What is the role of platelet-rich plasma in the treatment of osteoarthritis (OA)?

Updated: Jun 10, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Platelet-rich plasma (PRP) is defined as a volume of plasma with a platelet concentration higher than the average in peripheral blood (150,000–350,000 platelets/μl). [98]  A meta-analysis of 10 randomized controlled trials (RCTs) with a total of 1069 patients found that intra-articular PRP injection may have more benefit in pain relief and functional improvement than hyaluronic acid or saline in patients with symptomatic knee osteoarthritis at 1 year postinjection. [99]

Because of its high platelet concentration, PRP contains hyperphysiologic levels of clotting and growth factors, including insulinlike growth factor 1 (IGF-1), transforming growth factor  beta (TGF-beta), and platelet-derived growth factor (PDGF), among others. [100] Increased cell proliferation, collagen synthesis, and vascularity has been attributed to the activity of PRP. [100] However, concerns have been raised regarding the clinical efficacy of PRP, mainly due to the heterogeneity of preparation methods and resulting products, the scarceness of high-quality RCTs, and the contradictory results that have been found so far. [101]  

The FDA has cleared PRP preparation systems as a device "substantially equivalent" to another device previously cleared. However, the clearance applies only to the device and its intended use in an operative setting and makes no claim about its effectiveness for a particular indication. Similarly, in the European Union, only the preparation procedure, and not the product itself, is regulated, and the regulation does not include any requirements about the composition or effectiveness of PRP. [98]


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