A Great RCT About PRP for OA

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A Great RCT About PRP for OA

What’s the Claim?

An RCT compared platelet-rich plasma (PRP) injections to a 6-week structured exercise program, or PRP plus exercise among patients with mild-to-moderate knee osteoarthritis, and found that after 6 months:

  • PRP delivered no clinically important reduction in pain relative to the other groups
  • PRP was not better than exercise in terms of WOMAC scores, objective functional metrics (40-m fast-paced walk test, stair climbing test), or SF-12 scores
  • Exercise alone outperformed PRP in several metrics the authors assessed

How’s It Stack Up?

A recent large-scale summary of available clinical practice guidelines found “insufficient evidence to make a conclusive recommendation for or against” the use of PRP, and so the findings of this RCT are real-world practical. And many studies (as well as meta-analyses) on this topic have focused unreasonably on p values without regard for effect sizes. Patients don't perceive p values, they perceive effect sizes.

What’s Our Take?

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Smart Practice: Skip the PRP for your patients with osteoarthritis, and use this specific exercise program instead.

It seems that surgeons, rehabilitation medicine specialists, and others are using PRP for everything from osteoarthritis to tendinopathy to long hair on boys. The best-available evidence on this topic suggests that the results aren’t favorable, and the favorable evidence doesn’t withstand close scrutiny. The AAOS’s OrthoInfo page about PRP is overly enthusiastic. An accompanying commentary to the RCT we’re covering nails it:

Anyone who has encountered the polished and sclerotic bone in endstage osteoarthritis will understand that it is more likely that sunflower seeds spilled on concrete in a dark corner of the basement will turn into a bed of sunflowers than that cartilage will regenerate on sclerotic bone that is exposed to weightbearing.

This study shows it doesn’t work for mild-to-moderate osteoarthritis, either.

One parting thought: Surgeons often believe that we prescribe “physical therapy.” That’s a misconception. Physical Therapy is a profession, not a treatment. The treatment in question here is exercises, and the exercise regimen almost certainly makes a difference. The authors in this study were very specific about the regimen they used, and if you want the results they achieved, you should prescribe the regimen they employed. Here, it was better than PRP.

Source

Karaborklu Argut S, Celik D, Ergin ON, Kilicoglu OI. Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial. Clin Orthop Relat Res. 2024;482:1051-1061. 

Further Commentary

Boettner F. CORR Insights®: Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial. Clin Orthop Relat Res. 2024;482:1062-1064.