Platelet rich plasma and exercise for pain relief in end stage knee osteoarthritis

Authors

  • Abdullah Ahmed Mohammad Department of Family Medicine, AL-Mansor Primary Health Center, Kirkuk, Iraq.
  • Hayder Ghali Wadi Algawwam National TB Control Program, Iraq.
  • Huda Ihsan KhairuAllah Department of Rheumatology & Medical Rehabilitation, Azadi Teaching Hospital, Kirkuk, Iraq.
  • Nuha Abdulwahab Muhammed Ali Department of Rheumatology & Medical Rehabilitation, Azadi Teaching Hospital, Kirkuk, Iraq.
  • Safwat Abbas Ali Department of Anesthesia and Intensive Care, Medicana International Hospital, Istanbul, Turkey.

DOI:

https://doi.org/10.22317/imj.v6i4.1211

Keywords:

Osteoarthritis, Knee Joint, Pain, Exercise, Ozone, Platelet-Rich Plasma

Abstract

Objective: To evaluate the efficacy of exercise and intra-articular ozonized platelet rich plasma (IA-OPRP) injections as management for sever grad IV knee osteoarthritis (KOA).

Methods: Over 18-month period (January 1, 2018– July 31, 2019), 33 patients (21 females and 12 males) with 58 grade IV osteoarthritic knees were retrospectively studied. Severity of KOA was assessed according to the clinical features and Kellgren &Lawrencegrading scale. All patients underwent 8-weeks simple exercises followed by 4 sessions of IA-OPRP.OPRP was prepared by centrifuging patients’ own blood and activated by passing 1 ml of ozone for each 1 ml of platelet rich plasma. A questionnaire was used to categorize the pain severity into mild, moderate, and severe and the response to therapy was graded as excellent, good, fair, and poor.

Results: The mean age was 63.7 years. The top co-morbid condition were overweight and obesity (n=28, 84.8%) whereas diabetes and hypertension ranked second (n=15 each, 45.4%). All patients had severe pain of grad IV knee OA. Overall, exercise and four IA-OPRP injections yielded good-excellent results in (72.4%) of the treated joints (p˂0.01) with no significant sex-related difference in pain response (p>0.01).

Conclusion: Exercise and IA-OPRP seems to be a safe, effective and cheap method for relieving the chronic pain of severeknee OA.

References

- Fukui N, Yamane S, Ishida S, Tanaka K, Masuda R, Tanaka N, Katsuragawa Y, Fukui S. Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: a three-year prospective study. BMC Musculoskeletal Disorders. 2010 Dec;11(1):1-0.

- Mohammad AA, Algawwam HG. Efficacy of intra-articular injection of activated platelet rich plasma as pain management method in chronic knee pain. Iraq Med J 2019;4:106–110.

- Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proceedings of the National Academy of Sciences. 2017 Aug 29;114(35):9332-6.

- Drummer D, McAdam J, Seay R, Ferrando A, Bridges Jr SL, Singh JA, Bamman M. Osteoarthritis Progression: Mitigation and Rehabilitation Strategies. Frontiers in Rehabilitation Sciences. 2021:31.

- Kan HS, Chan PK, Chiu KY, Yan CH, Yeung SS, Ng YL, Shiu KW, Ho T. Non-surgical treatment of knee osteoarthritis. Hong Kong Medical Journal. 2019 Apr 1;25(2):127.

- Cubukcu D, Sarsan A, Alkan H. Relationships between pain, function and radiographic findings in osteoarthritis of the knee: a cross-sectional study. Arthritis. 2012;2012.

- Wick MC, Kastlunger M, Weiss RJ. Clinical imaging assessments of knee osteoarthritis in the elderly: a mini-review. Gerontology. 2014;60(5):386-94.

- Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clinical Orthopaedics and Related Research®. 2016 Aug;474(8):1886-93.

- Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of pain research. 2018;11:2189.

- Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH. Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities. Journal of physical therapy science. 2018;30(2):307-12.

- Knoop J, Dekker J, Van Der Leeden M, Van Der Esch M, Klein JP, Hunter DJ, Roorda LD, Steultjens MP, Lems WF. Is the severity of knee osteoarthritis on magnetic resonance imaging associated with outcome of exercise therapy?. Arthritis Care & Research. 2014 Jan;66(1):63-8.

- Jadidi S. A Review of Non-Surgical Pain Management in Osteoarthritis. Cureus. 2020 Oct 6;12(10):e10829. doi: 10.7759/cureus.10829. Erratum in: Cureus. 2021 Jul 14;13(7):c45. PMID: 33173635; PMCID: PMC7645314.

- Mohammad AA. Clinical applications of ozone: a review of 94 cases from Iraq.

Iraq Med J. 2018;2:10–14.

- Mohammad AA, Algawwam HG. Para-vertebral intramuscular platelet rich plasma vs. subcutaneous ozone injection for chronic low back pain. Iraq Med J . 2019: 3. 47–51.

- Naomi Nakada L, Aquino dos Santos FR, Rabay Pimentel Abicalaf CA, Imamura M, Rizzo Battistella L. Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 Patients. Rev. Med. (São Paulo) [Internet]. 4 de novembro de 2020 [citado 9 de março de 2022];99(Suppl):4-. Disponível em: https://www.revistas.usp.br/revistadc/article/view/176772

- Tiulpin A, Thevenot J, Rahtu E, Lehenkari P, Saarakkala S. Automatic knee osteoarthritis diagnosis from plain radiographs: a deep learning-based approach. Scientific reports. 2018 Jan 29;8(1):1-0.

- Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold‐Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews. 2016(3).

- Rafiq MT, Hamid MS, Hafiz E. Short-Term Effects of Strengthening Exercises of the Lower Limb Rehabilitation Protocol on Pain, Stiffness, Physical Function, and Body Mass Index among Knee Osteoarthritis Participants Who Were Overweight or Obese: A Clinical Trial. The Scientific World Journal. 2021 Jan 1;2021.

- Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers MF. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists. 2010 Jul;89(7):541.

- Pradelli L, Sinigaglia T, Migliore A, Checchia GA, Franceschi F, Frediani B, Iannone F, Romanini E. Non-surgical treatment of knee osteoarthritis: Multidisciplinary Italian Consensus on Best Practice. Therapeutics and Clinical Risk Management. 2021;17:507.

- King LK, Waugh EJ, Marshall DA, Hawker GA. Association between comorbidity and non-surgical treatment of patients with knee osteoarthritis. Osteoarthritis and Cartilage. 2017 Apr 1;25:S347-8.

- Teo PL, Bennell KL, Lawford B, Egerton T, Dziedzic K, Hinman RS. Patient experiences with physiotherapy for knee osteoarthritis in Australia—a qualitative study. BMJ open. 2021 Mar 1;11(3):e043689.

- Algawwam HG, KhairuAllah HI, Mohammad AA, Muhammed Ali NA. Ultrasound Guided Platelets Rich Plasma Injection as Pain Management Method for Knee Pain in Partial Medial Collateral Ligament Injury. Journal of medical & pharmaceutical Sciences. 2021; 5.29-38.

- Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis and cartilage. 2005 Sep 1;13(9):769-81.

- Boyan BD, Tosi L, Coutts R, Enoka R, Hart DA, Nicolella DP, Berkley K, Sluka K, Kwoh K, O'Connor MI, Kohrt W. Sex differences in osteoarthritis of the knee. The Journal of the American Academy of Orthopaedic Surgeons. 2012 Oct;20(10):668.

- Zeni Jr JA, Axe MJ, Snyder-Mackler L. Clinicallepredictors of elective total joint replacement in persons with end-stage knee osteoarthritis.Musculoskeletal Disorders 2010;11:86.

- Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, Lui LY, Felson DT. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2001 Sep;44(9):2065-71.

- Lee JY, Han K, Park YG, Park SH. Effects of education, income, and occupation on prevalence and symptoms of knee osteoarthritis. Scientific Reports. 2021 Jul 7;11(1):1-8.

- Lohmander LS. Gerhardsson de Verdier M, Rollof J, Nilsson PM, Engstrom G: Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis. 2009;68:490-6.

- Muckelt PE, Roos EM, Stokes M, McDonough S, Grønne DT, Ewings S, Skou ST. Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care. Journal of Comorbidity. 2020 May 8;10:2235042X20920456.

- Marshall DA, Liu X, Barnabe C, Yee K, Faris PD, Barber C, Mosher D, Noseworthy T, Werle J, Lix L. Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada. BMJ open. 2019 Nov 1;9(11):e033334.

- Hegaze AH, Hamdi AS, Alqrache A, Hegazy M. Efficacy of Platelet-Rich Plasma on Pain and Function in the Treatment of Knee Osteoarthritis: A Prospective Cohort Study. DOI: 10.7759/cureus.13909.

- Chen S-H, Kuan T-S, Kao M-J, Wu W-T, Chou L-W. Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports. Clinical intervention in aging 2016;11:1213-1219.

- Baki NM, Nawito ZO, Abdelsalam N, Sabry D, Elashmawy H, Seleem NA, Taha AA, El Ghobashy M. Does Intra-Articular Injection of Platelet-Rich Plasma Have an Effect on Cartilage Thickness in Patients with Primary Knee Osteoarthritis?. Current Rheumatology Reviews. 2021 Aug 1;17(3):294-302.

- Ghasroldasht MM, Moayednia A, Shahrezaee M. Effectiveness of Platelet-ich Plasma Based on Gene Expression in Knee Osteoarthritis. Archives of Bone and Joint Surgery. 2019 Sep;7(5):435.

- Rodríguez-Merchán EC. Intra-Articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Degree of Efficacy. International Journal of Molecular Sciences. 2022 Jan;23(3):1301.

- Arias-Vázquez PI, Tovilla-Zárate CA, Legorreta-Ramírez BG, Fonz WB, Magaña-Ricardez D, González-Castro TB, Juárez-Rojop IE, López-Narváez ML. Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials. Advances in Rheumatology. 2019 Aug 29;59.

Saita Y, Kobayashi Y, Nishio H, Wakayama T, Fukusato S, Uchino S, Momoi Y, Ikeda H, Kaneko K. Predictors of Effectiveness of Platelet-Rich Plasma Therapy for Knee Osteoarthritis: A Retrospective Cohort Study. Journal of Clinical Medicine. 2021 Jan;10(19):4514.

Downloads

Published

2022-12-26

How to Cite

1.
Ahmed Mohammad A, Ghali Wadi Algawwam H, Ihsan KhairuAllah H, Abdulwahab Muhammed Ali N, Abbas Ali S. Platelet rich plasma and exercise for pain relief in end stage knee osteoarthritis. Iraq Med J [Internet]. 2022 Dec. 26 [cited 2024 Nov. 23];6(4). Available from: https://iraqmedj.org/index.php/imj/article/view/1211

Issue

Section

Articles

Most read articles by the same author(s)