total score at 12 months post-injection. The number of patients in each group who achieved MCID of primary outcome showed a statistically significant difference only at 3-month (27/39 vs. 5/39, p = 0.001) and 6-month (15/39 vs. 3/38, p = 0.032). The difference in WOMAC total score exceeded the MCID only at 3 month (mean difference of -15.1 [95% CI -20.7 to -9.5], p < 0.001). Results suggest that allogeneic PRP was superior to placebo only with respect to symptoms at 3-month of follow-up.
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Affiliation(s)
- Xiaohang Zhu
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Lingying Zhao
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
- China-Europe Sports Medicine Belt-and-Road Joint Laboratory, Ministry of Education of PRC, Suzhou, P.R. China
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ziqiang Yu
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
| | - Miao Jiang
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
| | - Feng Zhou
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Alexander Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Haematology, Mater Dei Hospital, Msida, Malta
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Jiong Jiong Guo
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
- China-Europe Sports Medicine Belt-and-Road Joint Laboratory, Ministry of Education of PRC, Suzhou, P.R. China
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Moulton SG, Hartwell MJ, Feeley BT. Evaluation of Spin Bias in Systematic Reviews and Meta-analyses of Rotator Cuff Repair With Platelet-Rich Plasma. Am J Sports Med 2024:3635465231213039. [PMID: 38323324 DOI: 10.1177/03635465231213039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND The use of platelet-rich plasma (PRP) in orthopaedics continues to increase. One common use of PRP is as an adjunct in rotator cuff repair surgery. Multiple systematic reviews and meta-analyses have summarized the data on PRP use in rotator cuff repair surgery. However, systematic reviews and meta-analyses are subject to spin bias, where authors' interpretations of results influence readers' interpretations. PURPOSE To evaluate spin in the abstracts of systematic reviews and meta-analyses of PRP with rotator cuff repair surgery. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS A PubMed and Embase search was conducted using the terms rotator cuff repair and PRP and systematic review or meta-analysis. After review of 74 initial studies, 25 studies met the inclusion criteria. Study characteristics were documented, and each study was evaluated for the 15 most common forms of spin and using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Version 2) rating system. Correlations between spin types and study characteristics were evaluated using binary logistic regression for continuous independent variables and a chi-square test or Fisher exact test for categorical variables. RESULTS At least 1 form of spin was found in 56% (14/25) of the included studies. In regard to the 3 different categories of spin, a form of misleading interpretation was found in 56% (14/25) of the studies. A form of misleading reporting was found in 48% (12/25) of the studies. A form of inappropriate extrapolation was found in 16% (4/25) of the studies. A significant association was found between misleading interpretation and publication year (odds ratio [OR], 1.41 per year increase in publication; 95% CI, 1.04-1.92; P = .029) and misleading reporting and publication year (OR, 1.41 per year increase in publication; 95% CI, 1.02-1.95; P = .037). An association was found between inappropriate extrapolation and journal impact factor (OR, 0.21 per unit increase in impact factor; 95% CI, 0.044-0.99; P = .048). CONCLUSION A significant amount of spin was found in the abstracts of systematic reviews and meta-analyses of PRP use in rotator cuff repair surgery. Given the increasing use of PRP by clinicians and interest among patients, spin found in these studies may have a significant effect on clinical practice.
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Affiliation(s)
- Samuel G Moulton
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Magruder ML, Caughey S, Gordon AM, Capotosto B S S, Rodeo SA. Trends in utilization, demographics, and costs of platelet-rich plasma injections: a ten-year nationwide investigation. PHYSICIAN SPORTSMED 2024; 52:89-97. [PMID: 36755520 DOI: 10.1080/00913847.2023.2178816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Platelet-Rich Plasma (PRP) has become one of the most popular biologic treatments in orthopedic surgery. Despite this, its utilization over the last decade has not been investigated. METHODS We conducted a search using Current Procedural Terminology codes to identify patients who received PRP injections between 2010 and 2019 using the PearlDiver database. The purpose was to 1) determine annual trends of PRP injections of the ankle, hip, knee, shoulder, and elbow for cartilaginous, tendinous, ligamentous, meniscal/labral, and miscellaneous pathologies; 2) compare baseline demographics of patients receiving these injections; and 3) analyze costs. RESULTS A total of 23,716 patients who received PRP injections were identified; 54.4% were female. The incidence of PRP injections was between 1.6 and 4.3 per 100,000 orthopedic patients. The most common anatomic locations targeted for PRP therapy was the knee (36.7%), followed by the shoulder/elbow (30.5%), then the ankle (19.6%) and hip (13.6%). Subgroup analysis revealed that most common use of PRP was for knee cartilaginous pathologies, followed by shoulder/elbow tendinous pathologies. The number of injections used in the knee significantly increased between 2010 and 2019 (p< 0.001), and trended toward significantly increasing in the shoulder/elbow (p = 0.055). Average annual costs for PRP injections ranged from $711.65 for ankles and $1,711.63 for hips; costs significantly changed for 3 of the 4 anatomic locations. By 2019, average PRP injection costs for each area clustered around $1000. CONCLUSION Between 2010 and 2019, there was an increase in usage of PRP injections in the knee (cartilaginous pathologies) and the shoulder/elbow (tendinous pathologies). PRP costs demonstrated early variability but clustered around $1000 by 2019. Further studies into drivers of prices and cost-effectiveness of PRP are needed to provide clarity into the true costs to patients and healthcare providers.
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Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sarah Caughey
- Department of Regenerative Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- Questrom School of Business, Boston University, Boston, MA, USA
| | | | - Scott A Rodeo
- Department of Regenerative Medicine, Hospital for Special Surgery, New York, NY, USA
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Klifto KM, Klifto CS, Pidgeon TS, Richard MJ, Ruch DS, Colbert SH. Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Markov Cost-Effectiveness Decision Analysis. Hand (N Y) 2024; 19:113-127. [PMID: 35603672 PMCID: PMC10786099 DOI: 10.1177/15589447221092056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) or corticosteroid injections may be used to conservatively treat mild-to-moderate carpal tunnel syndrome (CTS). We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of mild-to-moderate CTS. METHODS Markov modeling was used to analyze the base-case 45-year-old patient with mild-to-moderate CTS, unresponsive to conservative treatments, never previously treated with an injection or surgery, treated with a single injection of PRP, or methylprednisolone/triamcinolone 40 mg/mL. Transition probabilities were derived from level-I/II studies, utility values from the Tufts University Cost-Effectiveness Analysis Registry reported using visual analog scale (VAS), Boston Carpal Tunnel Questionnaire Symptom severity (BCTQ-S), and Boston Carpal Tunnel Questionnaire Functional status (BCTQ-F), and costs from Medicare, published studies, and industry. Analyses were performed from healthcare/societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay thresholds were $50 000 and $100 000. Deterministic/probabilistic sensitivity analyses were performed. RESULTS From a healthcare perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$13.52/quality-adjusted-life-years (QALY), BCTQ-S: -$11.88/QALY, and BCTQ-F: -$16.04/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 941.12 versus $375 788.21, BCTQ-S: $417 115.09 versus $356 614.18, and BCTQ-F: $421 706.44 versus $376 908.45. From a societal perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$1024.40/QALY, BCTQ-S: -$899.95/QALY, and BCTQ-F: -$1215.51/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 171.63 versus $373 944.39, BCTQ-S: $416 345.61 versus $354 770.36, and BCTQ-F: $420 936.95 versus $375 064.63. CONCLUSIONS PRP injections were more cost-effective than methylprednisolone/triamcinolone injections from healthcare and societal perspectives for mild-to-moderate CTS.
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Affiliation(s)
- Kevin M. Klifto
- University of Missouri School of Medicine, Columbia, USA
- Duke University School of Medicine, Durham, NC, USA
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5
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Patel H, Pundkar A, Shrivastava S, Chandanwale R, Jaiswal AM. A Comprehensive Review on Platelet-Rich Plasma Activation: A Key Player in Accelerating Skin Wound Healing. Cureus 2023; 15:e48943. [PMID: 38106716 PMCID: PMC10725573 DOI: 10.7759/cureus.48943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Platelet-rich plasma (PRP) activation is emerging as a promising and multifaceted tool for accelerating skin wound healing. This review extensively examines PRP's role in wound healing, focusing on its composition, mechanisms of action, activation methods, and clinical applications. PRP's potential to enhance both chronic and acute wound healing and its applications in cosmetic and aesthetic procedures are explored. Furthermore, this review investigates safety concerns, including adverse reactions, infection risks, and long-term safety implications. Looking to the future, emerging technologies, combination therapies, personalized medicine approaches, and regulatory developments are discussed, pointing towards an important and transformative era in wound healing and regenerative medicine. With its wide-ranging implications for healthcare, PRP activation has the potential to become a ubiquitous and essential therapeutic option, improving patient outcomes and reducing healthcare costs.
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Affiliation(s)
- Hardik Patel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditya Pundkar
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rohan Chandanwale
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankit M Jaiswal
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Stewart ZE, Lee K. Lower extremity ultrasound-guided interventions: tendon, ligament, and plantar fascia. Skeletal Radiol 2023; 52:991-1003. [PMID: 36326878 DOI: 10.1007/s00256-022-04212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity tendinopathy and soft tissue injury are common clinical problems that can cause significant disability. Ultrasound-guided minimally invasive treatments using orthobiologics and image-guided percutaneous treatments continue to gain relevance with an ever-growing body of literature. We review the indications, technique, risks, and benefits according to the literature of common ultrasound-guided interventions utilized in the lower extremities.
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Affiliation(s)
- Zachary E Stewart
- Department of Radiology - Musculoskeletal Imaging and Intervention, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey Bldg Room 6033, Boston, MA, 02114, USA.
| | - Kenneth Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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The Epidemiology of Platelet-Rich Plasma Injections From 2010 to 2020 in a Large US Commercial Insurance Claims Database: A Recent Update. J Am Acad Orthop Surg 2023; 31:e135-e147. [PMID: 36584347 DOI: 10.5435/jaaos-d-22-00397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The popularity of platelet-rich plasma (PRP) injections for the treatment of orthopaedic conditions has grown markedly. We sought to better define the trends in the usage of orthopaedic PRP injections across an insured US population over the past decade. METHODS The PearlDiver M91Ortho commercial administrative claims database was queried for all patients receiving PRP injections for orthopaedic conditions from 2010 through the first quarter of 2020 (Q1.2020). Trends in PRP use, reimbursement charges, demographics, joints injected, and administering physicians were assessed over time and reported as year-over-year (YOY) changes. RESULTS Over the study period, 14,096 unique patients had 17,759 orthopaedic PRP injections. The number of PRP injections administered had a YOY increase of 7.1% (144 injections/year, 95% confidence interval [CI] = 89 to 199, Ptrend = 0.0009). A YOY increase of 895% was observed in total nonsurgical charges ($683,974/yr, 95% CI 441,504 to 926,444, Ptrend = 0.0009). The median age of PRP recipients increased (YOY change = +0.6 years, 95% CI 0.4 to 0.8, Ptrend = 0.0005). Injections to the elbow (YOY change = -0.8%, 95% CI -0.10% to [-0.06%], Ptrend = 0.005) and foot/ankle (YOY change = -1.0%, 95% CI -1.4% to [-0.06%], Ptrend = 0.002) decreased, whereas hip (YOY change = +0.4%, 95% CI 0.2% to 0.6%, Ptrend = 0.019), knee (YOY change = +0.9%, 95% CI 0.3% to 1.2%, Ptrend = 0.016), and spine (YOY change = +0.2%, 95% CI 0.0% to 0.4%, Ptrend = 0.033) injections increased. PRP injections given by sports medicine orthopaedic surgeons (YOY change = +0.8%, 95% CI 0.6% to 1.2%, Ptrend <0.0001) increased over time, whereas those by general orthopaedic surgeons decreased (YOY change = -0.9, 95% CI -1.2 to [-0.6%], Ptrend = 0.001). CONCLUSION PRP injections quadrupled in prevalence from 2010 to Q1.2020, with a projected increase in annual usage in this data set of 66% by 2030. As greater evidence-based indications for PRP use are identified, more specialists and insurance providers may consider expanding their involvement in this growing field. LEVEL OF EVIDENCE III, retrospective cohort study.
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Schoch BS, Werner BC, Shapiro SA, Camp CL, Chalmers PN, Cancienne JM. Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221127004. [PMID: 36353396 PMCID: PMC9638537 DOI: 10.1177/23259671221127004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Bradley S. Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Shane A. Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Peter N. Chalmers
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
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Klifto KM, Colbert SH, Richard MJ, Anakwenze OA, Ruch DS, Klifto CS. Platelet-rich plasma vs. corticosteroid injections for the treatment of recalcitrant lateral epicondylitis: a cost-effectiveness Markov decision analysis. J Shoulder Elbow Surg 2022; 31:991-1004. [PMID: 35031496 DOI: 10.1016/j.jse.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both platelet-rich plasma (PRP) and corticosteroid injections may be used to treat lateral epicondylitis. We evaluated the cost-effectiveness of PRP injections vs. corticosteroid injections for the treatment of recalcitrant lateral epicondylitis. METHODS Markov modeling was used to analyze the base-case 45-year-old patient with recalcitrant lateral epicondylitis, unresponsive to conservative measures, treated with a single injection of PRP or triamcinolone 40 mg/mL. Transition probabilities were derived from randomized controlled trials, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry reported using Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and costs from institution financial records. Analyses were performed from health care and societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICERs), reported as US dollars / quality-adjusted life-year (USDs/QALY) and net monetary benefit (NMB) to represent the values of an intervention in monetary terms. Willingness-to-pay thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed over 10,000 iterations. RESULTS Both PRP and triamcinolone 40-mg/mL injections were considered cost-effective interventions from a health care and societal perspective below the WTP threshold of $50,000. From a health care perspective, PRP injections were dominant compared with triamcinolone 40-mg/mL injections, with an ICER of -$5846.97/QALY. PRP injections provided an NMB of $217,863.98, whereas triamcinolone 40 mg/mL provided an NMB of $197,534.18. From a societal perspective, PRP injections were dominant compared to triamcinolone 40-mg/mL injections, with an ICER of -$9392.33/QALY. PRP injections provided an NMB of $214,820.16, whereas triamcinolone 40 mg/mL provided an NMB of $193,199.75. CONCLUSIONS Both PRP and triamcinolone 40-mg/mL injections provided cost-effective treatments from health care and societal perspectives. Overall, PRP injections were the dominant treatment, with the greatest NMB for recalcitrant lateral epicondylitis over the time horizon of 5 years.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Stephen H Colbert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Oke A Anakwenze
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
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Arthurs JR, Nordan LM, Hultgren BH, Heckman MG, Martinez D, Master Z, Shapiro SA. Patients seeking stem cell therapies-a prospective qualitative analysis from a Regenerative Medicine Consult Service. NPJ Regen Med 2022; 7:20. [PMID: 35338147 PMCID: PMC8956610 DOI: 10.1038/s41536-022-00215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/15/2022] [Indexed: 02/08/2023] Open
Abstract
Despite patient demand for stem cell therapies (SCTs) for musculoskeletal conditions, there remains limited research on why patients seek SCTs or their sources of information. We employ three questions into a consult intake form: (1) Why are you interested in stem cell treatment for your condition? (2) How did you find out about stem cell treatment for your condition? (3) Have you contacted a stem cell clinic? Responses analyzed, using a qualitative content analysis approach to identify themes reveal many patients seek SCTs to treat pain or delay surgery which may align with some current clinical evidence while other patients express motivations as expected outcomes (e.g., SCTs are better than standard of care or can regenerate tissue) which are not supported by current medical evidence. These differences suggests that patient-centered counseling may help patients by addressing misconceptions and increasing health literacy about expected outcomes of SCTs for treating musculoskeletal conditions.
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Affiliation(s)
| | - Lisa M Nordan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Brian H Hultgren
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Dayana Martinez
- United States Navy, Washington, DC, USA
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Zubin Master
- Biomedical Ethics Research Program and the Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Transforaminal Endoscopic Lumbar Discectomy with versus without Platelet-Rich Plasma Injection for Lumbar Disc Herniation: A Prospective Cohort Study. Pain Res Manag 2022; 2022:6181478. [PMID: 35296040 PMCID: PMC8920626 DOI: 10.1155/2022/6181478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
Objective Transforaminal endoscopic lumbar discectomy (TELD) is an effective treatment for patients with lumbar disc herniation (LDH) with failure of conservative treatment. However, defects in the annulus fibrosus after TELD usually lead to a recurrence of LDH. Platelet-rich plasma (PRP) injection has shown promising potential for the repair of injured tissues. The combination of TELD and PRP injection has rarely been reported. Hence, this study aimed to evaluate the effectiveness, disc remodeling, and recurrence rate of LDH in TELD with or without PRP in LDH treatment. Methods A total of 108 consecutive patients who underwent TELD were prospectively registered between July 2018 and December 2019 (https://clinicaltrials.gov/ct2/show/ChiCTR1800017228). Fifty-one and fifty-seven patients underwent TELD with PRP injections and TELD only, respectively. The visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria were evaluated, and perioperative complications were documented. The disc protrusion, spinal cross-sectional area (SCSA), and disc height were measured on MRI and evaluated preoperatively, postoperatively, and at regular follow-up. Results All patients were followed up. Clinical improvement was noted in both groups. There were statistical differences in the VAS scores of back and leg pain and ODI between the two groups at 3 months, 6 months, and 1 year follow-up (P < 0.05); the improvement in the PRP group was significant. The disc protrusion and SCSA on MRI in the PRP group showed better improvement, with lower recurrence rate, than that in the control group at the final follow-up (P < 0.05). No adverse events were reported in our study following PRP injection. Conclusion Our study showed that TELD with PRP injection was a safe and effective treatment for patients with LDH in the medium and long-term follow-up. PRP injection was beneficial for disc remodeling after endoscopic discectomy and decreased the recurrence of LDH.
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Klifto KM, Othman S, Kovach SJ. Minoxidil, Platelet-Rich Plasma (PRP), or Combined Minoxidil and PRP for Androgenetic Alopecia in Men: A Cost-Effectiveness Markov Decision Analysis of Prospective Studies. Cureus 2021; 13:e20839. [PMID: 35141088 PMCID: PMC8800610 DOI: 10.7759/cureus.20839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Androgenetic alopecia (AGA) is the most common cause of hair loss in men. In this study, we evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil and platelet-rich plasma (PRP) combined therapy, and PRP monotherapy for the long-term treatment of early-onset AGA Hamilton-Norwood stages I-V in men. Methodology Markov modeling was performed to analyze the base-case parameters from 18 level I/II studies. The model base-case assumes a healthy 25-year-old man presenting to a dermatologist or plastic surgeon’s office as a new patient for the evaluation and treatment of AGA Hamilton-Norwood stages I-V (non-severe AGA in men). Simulations began at an age of 25 years and ran over 35 years. Analyses were conducted from healthcare and societal perspectives. Outcomes included incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay (WTP) thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty over 10,000 simulations. Results From a healthcare perspective, compared to minoxidil monotherapy, the ICER for minoxidil+PRP was $52,036/quality-adjusted-life-year (QALY) and the ICER for PRP monotherapy was $439,303/QALY. The NMB of minoxidil monotherapy was $914,887, minoxidil+PRP was $914,350, and PRP monotherapy was $904,572 at a WTP threshold of $50,000. When the WTP threshold was increased to $100,000, the NMB of minoxidil+PRP was $1,843,908, minoxidil monotherapy was $1,831,237, and PRP monotherapy was $1,822,246. Societal trends were similar. Conclusions Minoxidil 5% topical twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000, whereas combining minoxidil 5% with PRP provided cost-effective treatment at a WTP threshold of $100,000. Level of evidence: Level II.
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Bennell KL, Paterson KL, Metcalf BR, Duong V, Eyles J, Kasza J, Wang Y, Cicuttini F, Buchbinder R, Forbes A, Harris A, Yu SP, Connell D, Linklater J, Wang BH, Oo WM, Hunter DJ. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA 2021; 326:2021-2030. [PMID: 34812863 PMCID: PMC8611484 DOI: 10.1001/jama.2021.19415] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Most clinical guidelines do not recommend platelet-rich plasma (PRP) for knee osteoarthritis (OA) because of lack of high-quality evidence on efficacy for symptoms and joint structure, but the guidelines emphasize the need for rigorous studies. Despite this, use of PRP in knee OA is increasing. OBJECTIVE To evaluate the effects of intra-articular PRP injections on symptoms and joint structure in patients with symptomatic mild to moderate radiographic medial knee OA. DESIGN, SETTING, AND PARTICIPANTS This randomized, 2-group, placebo-controlled, participant-, injector-, and assessor-blinded clinical trial enrolled community-based participants (n = 288) aged 50 years or older with symptomatic medial knee OA (Kellgren and Lawrence grade 2 or 3) in Sydney and Melbourne, Australia, from August 24, 2017, to July 5, 2019. The 12-month follow-up was completed on July 22, 2020. INTERVENTIONS Interventions involved 3 intra-articular injections at weekly intervals of either leukocyte-poor PRP using a commercially available product (n = 144 participants) or saline placebo (n = 144 participants). MAIN OUTCOMES AND MEASURES The 2 primary outcomes were 12-month change in overall average knee pain scores (11-point scale; range, 0-10, with higher scores indicating worse pain; minimum clinically important difference of 1.8) and percentage change in medial tibial cartilage volume as assessed by magnetic resonance imaging (MRI). Thirty-one secondary outcomes (25 symptom related and 6 MRI assessed; minimum clinically important difference not known) evaluated pain, function, quality of life, global change, and joint structures at 2-month and/or 12-month follow-up. RESULTS Among 288 patients who were randomized (mean age, 61.9 [SD, 6.5] years; 169 [59%] women), 269 (93%) completed the trial. In both groups, 140 participants (97%) received all 3 injections. After 12 months, treatment with PRP vs placebo injection resulted in a mean change in knee pain scores of -2.1 vs -1.8 points, respectively (difference, -0.4 [95% CI, -0.9 to 0.2] points; P = .17). The mean change in medial tibial cartilage volume was -1.4% vs -1.2%, respectively (difference, -0.2% [95% CI, -1.9% to 1.5%]; P = .81). Of 31 prespecified secondary outcomes, 29 showed no significant between-group differences. CONCLUSIONS AND RELEVANCE Among patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617000853347.
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Affiliation(s)
- Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kade L. Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben R. Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jillian Eyles
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Rheumatology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Shirley P. Yu
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David Connell
- Imaging @ Olympic Park, Melbourne, Victoria, Australia
| | | | - Bing Hui Wang
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Mandalay, Myanmar
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Cohen SA, Zhuang T, Xiao M, Michaud J, Amanatullah DF, Kamal RN. Google Trends Analysis Shows Increasing Public Interest in Platelet-Rich Plasma Injections for Hip and Knee Osteoarthritis. J Arthroplasty 2021; 36:3616-3622. [PMID: 34172346 PMCID: PMC8478783 DOI: 10.1016/j.arth.2021.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/15/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential nonoperative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis. METHODS Google Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of "arthritis," "osteoarthritis," "PRP," "platelet-rich plasma," "knee," and "hip" were entered into the Google Trends tool and trend analyses were performed. RESULTS Three linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (P < .001), with R2 ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted. CONCLUSION Our results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.
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Affiliation(s)
- Samuel A. Cohen
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
| | - Michelle Xiao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
| | - John Michaud
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
| | - Derek F. Amanatullah
- Stanford University, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063
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Hohmann E. Editorial Commentary: Injection of Platelet-Rich Plasma Appears Superior to Hyaluronic Acid and Adipose- or Bone-Derived Marrow Stem Cells for Knee Osteoarthritis. Arthroscopy 2021; 37:2315-2317. [PMID: 34226015 DOI: 10.1016/j.arthro.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
Injection therapy for knee osteoarthritis continues to be a controversial topic. Commonly accepted treatment options are corticosteroid and hyaluronic acid injections, but recently platelet-rich plasma also has been a promising biologic treatment option. Adipose and bone marrow-derived mesenchymal stem cells have been applied clinically, but there is no strong supporting evidence for their use. It is also currently unknown whether stem cells can regenerate cartilage. As there is no cure for painful knee osteoarthritis, injection therapy can provide symptom relief. Recent network meta-analyses suggest that platelet-rich plasma provides the best functional improvement and safety for knee osteoarthritis, and adipose-derived mesenchymal stem cells provide excellent pain relief. We must bear in mind that other network meta-analyses report different results, and a challenge of network meta-analysis is inconsistency that can lead to biased treatment effect estimates.
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Chillemi C, Paglialunga C, De Giorgi G, Proietti R, Carli S, Damo M. Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study. World J Orthop 2021; 12:403-411. [PMID: 34189078 PMCID: PMC8223723 DOI: 10.5312/wjo.v12.i6.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world’s population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components.
AIM To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis.
METHODS This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR.
RESULTS In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case.
CONCLUSION HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.
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Affiliation(s)
- Claudio Chillemi
- Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico, Latina 04100, Lazio, Italy
| | - Carlo Paglialunga
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Greta De Giorgi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Stefano Carli
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Marco Damo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
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