Efficacy and safety of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XING Fei , DUAN Xin , CHEN Jialei ,  LIU Ming

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China;

Corresponding author：

LIU Ming, Email: liuming15@qq.com

Keywords：

Femoral neck fracture; Internal fixation; Cannulated screw; Platelet-rich plasma; Randomized controlled trial

DOI：

10.7507/1672-2531.201905101

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the safety and efficacy of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture.Methods Databases including The Cochrane Library, PubMed, Web of Science, WanFang Data, CBM, EMbase and CNKI were searched to collect randomized controlled trials (RCTs) on operation versus operation combined with platelet-rich plasma for patients with femoral neck fracture from inception to April 30^th, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.Results A total of 8 RCTs, including 916 patients with femoral neck fracture were enrolled in the analysis. The results of meta-analysis showed that compared with the group of internal fixation, the group of internal fixation combined with platelet-rich plasma could significantly shorten healing duration of fracture (MD=−2.18, 95%CI −3.37 to −0.99, P=0.000 3), improve the fracture healing rate (RR=1.14, 95%CI 1.03 to 1.25, P<0.000 01) and hip function score (MD=10.18, 95%CI 5.99 to 14.37, P<0.000 01), and effectively reduce the femoral head necrosis rate after operation (RR=0.35, 95%CI 0.22 to 0.57, P<0.000 1).Conclusion Current evidence shows that the method of internal fixation combined with platelet-rich plasma could effectively shorten healing duration, improve healing rate and hip function score, and reduce the rate of femoral head necrosis. Due to the limited quality of the included studies, more large scale, high-quality studies are required to verify the above conclusion.

Citation： XING Fei, DUAN Xin, CHEN Jialei, LIU Ming. Efficacy and safety of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(12): 1453-1459. doi: 10.7507/1672-2531.201905101 Copy

1.	Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc, 2003, 51(3): 364-370.
2.	Chehade MJ, Carbone T, Awward D, et al. Influence of fracture stability on early patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures. J Orthop Trauma, 2015, 29(12): 538-543.
3.	Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012, 23(9): 2239-2256.
4.	Berggren M, Stenvall M, Englund U, et al. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatr, 2016, 16(1): 120.
5.	Veldman HD, Heyligers IC, Grimm B, et al. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J, 2017, 99-B(4): 421-431.
6.	Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J, 2016, 98-B(3): 291-297.
7.	Luo P, Gao F, Han J, et al. The role of autophagy in steroid necrosis of the femoral head: a comprehensive research review. Int Orthop, 2018, 42(7): 1747-1753.
8.	Grace TR, Patterson JT, Tangtiphaiboontana J, et al. Hip fractures and the bundle: a cost analysis of patients undergoing hip arthroplasty for femoral neck fracture vs degenerative joint disease. J Arthroplasty, 2018, 33(6): 1681-1685.
9.	Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399): 87-109.
10.	Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg, 2004, 62(4): 489-496.
11.	Wu PI, Diaz R, Borg-Stein J. Platelet-rich plasma. Phys Med Rehabil Clin N Am, 2016, 27(4): 825-853.
12.	Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg, 2004, 114(6): 1502-1508.
13.	Masuki H, Okudera T, Watanebe T, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent, 2016, 2(1): 19.
14.	Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
15.	Griffin XL, Achten J, Parsons N, et al. Platelet-rich therapy in the treatment of patients with hip fractures: a single centre, parallel group, participant-blinded, randomised controlled trial. BMJ Open, 2013, 3(6): e002583.
16.	Samy AM. The role of platelet rich plasma in management of fracture neck femur: new insights. Int Orthop, 2016, 40(5): 1019-1024.
17.	张浩, 龙亨国. 富血小板血浆对股骨颈骨折愈合及髋关节功能恢复的 120 例临床研究. 黑龙江中医药, 2016, 45(2): 21-22.
18.	张洪斌. 探讨应用富血小板血桨(PRP)对股骨颈骨折愈合及股骨头坏死治疗效果的影响. 中外医疗, 2017, 36(31): 100-102.
19.	秦立武, 姜红江, 黄相杰, 等. 富血小板血浆联合空心钉治疗股骨颈骨折的疗效观察. 中国骨与关节损伤杂志, 2014, 29(12): 1250-1251.
20.	张福田, 孔祥全, 张桂红, 等. 富血小板血浆与空心钉锁定钢板治疗股骨颈骨折. 中国矫形外科杂志, 2017, 25(14): 1277-1281.
21.	向登, 林炎水, 贺军, 等. 富血小板血桨对股骨颈骨折愈合及股骨头坏死治疗效果的影响. 西部医学, 2017, 29(1): 103-105.
22.	丁俊杰, 丁涛, 董卫东. 富血小板血浆对股骨颈骨折患者骨折愈合及股骨头坏死的影响. 海南医学, 2015, 26(19): 2912-2913.
23.	Daif ET. Effect of autologous platelet-rich plasma on bone regeneration in mandibular fractures. Dent Traumatol, 2013, 29(5): 399-403.
24.	Li H, Hicks JJ, Wang L, et al. Customized platelet-rich plasma with transforming growth factor β1 neutralization antibody to reduce fibrosis in skeletal muscle. Biomaterials, 2016, 87: 147-156.
25.	Marx RE, Carlson ER, Eichstaedt RM, et al. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(6): 638-646.
26.	Foster TE, Puskas BL, Mandelbaum BR, et al. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med, 2009, 37(11): 2259-2272.
27.	Cheng X, Lei D, Mao T, et al. Repair of critical bone defects with injectable platelet rich plasma/bone marrow-derived stromal cells composite: experimental study in rabbits. Ulus Travma Acil Cerrahi Derg, 2008, 14(2): 87-95.
28.	Gómez-Barrena E, Rosset P, Lozano D, et al. Bone fracture healing: cell therapy in delayed unions and nonunions. Bone, 2015, 70: 93-101.
29.	Andia I, Rubio-Azpeitia E, Maffulli N. Platelet-rich plasma modulates the secretion of inflammatory/angiogenic proteins by inflamed tenocytes. Clin Orthop Relat Res, 2015, 473(5): 1624-1634.
30.	Khatab S, van Buul GM, Kops N, et al. Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis. Am J Sports Med, 2018, 46(4): 977-986.
31.	Yamada Y, Ueda M, Naiki T, et al. Autogenous injectable bone for regeneration with mesenchymal stem cells and platelet-rich plasma: tissue-engineered bone regeneration. Tissue Eng, 2004, 10(5-6): 955-964.
32.	Rai B, Oest ME, Dupont KM, et al. Combination of platelet-rich plasma with polycaprolactone-tricalcium phosphate scaffolds for segmental bone defect repair. J Biomed Mater Res A, 2007, 81(4): 888-899.
33.	Osterman C, McCarthy MB, Cote MP, et al. Platelet-rich plasma increases anti-inflammatory markers in a human coculture model for osteoarthritis. Am J Sports Med, 2015, 43(6): 1474-1484.
34.	Mussano F, Genova T, Munaron L, et al. Cytokine, chemokine, and growth factor profile of platelet-rich plasma. Platelets, 2016, 27(5): 467-471.
35.	Xing F, Li L, Long Y, et al. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord, 2018, 19(1): 444.
36.	Arbab D, König DP. Atraumatic femoral head necrosis in adults. Dtsch Arztebl Int, 2016, 113(3): 31-38.
37.	Qiu S, Zhu T, Song L, et al. Internal fixation with cancellous bone screws is effective for femoral neck fractures by lowering the incidence of femoral head necrosis. Int J Clin Exp Med, 2016, 9(2): 3723-3728.
38.	Qiu G, Shi Z, Xu HHK, et al. Bone regeneration in minipigs via calcium phosphate cement scaffold delivering autologous bone marrow mesenchymal stem cells and platelet-rich plasma. J Tissue Eng Regen Med, 2018, 12(2): e937-e948.
39.	Chahal J, Van Thiel GS, Mather RC 3rd, et al. The patient acceptable symptomatic state for the modified harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med, 2015, 43(8): 1844-1849.
40.	Vishwanathan K, Akbari K, Patel AJ. Is the modified Harris hip score valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures? J Orthop, 2018, 15(1): 40-46.

1. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc, 2003, 51(3): 364-370.
2. Chehade MJ, Carbone T, Awward D, et al. Influence of fracture stability on early patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures. J Orthop Trauma, 2015, 29(12): 538-543.
3. Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012, 23(9): 2239-2256.
4. Berggren M, Stenvall M, Englund U, et al. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatr, 2016, 16(1): 120.
5. Veldman HD, Heyligers IC, Grimm B, et al. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J, 2017, 99-B(4): 421-431.
6. Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J, 2016, 98-B(3): 291-297.
7. Luo P, Gao F, Han J, et al. The role of autophagy in steroid necrosis of the femoral head: a comprehensive research review. Int Orthop, 2018, 42(7): 1747-1753.
8. Grace TR, Patterson JT, Tangtiphaiboontana J, et al. Hip fractures and the bundle: a cost analysis of patients undergoing hip arthroplasty for femoral neck fracture vs degenerative joint disease. J Arthroplasty, 2018, 33(6): 1681-1685.
9. Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399): 87-109.
10. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg, 2004, 62(4): 489-496.
11. Wu PI, Diaz R, Borg-Stein J. Platelet-rich plasma. Phys Med Rehabil Clin N Am, 2016, 27(4): 825-853.
12. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg, 2004, 114(6): 1502-1508.
13. Masuki H, Okudera T, Watanebe T, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent, 2016, 2(1): 19.
14. Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
15. Griffin XL, Achten J, Parsons N, et al. Platelet-rich therapy in the treatment of patients with hip fractures: a single centre, parallel group, participant-blinded, randomised controlled trial. BMJ Open, 2013, 3(6): e002583.
16. Samy AM. The role of platelet rich plasma in management of fracture neck femur: new insights. Int Orthop, 2016, 40(5): 1019-1024.
17. 张浩, 龙亨国. 富血小板血浆对股骨颈骨折愈合及髋关节功能恢复的 120 例临床研究. 黑龙江中医药, 2016, 45(2): 21-22.
18. 张洪斌. 探讨应用富血小板血桨(PRP)对股骨颈骨折愈合及股骨头坏死治疗效果的影响. 中外医疗, 2017, 36(31): 100-102.
19. 秦立武, 姜红江, 黄相杰, 等. 富血小板血浆联合空心钉治疗股骨颈骨折的疗效观察. 中国骨与关节损伤杂志, 2014, 29(12): 1250-1251.
20. 张福田, 孔祥全, 张桂红, 等. 富血小板血浆与空心钉锁定钢板治疗股骨颈骨折. 中国矫形外科杂志, 2017, 25(14): 1277-1281.
21. 向登, 林炎水, 贺军, 等. 富血小板血桨对股骨颈骨折愈合及股骨头坏死治疗效果的影响. 西部医学, 2017, 29(1): 103-105.
22. 丁俊杰, 丁涛, 董卫东. 富血小板血浆对股骨颈骨折患者骨折愈合及股骨头坏死的影响. 海南医学, 2015, 26(19): 2912-2913.
23. Daif ET. Effect of autologous platelet-rich plasma on bone regeneration in mandibular fractures. Dent Traumatol, 2013, 29(5): 399-403.
24. Li H, Hicks JJ, Wang L, et al. Customized platelet-rich plasma with transforming growth factor β1 neutralization antibody to reduce fibrosis in skeletal muscle. Biomaterials, 2016, 87: 147-156.
25. Marx RE, Carlson ER, Eichstaedt RM, et al. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(6): 638-646.
26. Foster TE, Puskas BL, Mandelbaum BR, et al. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med, 2009, 37(11): 2259-2272.
27. Cheng X, Lei D, Mao T, et al. Repair of critical bone defects with injectable platelet rich plasma/bone marrow-derived stromal cells composite: experimental study in rabbits. Ulus Travma Acil Cerrahi Derg, 2008, 14(2): 87-95.
28. Gómez-Barrena E, Rosset P, Lozano D, et al. Bone fracture healing: cell therapy in delayed unions and nonunions. Bone, 2015, 70: 93-101.
29. Andia I, Rubio-Azpeitia E, Maffulli N. Platelet-rich plasma modulates the secretion of inflammatory/angiogenic proteins by inflamed tenocytes. Clin Orthop Relat Res, 2015, 473(5): 1624-1634.
30. Khatab S, van Buul GM, Kops N, et al. Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis. Am J Sports Med, 2018, 46(4): 977-986.
31. Yamada Y, Ueda M, Naiki T, et al. Autogenous injectable bone for regeneration with mesenchymal stem cells and platelet-rich plasma: tissue-engineered bone regeneration. Tissue Eng, 2004, 10(5-6): 955-964.
32. Rai B, Oest ME, Dupont KM, et al. Combination of platelet-rich plasma with polycaprolactone-tricalcium phosphate scaffolds for segmental bone defect repair. J Biomed Mater Res A, 2007, 81(4): 888-899.
33. Osterman C, McCarthy MB, Cote MP, et al. Platelet-rich plasma increases anti-inflammatory markers in a human coculture model for osteoarthritis. Am J Sports Med, 2015, 43(6): 1474-1484.
34. Mussano F, Genova T, Munaron L, et al. Cytokine, chemokine, and growth factor profile of platelet-rich plasma. Platelets, 2016, 27(5): 467-471.
35. Xing F, Li L, Long Y, et al. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord, 2018, 19(1): 444.
36. Arbab D, König DP. Atraumatic femoral head necrosis in adults. Dtsch Arztebl Int, 2016, 113(3): 31-38.
37. Qiu S, Zhu T, Song L, et al. Internal fixation with cancellous bone screws is effective for femoral neck fractures by lowering the incidence of femoral head necrosis. Int J Clin Exp Med, 2016, 9(2): 3723-3728.
38. Qiu G, Shi Z, Xu HHK, et al. Bone regeneration in minipigs via calcium phosphate cement scaffold delivering autologous bone marrow mesenchymal stem cells and platelet-rich plasma. J Tissue Eng Regen Med, 2018, 12(2): e937-e948.
39. Chahal J, Van Thiel GS, Mather RC 3rd, et al. The patient acceptable symptomatic state for the modified harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med, 2015, 43(8): 1844-1849.
40. Vishwanathan K, Akbari K, Patel AJ. Is the modified Harris hip score valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures? J Orthop, 2018, 15(1): 40-46.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture: a meta-analysis

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