Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study_West China Medical Journal

Authors：

WANG Shaoling , LUAN Shuo , FAN Shengnuo , LIU Cuicui , LI Xiao , MA Chao ,  WU Shaoling

Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding?author：

WU Shaoling, Email: wushaolinggz@126.com

Keywords：

Osteonecrosis of the femoral head; Platelet-rich plasma; Ultrasound-guided intra-articular injection; Retrospective study

DOI：

10.7507/1002-0179.202103062

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Objective To explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of avascular necrosis of the femoral head.Methods We retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received 4 injections at one-week intervals. The Visual Analogue Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Harris Hip Joint Function Scale (HHS) were evaluated before treatment and 1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance; the non-normally distributed data were presented as median (lower quartile, upper quartile), and analyzed by Friedman test.Results A total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and 1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0 (5.5, 8.0), 4.0 (3.0, 5.0), 3.0 (2.0, 3.0), and 3.0 (2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0 (40.0, 64.0), 71.0 (57.5, 75.0), 78.0 (68.0, 80.5), and 78.0 (64.0, 80.0), respectively. The time effects in VAS (χ²=65.423, P<0.001), WOMAC (F=46.710, P<0.001), and HHS (χ²=66.347, P<0.001) were all statistically significant. There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant difference in each index between the value 1 month after treatment and that 3 months after treatment (P<0.05). There was no significant difference in any indicator between the value 6 months after treatment and that 3 months after treatment (P>0.05). Significant difference was shown between the value 6 months after treatment and that 1 month after treatment in WOMAC (P=0.016), but not in VAS or HHS (P>0.05). No obvious adverse event was reported during the follow-up period.Conclusions Ultrasound-guided intra-articular PRP injection can effectively alleviate the pain and improve the hip joint function of patients with femoral head necrosis for at least 6 months. However, randomized controlled studies with a larger sample size and longer-term follow-up are needed in the future to confirm the efficacy and safety of PRP injection in femoral head necrosis.

Citation： WANG Shaoling, LUAN Shuo, FAN Shengnuo, LIU Cuicui, LI Xiao, MA Chao, WU Shaoling. Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study. West China Medical Journal, 2021, 36(5): 617-622. doi: 10.7507/1002-0179.202103062 Copy

1.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2.	Xu HH, Li SM, Fang L, et al. Platelet-rich plasma promotes bone formation, restrains adipogenesis and accelerates vascularization to relieve steroids-induced osteonecrosis of the femoral head. Platelets, 2020: 1-10.
3.	趙德偉, 程亮亮. 淺談全髖關節置換術的年輕化. 中華骨與關節外科雜志, 2019, 12(5): 328-330.
4.	Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther, 2016, 16(2): 213-232.
5.	Akeda K, An HS, Okuma M, et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage, 2006, 14(12): 1272-1280.
6.	Yancopoulos GD, Davis S, Gale NW, et al. Vascular-specific growth factors and blood vessel formation. Nature, 2000, 407(6801): 242-248.
7.	Fiz N, Delgado D, Garate A, et al. Intraosseous infiltrations of platelet-rich plasma for severe hip osteoarthritis: a pilot study. J Clin Orthop Trauma, 2020, 11(Suppl 4): S585-S590.
8.	欒爍, 栗曉, 林彩娜, 等. 超聲引導下關節腔注射富血小板血漿治療膝骨性關節炎療效的回顧性研究. 華西醫學, 2020, 35(5): 568-573.
9.	Tong S, Yin J, Liu J. Platelet-rich plasma has beneficial effects in mice with osteonecrosis of the femoral head by promoting angiogenesis. Exp Ther Med, 2018, 15(2): 1781-1788.
10.	Yokota K, Ishida O, Sunagawa T, et al. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: an experimental study in rabbits. Acta Orthop, 2008, 79(1): 106-110.
11.	Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J, 2013, 54(3): 219-224.
12.	Pak J, Lee JH, Jeon JH, et al. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res, 2014, 42(6): 1353-1362.
13.	Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14.	Dallari D, Stagni C, Rani N, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med, 2016, 44(3): 664-671.
15.	楊富強, 楊曉明, 葛建健. 髓芯減壓植骨聯合富血小板血漿治療股骨頭缺血性壞死的前瞻隨機對照研究. 中華關節外科雜志, 2016, 2: 22-25.
16.	D’Ambrosi R, Hantes ME, Mariani I, et al. Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication. Knee Surg Sports Traumatol Arthrosc, 2021, 29(5): 1370-1377.
17.	中國醫師協會骨科醫師分會骨循環與骨壞死專業委員會, 中華醫學會骨科分會骨顯微修復學組, 國際骨循環學會中國區. 中國成人股骨頭壞死臨床診療指南(2020). 中華骨科雜志, 2020, 40(20): 1365-1376.
18.	Han J, Gao F, Li Y, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int, 2020, 2020: 2642439.
19.	Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R, 2012, 4(12): 1015-1019.
20.	Luan S, Liu C, Lin C, et al. Platelet-rich plasma for the treatment of adolescent late-stage femoral head necrosis: a case report. Regen Med, 2020, 15(9): 2067-2073.
21.	Aggarwal AK, Poornalingam K, Jain A, et al. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: a 4.5- to 6-year prospective randomized comparative study. J Arthroplasty, 2021, 36(1): 54-61.
22.	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
23.	Byrd JW, Potts EA, Allison RK, et al. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy, 2014, 30(1): 42-46.
24.	馬良彧, 王善正, 郭玉冬, 等. 富血小板血漿治療骨性關節炎的現狀. 中國矯形外科雜志, 2018, 26(15): 1396-1399.
25.	Amin I, Gellhorn AC. Platelet-rich plasma use in musculoskeletal disorders: are the factors important in standardization well understood?. Phys Med Rehabil Clin N Am, 2019, 30(2): 439-449.

1. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2. Xu HH, Li SM, Fang L, et al. Platelet-rich plasma promotes bone formation, restrains adipogenesis and accelerates vascularization to relieve steroids-induced osteonecrosis of the femoral head. Platelets, 2020: 1-10.
3. 趙德偉, 程亮亮. 淺談全髖關節置換術的年輕化. 中華骨與關節外科雜志, 2019, 12(5): 328-330.
4. Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther, 2016, 16(2): 213-232.
5. Akeda K, An HS, Okuma M, et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage, 2006, 14(12): 1272-1280.
6. Yancopoulos GD, Davis S, Gale NW, et al. Vascular-specific growth factors and blood vessel formation. Nature, 2000, 407(6801): 242-248.
7. Fiz N, Delgado D, Garate A, et al. Intraosseous infiltrations of platelet-rich plasma for severe hip osteoarthritis: a pilot study. J Clin Orthop Trauma, 2020, 11(Suppl 4): S585-S590.
8. 欒爍, 栗曉, 林彩娜, 等. 超聲引導下關節腔注射富血小板血漿治療膝骨性關節炎療效的回顧性研究. 華西醫學, 2020, 35(5): 568-573.
9. Tong S, Yin J, Liu J. Platelet-rich plasma has beneficial effects in mice with osteonecrosis of the femoral head by promoting angiogenesis. Exp Ther Med, 2018, 15(2): 1781-1788.
10. Yokota K, Ishida O, Sunagawa T, et al. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: an experimental study in rabbits. Acta Orthop, 2008, 79(1): 106-110.
11. Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J, 2013, 54(3): 219-224.
12. Pak J, Lee JH, Jeon JH, et al. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res, 2014, 42(6): 1353-1362.
13. Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14. Dallari D, Stagni C, Rani N, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med, 2016, 44(3): 664-671.
15. 楊富強, 楊曉明, 葛建健. 髓芯減壓植骨聯合富血小板血漿治療股骨頭缺血性壞死的前瞻隨機對照研究. 中華關節外科雜志, 2016, 2: 22-25.
16. D’Ambrosi R, Hantes ME, Mariani I, et al. Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication. Knee Surg Sports Traumatol Arthrosc, 2021, 29(5): 1370-1377.
17. 中國醫師協會骨科醫師分會骨循環與骨壞死專業委員會, 中華醫學會骨科分會骨顯微修復學組, 國際骨循環學會中國區. 中國成人股骨頭壞死臨床診療指南(2020). 中華骨科雜志, 2020, 40(20): 1365-1376.
18. Han J, Gao F, Li Y, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int, 2020, 2020: 2642439.
19. Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R, 2012, 4(12): 1015-1019.
20. Luan S, Liu C, Lin C, et al. Platelet-rich plasma for the treatment of adolescent late-stage femoral head necrosis: a case report. Regen Med, 2020, 15(9): 2067-2073.
21. Aggarwal AK, Poornalingam K, Jain A, et al. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: a 4.5- to 6-year prospective randomized comparative study. J Arthroplasty, 2021, 36(1): 54-61.
22. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
23. Byrd JW, Potts EA, Allison RK, et al. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy, 2014, 30(1): 42-46.
24. 馬良彧, 王善正, 郭玉冬, 等. 富血小板血漿治療骨性關節炎的現狀. 中國矯形外科雜志, 2018, 26(15): 1396-1399.
25. Amin I, Gellhorn AC. Platelet-rich plasma use in musculoskeletal disorders: are the factors important in standardization well understood?. Phys Med Rehabil Clin N Am, 2019, 30(2): 439-449.

West China Medical Journal

Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study

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