Effectiveness of Platelet-Rich Plasma as an Adjunct to Core Decompression to Treatment Outcomes and Femoral Head Preservation in Avascular Necrosis of the Hip: A Meta-Analysis of Randomized Controlled Trials
Carlo F. Fernandez, Byron S. Angeles, Carmelo L. Braganza
Oct 2023 DOI 10.35460/2546-1621.2023-0054 Access
Abstract
Background: Avascular necrosis (AVN) of the femoral head results from intraosseous pathology causing functional impairment. Early diagnosis allows conservative treatment like core decompression, delaying total hip arthroplasty.
Objective: This meta-analysis aims to summarize platelet-rich plasma's (PRP) impact as an adjunct to core decompression (CD) on treatment outcomes and femoral head preservation in hip AVN.
Methods: The study conducted a comprehensive literature search using PubMed, Cochrane Library, Science Direct, Google Scholar and Med Line, including randomized controlled trials (RCTs) and previous meta-analyses from various databases. Using a random effects model, it compared PRP+CD with bone grafting to CD with bone grafting alone in AVN patients, evaluating function, pain scores, disease progression and the need for hip surgery.
Results: The meta-analysis examined 1041 records and included three studies. The primary outcomes were function and pain scores using Harris Hip Scoring (HHS) and Visual Analog Scale (VAS). Postoperative HHS scores at final follow-up favored the PRP+CD group significantly over CD alone. Postoperative VAS scores showed a trend towards higher scores in the CD alone group. The PRP+CD group demonstrated higher survival from disease progression compared to CD alone. Overall, the study suggests that PRP+CD led to better functional outcomes and disease progression outcomes than CD alone in AVN of the hip.
Conclusion: The PRP+CD treatment group showed significant benefits in AVN patients compared to CD alone, including higher HHS scores, improved disease progression survival and reduced need for hip surgery. Although PRP+CD resulted in decreased VAS scores, the difference was not statistically significant.
Keywords : Avascular Necrosis/AVN, Osteonecrosis, Femoral Head, Platelet-Rich Plasma, Core Decompression and Randomized Controlled Trial
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Kumar P, Shetty VD, Dhillon MS. Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip. J Hip Preserv Surg [Internet]. 2021;7(3):423–38. Available from: http://dx.doi.org/10.1093/jhps/hnaa051
-
Aggarwal AK, Poornalingam K, Jain A, Prakash M. 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 [Internet]. 2021;36(1):54–61. Available from: http://dx.doi.org/10.1016/j.arth.2020.07.010
-
Narayanan A, Khanchandani P, Borkar RM, Ambati CR, Roy A, Han X, et al. Avascular necrosis of femoral head: A metabolomic, biophysical, biochemical, electron microscopic and histopathological characterization. Sci Rep [Internet]. 2017;7(1):10721. Available from: http://dx.doi.org/10.1038/s41598-017-10817-w
-
D’Ambrosi R, Biancardi E, Massari G, Ragone V, Facchini RM. Survival analysis after core decompression in association with platelet-rich plasma, mesenchymal stem cells, and synthetic bone graft in patients with osteonecrosis of the femoral head. Joints [Internet]. 2018;6(1):16–22. Available from: http://dx.doi.org/10.1055/s-0038-1626740
-
Bachiller FG-C, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res [Internet]. 2002;399:87–109. Available from: http://dx.doi.org/10.1097/00003086-200206000-00012
-
Issa K, Pivec R, Kapadia BH, Banerjee S, Mont MA. Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J [Internet]. 2013;95-B(11 Suppl A):46–50. Available from: http://dx.doi.org/10.1302/0301-620X.95B11.32644
-
Xian H, Luo D, Wang L, Cheng W, Zhai W, Lian K, et al. Platelet-rich plasma-incorporated autologous granular bone grafts improve outcomes of post-traumatic osteonecrosis of the femoral head. J Arthroplasty [Internet]. 2020;35(2):325–30. Available from: http://dx.doi.org/10.1016/j.arth.2019.09.001
-
Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod [Internet]. 1998;85(6):638–46. Available from: http://dx.doi.org/10.1016/s1079-2104(98)90029-4
-
Sierra R, Houdek M, Wyles C, Martin J. Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning [Internet]. 2014;65. Available from: http://dx.doi.org/10.2147/sccaa.s36584
-
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 [Internet]. 2013;54(3):219–24. Available from: http://dx.doi.org/10.3325/cmj.2013.54.219
-
Houdek MT, Wyles CC, Smith J-RH, Terzic A, Behfar A, Sierra RJ. Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head : mid-term update from a prospective study: Mid-term update from a prospective study. Bone Jt Open [Internet]. 2021;2(11):926–31. Available from: http://dx.doi.org/10.1302/2633-1462.211.BJO-2021-0132.R1
-
Yang J-H, Su X, Zhu S. Medium term effects of platelet rich plasma combined with alendronate in preventing the collapse of femoral head necrosis. World Clinical Drugs, 2019;40(7). Available from: https://doi.org/10.13683/j.wph.2019.07.009
-
Ringshawl ZY, MBBS, Post Graduate Scholar, Deptt. of Orthopaedics, Government Medical College, Srinagar. Functional outcome of uncemented modular bipolar hemiarthroplasty using modified Harris hip score for fractures of femoral neck in elderly patients. J Med Sci Clin Res [Internet]. 2020;08(09). Available from: http://dx.doi.org/10.18535/jmscr/v8i9.04
-
Kirk K, Martin DJ, Steedman W, Ravey J. Comparison of visual analogue scales (VAS) and verbal rating scales (VRS) as assessment tools of pain intensity and pain unpleasantness. Physiotherapy [Internet]. 1996;82(11):638. Available from: http://dx.doi.org/10.1016/s0031-9406(05)66350-x
-
Bayliss AP, Davidson JK. Traumatic osteonecrosis of the femoral head following intracapsular fracture: incidence and earliest radiological features. Clin Radiol [Internet]. 1977;28(4):407–14. Available from: http://dx.doi.org/10.1016/s0009-9260(77)80149-9
-
Han J, Gao F, Li Y, Ma J, Sun W, Shi L, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: A systematic review. Biomed Res Int [Internet]. 2020;2020:1–11. Available from: http://dx.doi.org/10.1155/2020/2642439
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