Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis

Summary

Knee osteoarthritis is frequently seen in the orthopedic department. We introduce in detail the entire knee osteoarthritis treatment process with platelet-rich plasma injection, including preparation, procedures, and evaluation.

Abstract

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department. Existing non-surgical treatments have a limited effect on the repair of cartilage and on bone regeneration. Platelet-rich plasma (PRP) is an autologous bioactive substance that can repair cartilage injury and accelerate bone regeneration effectively. However, reporting of PRP preparation protocols in clinical studies is highly inconsistent, with the majority of studies providing insufficient information to allow the protocol to be reproduced. We describe a repeatable method of preparing PRP visually, the treatment of KOA using PRP intra-articular injection, and methods of evaluating the outcome. PRP was prepared using manual double centrifugation. The PRP layer was extracted from peripheral blood and used for knee joint cavity injection. Evaluations included assessments of blood platelet concentrations and clinical outcomes. Preparation of PRP by manual centrifugation requires less apparatus and is less costly than plasma filtration or centrifugation using equipment. The centrifugation time of our double centrifugation method was 6 and 5 minutes for the respective centrifugations at forces of 800 and 1400 x g, respectively, to allow for the consistent preparation of standardized PRP. However, a manual method is susceptible to operator error, and PRP batch preparation is not available. Intra-articular injection of PRP proved to be an effective treatment for knee osteoarthritis. The entire treatment procedure took less than 30 minutes, the blood platelet concentration of PRP could be standardized, and treatment was proven to be effective when evaluated by follow-up.

Introduction

Knee osteoarthritis (KOA) is one of the most frequently seen diseases in the orthopedic department; 30%-50% of people over the age of 65 years experience this disease¹. At present, the conservative management of KOA mainly includes oral administration of non-steroidal anti-inflammatory drugs and cartilage nutrient drugs, intra-articular injection of sodium hyaluronate, and physiotherapy. However, these methods cannot stop the process of knee joint degeneration². Articular cartilage defects can cause articular surface wear, joint instability, and metabolic changes, which are part of the pathogenesis of KOA

Protocol

The methods described were approved by the Ethics Committee of Guangdong General Hospital.

1. Obtain PRP by Manual Centrifugation

1. Prepare the patient in a supine position in a sterile laminar flow operating room with a comfortable room temperature and humidity: room temperature is 22 °C and room humidity is 60%.
2. Use a 1-mL syringe to draw 0.2 mL of heparin sodium (2 mL = 12,500 U), and then moisten a 50-mL syringe.
   NOTE: 3 mL of sodium citrate is also typical in this step to replace the heparin sodium.
3. Rig a tourniquet, sterilize the elbow 2-3 times, and use the moist 50-mL syringe to draw 30 mL o....

Results

As a result, the platelet count of the PRP reached a standard concentration level of 1121 x 10³/µL. We conducted the 15 follow-up surveys described in the protocol on a 55-year-old male patient with early KOA. It was obvious that early clinical outcome was satisfactory after the intra-articular administration of PRP (Figure 2). However, medium-term efficacy was slightly inferior. A markedly significant analgesic effect was observed (

Discussion

The concentration of blood platelets in normal human blood is between 150,000/µL and 350,000/µL, and it is widely believed that blood platelet concentration of PRP should reach 1,000,000/µL, which is 3 to 5 times normal concentrations⁹. According to the PAW hierarchy system, it is believed that PRP has no obvious effect when the blood platelet concentration is less than three times the normal concentration, while PRP has an inhibiting effect when its blood platelet concentration is .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Centrifuge	Eppendorf	5702
Centrifuge tube	CORNING	430828
Horizontal rotor	Eppendorf	LL080
Anerdian III	Shanghai Likang Disinfectant HiTech Co., LTD	310173	Disinfect the skin
1ml Syringe	KDL  Medical Equipment Co., LTD	0.4*13 RWLB
10ml Syringe	KDL  Medical Equipment Co., LTD	1.2*38 TWSB
50ml Syringe	KDL  Medical Equipment Co., LTD	0.7*32 TWLB
Medical Tourniquet	Changzhou Jinli Latex Products Co., LTD	0087-2011
Single-use sterile rubber surgical gloves	Shanghai jinxiang Latex Products Co., LTD	17060
Disposable Draw Blood Needle	KDL  Medical Equipment Co., LTD	0.55*20 L(II) RWLB
Heparin Sodium Injection	SPH No.1 Biochemical & Pharmaceutical Co., LTD	1706101	2ml:12500U
Jifro Hand Antiseptic Rinse Free Gel	Shanghai Likang Disinfectant HiTech Co., LTD	311793
Medical Cotton Swab	Foshan Kangzheng Medical Supplies Co., LTD	KZ3-12	Disinfect the skin
10ml Normal Saline	Jiangxi Shuangshi Pharmecutical Co., LTD	140211458
Automatic Blood Cell Analyzer	Beckman Coulter	LH-750
Hole-towe			Sterile
Anticoagulation Tube(Blood Collection Tubes, K2E 3.6mg)	Becton, Dickinson and Company	CNL17-COO56	Store in a cool dry place within 4 to 25 degrees Celcius
Tweezers	RWD LIFE SCIENCE	F12006-10
Sterile Gauze	Guangdong Ze Chang Trade Co., LTD	170915
Adhesive Plaster	3M Transpore	1527C-0
Skin Marker Pen	Guangzhou Mingjia Medical Device Manufacturing Co., LTD	10110