Prospective clinical study on extracorporeal shock wave therapy combined with platelet-rich plasma injection for knee osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SU Wenzhen ,  LIN Yongjie , WANG Guowei , GENG Zhen , WANG Zhengyu , HOU Dalong , SUO Beibei

Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China;

Corresponding author：

LIN Yongjie, Email: linyongj123@163.com

Keywords：

Knee; osteoarthritis; extracorporeal shock wave; platelet-rich plasma

DOI：

10.7507/1002-1892.201905007

Video：

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Objective To investigate the effectiveness of extracorporeal shock wave therapy combined with platelet-rich plasma (PRP) injection in treatment of knee osteoarthritis (KOA) by prospective clinical study.Methods Between June 2015 and June 2018, 180 patients with KOA met the inclusion criteria were included in study and randomly allocated to group A (n=60), group B (n=60), and group C (n=60). The patients were treated with autologous PRP intra-articular injection in group A, extracorporeal shock wave therapy in group B, and extracorporeal shock wave therapy combined with autologous PRP intra-articular injection in group C, once a week and 5 times a duration of treatment. There was no significant difference in age, gender, disease duration, side of KOA, and Kellgren-Lawrence grading between groups (P>0.05). The pain and function of knee joint were assessed by visual analogue scale (VAS) score, Lequesne Index score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint activity before treatment and at 1, 3, and 5 weeks after the first treatment.Results There were significant differences in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between pre- and post-treatment in all groups (P<0.05). VAS score, Lequesne Index score, and WOMAC score gradually decreased with the prolongation of treatment time (P<0.05); but there was no significant difference in knee joint activity between different time points (P>0.05). There was no significant difference in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between groups before treatment (P>0.05); the scores of group C were superior to groups A and B (P< 0.05) at different time points after treatment; while the knee joint activities of 3 groups were similar (P>0.05).Conclusion The extracorporeal shock wave therapy combined with PRP injection can relieve the pain synergistically for KOA.

Citation： SU Wenzhen, LIN Yongjie, WANG Guowei, GENG Zhen, WANG Zhengyu, HOU Dalong, SUO Beibei. Prospective clinical study on extracorporeal shock wave therapy combined with platelet-rich plasma injection for knee osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1527-1531. doi: 10.7507/1002-1892.201905007 Copy

1.	Zhong Z, Liu B, Liu G, et al. A randomized controlled trial on the effects of low-dose extracorporeal shock wave therapy in patients with knee osteoarthritis. Arch Phys Med Rehabil, 2019, 100(9): 1695-1702.
2.	孙伟, 李子荣. 体外震波治疗股骨头坏死: 误区和挑战. 中国修复重建外科杂志, 2019, 33(6): 659-661.
3.	邓伟, 邓晖, 王磊, 等. 体外冲击波治疗膝关节骨性关节炎的疗效观察. 中华物理医学与康复杂志, 2016, 38(6): 458-459.
4.	Su K, Bai Y, Wang J, et al. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol, 2018, 37(5): 1341-1350.
5.	D’souza N, Rossignoli F, Golinelli G, et al. Mesenchymal stem/stromal cells as a delivery platform in cell and gene therapies. BMC Med, 2015, 13: 186.
6.	薛庆云, 王坤正, 裴福兴, 等. 中国 40 岁以上人群原发性骨关节炎患病状况调查. 中华骨科杂志, 2015, 35(1): 1206-1212.
7.	Cicuttini FM, Wluka AE. Osteoarthritis: is OA a mechanical or systemic disease? Nat Rev Rheumatol, 2014, 10(9): 515-516.
8.	Almasry SM, Soliman HM, El-Tarhouny SA, et al. Platelet rich plasma enhances the immunohistochemical expression of platelet derived growth factor and vascular endothelial growth factor in the synovium of the meniscectomized rat models of osteoarthritis. Ann Anat, 2015, 197: 38-49.
9.	Rasheed N, Hafeez K, Zaidi IH, et al. Role of platelet-rich plasma in early osteoarthritis of knee joint: Experience from a tertiary care center in Pakistan. Orthop Surg (Hong Kong), 2019, 27(2): 2309499019853953.
10.	Papalia R, Zampogna B, Russo F, et al. The combined use of platelet rich plasma and hyaluronic acid: prospective results for the treatment of knee osteoarthritis. Biol Regul Homeost Agents, 2019, 33(2 Suppl 1): 21-28.
11.	Elik H, Doğu B, Yılmaz F, et al. Platelet rich plasma in osteoarthritis the efficiency of platelet rich plasma treatment in patients with knee osteoarthritis. J Back Musculoskelet Rehabil, 2019.
12.	陈玉书, 张燕红, 刘日许, 等. 富血小板血浆治疗膝关节骨关节炎的临床疗效. 中华关节外科杂志(电子版), 2017, 11(6): 589-592.
13.	翟文亮, 周亮, 刘晖, 等. 富血小板血浆与透明质酸钠治疗膝关节骨关节炎的临床观察. 中华关节外科杂志(电子版), 2017, 11(1): 96-100.
14.	Zhang HF, Wang CG, Li H, et al. Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Des Devel Ther, 2018, 12: 445-453.
15.	Han Y, Huang H, Pan J, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med, 2019, 20(7): 1418-1429.
16.	Chamberlain GA, Colborne GR. A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol, 2016, 29(2): 99-107.
17.	方善鸿, 王巍, 陈小勇, 等. 体外冲击波对兔膝骨性关节炎炎性介质及影像学的影响. 中华实验外科杂志, 2017, 34(1): 102-105.
18.	段好阳, 闫兆红, 李贞兰, 等. 体外冲击波联合中药药物离子导入治疗老年人膝关节骨性关节炎的临床疗效. 中华老年医学杂志, 2018, 37(1): 67-70.

1. Zhong Z, Liu B, Liu G, et al. A randomized controlled trial on the effects of low-dose extracorporeal shock wave therapy in patients with knee osteoarthritis. Arch Phys Med Rehabil, 2019, 100(9): 1695-1702.
2. 孙伟, 李子荣. 体外震波治疗股骨头坏死: 误区和挑战. 中国修复重建外科杂志, 2019, 33(6): 659-661.
3. 邓伟, 邓晖, 王磊, 等. 体外冲击波治疗膝关节骨性关节炎的疗效观察. 中华物理医学与康复杂志, 2016, 38(6): 458-459.
4. Su K, Bai Y, Wang J, et al. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol, 2018, 37(5): 1341-1350.
5. D’souza N, Rossignoli F, Golinelli G, et al. Mesenchymal stem/stromal cells as a delivery platform in cell and gene therapies. BMC Med, 2015, 13: 186.
6. 薛庆云, 王坤正, 裴福兴, 等. 中国 40 岁以上人群原发性骨关节炎患病状况调查. 中华骨科杂志, 2015, 35(1): 1206-1212.
7. Cicuttini FM, Wluka AE. Osteoarthritis: is OA a mechanical or systemic disease? Nat Rev Rheumatol, 2014, 10(9): 515-516.
8. Almasry SM, Soliman HM, El-Tarhouny SA, et al. Platelet rich plasma enhances the immunohistochemical expression of platelet derived growth factor and vascular endothelial growth factor in the synovium of the meniscectomized rat models of osteoarthritis. Ann Anat, 2015, 197: 38-49.
9. Rasheed N, Hafeez K, Zaidi IH, et al. Role of platelet-rich plasma in early osteoarthritis of knee joint: Experience from a tertiary care center in Pakistan. Orthop Surg (Hong Kong), 2019, 27(2): 2309499019853953.
10. Papalia R, Zampogna B, Russo F, et al. The combined use of platelet rich plasma and hyaluronic acid: prospective results for the treatment of knee osteoarthritis. Biol Regul Homeost Agents, 2019, 33(2 Suppl 1): 21-28.
11. Elik H, Doğu B, Yılmaz F, et al. Platelet rich plasma in osteoarthritis the efficiency of platelet rich plasma treatment in patients with knee osteoarthritis. J Back Musculoskelet Rehabil, 2019.
12. 陈玉书, 张燕红, 刘日许, 等. 富血小板血浆治疗膝关节骨关节炎的临床疗效. 中华关节外科杂志(电子版), 2017, 11(6): 589-592.
13. 翟文亮, 周亮, 刘晖, 等. 富血小板血浆与透明质酸钠治疗膝关节骨关节炎的临床观察. 中华关节外科杂志(电子版), 2017, 11(1): 96-100.
14. Zhang HF, Wang CG, Li H, et al. Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Des Devel Ther, 2018, 12: 445-453.
15. Han Y, Huang H, Pan J, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med, 2019, 20(7): 1418-1429.
16. Chamberlain GA, Colborne GR. A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol, 2016, 29(2): 99-107.
17. 方善鸿, 王巍, 陈小勇, 等. 体外冲击波对兔膝骨性关节炎炎性介质及影像学的影响. 中华实验外科杂志, 2017, 34(1): 102-105.
18. 段好阳, 闫兆红, 李贞兰, 等. 体外冲击波联合中药药物离子导入治疗老年人膝关节骨性关节炎的临床疗效. 中华老年医学杂志, 2018, 37(1): 67-70.

Chinese Journal of Reparative and Reconstructive Surgery

Prospective clinical study on extracorporeal shock wave therapy combined with platelet-rich plasma injection for knee osteoarthritis

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