Precision Assessment of Platelet Rich Plasma for Joint Preservation

VA Office of Research and Development90 enrolled

Overview

Knee Osteoarthritis (OA) is a leading cause of premature disability in Veterans who develop knee OA at higher rates and younger ages than the population in general. For those with symptomatic early knee OA, who are years to decades away from meeting clinical indications for knee replacement surgery, knee injections have been a key treatment option. In recent years, platelet rich plasma (PRP) injections have gained increasing attention for improving pain and function in patients with knee OA. Basic science studies also suggest that PRP may also potentially stimulate repair responses to articular cartilage. However, the mechanisms of action of PRP in the treatment of knee OA are unknown. Because autologous blood is used, the PRP composition differs between patients. It is also unknown whether these differences in PRP composition affect clinical outcomes. This study will address these gaps and provide critical new and objective information on PRP treatment effects in Veterans and additional women with early knee OA important to improving clinical use of this new treatment.

Because very little is known about either the mechanisms of action or objective clinical outcomes of PRP treatment for knee OA, the investigators propose a prospective "pre-post" study that will permit us to identify areas where more rigorous clinical outcomes and mechanistic research may be warranted. The proposed work includes special elements of: (1) quantitative metrics to assess clinical outcomes, (2) correlation of candidate beneficial proteins with clinical outcomes, and (3) proteomic evaluation of the injected PRP. This work will use an innovative multi-disciplinary, personalized approach to evaluate the effects of PRP composition on both function, as assessed by patient-reported outcomes and gait analysis, and cartilage matrix structure as assessed by quantitative MRI

Study Type

OBSERVATIONAL

Enrollment

Conditions

Osteoarthritis

Medical Language ↔ Plain English

Inclusion Criteria: * symptomatic early knee OA * full weight-bearing status * have elected to receive PRP treatment * Male veterans * Female veterans Exclusion Criteria: * inflammatory arthritis, gout or recurrent pseudogout * symptomatic OA of other lower extremity joints * BMI \>35 kg/m2 * use of walking, orthopedic, or prosthetic assistive device * severe systemic disease defined as American Society of Anesthesiologists (ASA) 3 or above56 * inability to have MRI * pregnant or intending to become pregnant during the study * predominantly patellofemoral disease

Outcomes

Primary Outcomes

Number of Participants With Successful Knee Pain Improvement Over 6 Months Following PRP Injections

Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain scores were determined through standardized questionnaires to evaluate osteoarthritis of the knee. The KOOS Pain scale consists of 9 questions with each response valued on an ordinal scale 0-4. KOOS Pain scores are transformed so that higher scores indicate less pain. Successful pain improvement is determined from the number of participants with changes in KOOS Pain in excess of the previously determined threshold of 12.4pts for minimal important change after non-surgical intervention for knee pain.

Time frame: Baseline to 6 months

Number of Participants With Successful Knee Function Improvement Over 6 Months Following PRP Injections

Knee Function was determined from Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, standardized questionnaires to evaluate osteoarthritis of the knee. The WOMAC Function scale consists of 17 questions, with each response valued on an ordinal scale of 0-4. Higher numbers indicate more physical disability. Successful functional improvement is determined from the number of participants with changes in the WOMAC Function score in excess of the previously determined threshold of -17pts for minimal important functional change after non-surgical intervention.