Efficacy of different platelet‐rich plasma injections in the treatment of mild‐moderate knee osteoarthritis: A systematic review and meta‐analysis

Osteoarthritis (OA) is a highly prevalent, disabling disease, with a commensurate tremendous individual and socioeconomic burden. This Perspectives article focuses on the burden of OA for the individual, the health-care system and society, to draw attention to the magnitude of the current problem with some reference to projected figures. We have an urgent opportunity to make fundamental changes to the way we care for individuals with OA that will have an effect upon the direct and indirect costs of this disease. By focusing on the burden of this prevalent, disabling, and costly disease, we hope to highlight the opportunity for shifts in health-care policy towards prevention and chronic-disease management.

To estimate the US national prevalence of tibiofemoral radiographic knee osteoarthritis (RKOA) with and without symptoms, and its influence on functional tasks. Radiographic and interview data from the National Health and Nutrition Examination Survey (NHANES III), a nationally representative cross-sectional health examination survey, were used to estimate lifetime RKOA prevalence in adults age 60 years and older. Demographic trends, self-reported activity limitations, physical performance test results, and patterns of recent analgesic use were analyzed. Among US adults, the prevalence of RKOA and symptomatic RKOA was 37.4% and 12.1%, respectively. RKOA prevalence was greater among women than men (42.1% vs 31.2%). Women had significantly more Kellgren-Lawrence Grade 3-4 changes (12.9% vs 6.5% in men). However, symptomatic RKOA prevalence did not differ by sex. Additionally, some 1.6% of US adults had knee joint replacement. Multivariable analysis showed significantly higher odds of both RKOA and symptomatic RKOA with greater body mass index (BMI > or = 30), greater age, non-Hispanic Black race/ethnicity, and among men with manual labor occupations. Only symptomatic RKOA was significantly associated with self-reported activity limitations: difficulty walking, stooping, standing from a seated position, and stair climbing. Adults with symptomatic RKOA used significantly more assistive walking devices, had slower measured gait velocities, and used significantly more prescription nonsteroidal antiinflammatory drugs and prescription narcotics, and nonprescription acetaminophen. NHANES III data provide an overall national assessment of the prevalence, demographic distributions, and functional impact of symptomatic knee OA, which affects more than 1 in 10, or 4.3 million older US adults.

To determine (1) whether platelet-rich plasma (PRP) injection significantly improves validated patient-reported outcomes in patients with symptomatic knee osteoarthritis (OA) at 6 and 12 months postinjection, (2) differences in outcomes between PRP and corticosteroid injections or viscosupplementation or placebo injections at 6 and 12 months postinjection, and (3) similarities and differences in outcomes based on the PRP formulations used in the analyzed studies.