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.	孫偉, 李子榮. 體外震波治療股骨頭壞死: 誤區和挑戰. 中國修復重建外科雜志, 2019, 33(6): 659-661.
3.	鄧偉, 鄧暉, 王磊, 等. 體外沖擊波治療膝關節骨性關節炎的療效觀察. 中華物理醫學與康復雜志, 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.	薛慶云, 王坤正, 裴福興, 等. 中國 40 歲以上人群原發性骨關節炎患病狀況調查. 中華骨科雜志, 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, Do?u B, Y?lmaz 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.	陳玉書, 張燕紅, 劉日許, 等. 富血小板血漿治療膝關節骨關節炎的臨床療效. 中華關節外科雜志(電子版), 2017, 11(6): 589-592.
13.	翟文亮, 周亮, 劉暉, 等. 富血小板血漿與透明質酸鈉治療膝關節骨關節炎的臨床觀察. 中華關節外科雜志(電子版), 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.	方善鴻, 王巍, 陳小勇, 等. 體外沖擊波對兔膝骨性關節炎炎性介質及影像學的影響. 中華實驗外科雜志, 2017, 34(1): 102-105.
18.	段好陽, 閆兆紅, 李貞蘭, 等. 體外沖擊波聯合中藥藥物離子導入治療老年人膝關節骨性關節炎的臨床療效. 中華老年醫學雜志, 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. 孫偉, 李子榮. 體外震波治療股骨頭壞死: 誤區和挑戰. 中國修復重建外科雜志, 2019, 33(6): 659-661.
3. 鄧偉, 鄧暉, 王磊, 等. 體外沖擊波治療膝關節骨性關節炎的療效觀察. 中華物理醫學與康復雜志, 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. 薛慶云, 王坤正, 裴福興, 等. 中國 40 歲以上人群原發性骨關節炎患病狀況調查. 中華骨科雜志, 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, Do?u B, Y?lmaz 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. 陳玉書, 張燕紅, 劉日許, 等. 富血小板血漿治療膝關節骨關節炎的臨床療效. 中華關節外科雜志(電子版), 2017, 11(6): 589-592.
13. 翟文亮, 周亮, 劉暉, 等. 富血小板血漿與透明質酸鈉治療膝關節骨關節炎的臨床觀察. 中華關節外科雜志(電子版), 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. 方善鴻, 王巍, 陳小勇, 等. 體外沖擊波對兔膝骨性關節炎炎性介質及影像學的影響. 中華實驗外科雜志, 2017, 34(1): 102-105.
18. 段好陽, 閆兆紅, 李貞蘭, 等. 體外沖擊波聯合中藥藥物離子導入治療老年人膝關節骨性關節炎的臨床療效. 中華老年醫學雜志, 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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