Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study_West China Medical Journal

Authors：

WANG Shaoling , LUAN Shuo , FAN Shengnuo , LIU Cuicui , LI Xiao , MA Chao ,  WU Shaoling

Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

WU Shaoling, Email: wushaolinggz@126.com

Keywords：

Osteonecrosis of the femoral head; Platelet-rich plasma; Ultrasound-guided intra-articular injection; Retrospective study

DOI：

10.7507/1002-0179.202103062

Video：

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Objective To explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of avascular necrosis of the femoral head.Methods We retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received 4 injections at one-week intervals. The Visual Analogue Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Harris Hip Joint Function Scale (HHS) were evaluated before treatment and 1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance; the non-normally distributed data were presented as median (lower quartile, upper quartile), and analyzed by Friedman test.Results A total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and 1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0 (5.5, 8.0), 4.0 (3.0, 5.0), 3.0 (2.0, 3.0), and 3.0 (2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0 (40.0, 64.0), 71.0 (57.5, 75.0), 78.0 (68.0, 80.5), and 78.0 (64.0, 80.0), respectively. The time effects in VAS (χ²=65.423, P<0.001), WOMAC (F=46.710, P<0.001), and HHS (χ²=66.347, P<0.001) were all statistically significant. There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant difference in each index between the value 1 month after treatment and that 3 months after treatment (P<0.05). There was no significant difference in any indicator between the value 6 months after treatment and that 3 months after treatment (P>0.05). Significant difference was shown between the value 6 months after treatment and that 1 month after treatment in WOMAC (P=0.016), but not in VAS or HHS (P>0.05). No obvious adverse event was reported during the follow-up period.Conclusions Ultrasound-guided intra-articular PRP injection can effectively alleviate the pain and improve the hip joint function of patients with femoral head necrosis for at least 6 months. However, randomized controlled studies with a larger sample size and longer-term follow-up are needed in the future to confirm the efficacy and safety of PRP injection in femoral head necrosis.

Citation： WANG Shaoling, LUAN Shuo, FAN Shengnuo, LIU Cuicui, LI Xiao, MA Chao, WU Shaoling. Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study. West China Medical Journal, 2021, 36(5): 617-622. doi: 10.7507/1002-0179.202103062 Copy

1.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2.	Xu HH, Li SM, Fang L, et al. Platelet-rich plasma promotes bone formation, restrains adipogenesis and accelerates vascularization to relieve steroids-induced osteonecrosis of the femoral head. Platelets, 2020: 1-10.
3.	赵德伟, 程亮亮. 浅谈全髋关节置换术的年轻化. 中华骨与关节外科杂志, 2019, 12(5): 328-330.
4.	Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther, 2016, 16(2): 213-232.
5.	Akeda K, An HS, Okuma M, et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage, 2006, 14(12): 1272-1280.
6.	Yancopoulos GD, Davis S, Gale NW, et al. Vascular-specific growth factors and blood vessel formation. Nature, 2000, 407(6801): 242-248.
7.	Fiz N, Delgado D, Garate A, et al. Intraosseous infiltrations of platelet-rich plasma for severe hip osteoarthritis: a pilot study. J Clin Orthop Trauma, 2020, 11(Suppl 4): S585-S590.
8.	栾烁, 栗晓, 林彩娜, 等. 超声引导下关节腔注射富血小板血浆治疗膝骨性关节炎疗效的回顾性研究. 华西医学, 2020, 35(5): 568-573.
9.	Tong S, Yin J, Liu J. Platelet-rich plasma has beneficial effects in mice with osteonecrosis of the femoral head by promoting angiogenesis. Exp Ther Med, 2018, 15(2): 1781-1788.
10.	Yokota K, Ishida O, Sunagawa T, et al. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: an experimental study in rabbits. Acta Orthop, 2008, 79(1): 106-110.
11.	Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J, 2013, 54(3): 219-224.
12.	Pak J, Lee JH, Jeon JH, et al. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res, 2014, 42(6): 1353-1362.
13.	Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14.	Dallari D, Stagni C, Rani N, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med, 2016, 44(3): 664-671.
15.	杨富强, 杨晓明, 葛建健. 髓芯减压植骨联合富血小板血浆治疗股骨头缺血性坏死的前瞻随机对照研究. 中华关节外科杂志, 2016, 2: 22-25.
16.	D’Ambrosi R, Hantes ME, Mariani I, et al. Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication. Knee Surg Sports Traumatol Arthrosc, 2021, 29(5): 1370-1377.
17.	中国医师协会骨科医师分会骨循环与骨坏死专业委员会, 中华医学会骨科分会骨显微修复学组, 国际骨循环学会中国区. 中国成人股骨头坏死临床诊疗指南(2020). 中华骨科杂志, 2020, 40(20): 1365-1376.
18.	Han J, Gao F, Li Y, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int, 2020, 2020: 2642439.
19.	Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R, 2012, 4(12): 1015-1019.
20.	Luan S, Liu C, Lin C, et al. Platelet-rich plasma for the treatment of adolescent late-stage femoral head necrosis: a case report. Regen Med, 2020, 15(9): 2067-2073.
21.	Aggarwal AK, Poornalingam K, Jain A, et al. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: a 4.5- to 6-year prospective randomized comparative study. J Arthroplasty, 2021, 36(1): 54-61.
22.	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
23.	Byrd JW, Potts EA, Allison RK, et al. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy, 2014, 30(1): 42-46.
24.	马良彧, 王善正, 郭玉冬, 等. 富血小板血浆治疗骨性关节炎的现状. 中国矫形外科杂志, 2018, 26(15): 1396-1399.
25.	Amin I, Gellhorn AC. Platelet-rich plasma use in musculoskeletal disorders: are the factors important in standardization well understood?. Phys Med Rehabil Clin N Am, 2019, 30(2): 439-449.

1. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
2. Xu HH, Li SM, Fang L, et al. Platelet-rich plasma promotes bone formation, restrains adipogenesis and accelerates vascularization to relieve steroids-induced osteonecrosis of the femoral head. Platelets, 2020: 1-10.
3. 赵德伟, 程亮亮. 浅谈全髋关节置换术的年轻化. 中华骨与关节外科杂志, 2019, 12(5): 328-330.
4. Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther, 2016, 16(2): 213-232.
5. Akeda K, An HS, Okuma M, et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage, 2006, 14(12): 1272-1280.
6. Yancopoulos GD, Davis S, Gale NW, et al. Vascular-specific growth factors and blood vessel formation. Nature, 2000, 407(6801): 242-248.
7. Fiz N, Delgado D, Garate A, et al. Intraosseous infiltrations of platelet-rich plasma for severe hip osteoarthritis: a pilot study. J Clin Orthop Trauma, 2020, 11(Suppl 4): S585-S590.
8. 栾烁, 栗晓, 林彩娜, 等. 超声引导下关节腔注射富血小板血浆治疗膝骨性关节炎疗效的回顾性研究. 华西医学, 2020, 35(5): 568-573.
9. Tong S, Yin J, Liu J. Platelet-rich plasma has beneficial effects in mice with osteonecrosis of the femoral head by promoting angiogenesis. Exp Ther Med, 2018, 15(2): 1781-1788.
10. Yokota K, Ishida O, Sunagawa T, et al. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: an experimental study in rabbits. Acta Orthop, 2008, 79(1): 106-110.
11. Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J, 2013, 54(3): 219-224.
12. Pak J, Lee JH, Jeon JH, et al. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res, 2014, 42(6): 1353-1362.
13. Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
14. Dallari D, Stagni C, Rani N, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med, 2016, 44(3): 664-671.
15. 杨富强, 杨晓明, 葛建健. 髓芯减压植骨联合富血小板血浆治疗股骨头缺血性坏死的前瞻随机对照研究. 中华关节外科杂志, 2016, 2: 22-25.
16. D’Ambrosi R, Hantes ME, Mariani I, et al. Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication. Knee Surg Sports Traumatol Arthrosc, 2021, 29(5): 1370-1377.
17. 中国医师协会骨科医师分会骨循环与骨坏死专业委员会, 中华医学会骨科分会骨显微修复学组, 国际骨循环学会中国区. 中国成人股骨头坏死临床诊疗指南(2020). 中华骨科杂志, 2020, 40(20): 1365-1376.
18. Han J, Gao F, Li Y, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int, 2020, 2020: 2642439.
19. Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R, 2012, 4(12): 1015-1019.
20. Luan S, Liu C, Lin C, et al. Platelet-rich plasma for the treatment of adolescent late-stage femoral head necrosis: a case report. Regen Med, 2020, 15(9): 2067-2073.
21. Aggarwal AK, Poornalingam K, Jain A, et al. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: a 4.5- to 6-year prospective randomized comparative study. J Arthroplasty, 2021, 36(1): 54-61.
22. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
23. Byrd JW, Potts EA, Allison RK, et al. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy, 2014, 30(1): 42-46.
24. 马良彧, 王善正, 郭玉冬, 等. 富血小板血浆治疗骨性关节炎的现状. 中国矫形外科杂志, 2018, 26(15): 1396-1399.
25. Amin I, Gellhorn AC. Platelet-rich plasma use in musculoskeletal disorders: are the factors important in standardization well understood?. Phys Med Rehabil Clin N Am, 2019, 30(2): 439-449.

West China Medical Journal

Effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of osteonecrosis of the femoral head: a retrospective study

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