Outcome of three dose of Intra articular PRP in OA Knee

doi:10.21203/rs.3.rs-2477357/v1

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Research Article

Outcome of three dose of Intra articular PRP in OA Knee

https://doi.org/10.21203/rs.3.rs-2477357/v1

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Background

Osteoarthritis of knee develops after induction of cytokine and enzyme mediated damage to the articular cartilage. Platelet Rich Plasma (PRP) has been found to have high concentrations of growth factors which serve to promote local angiogenesis, modulate inflammation, inhibit catabolic enzymes and cytokines.

Methods

Total of 76 patients (100 knees) of OA Knee were studied. Functional outcome were analyzed after giving 3 doses of PRP one month apart, on the basis of VAS, Lequesne Index and WOMAC Score. At first visit patients were analyzed with WOMAC score, VAS Score, K-L grading and Lequesne Index. At second visit after one month, they were checked for WOMAC and VAS score. On third visit after 8 weeks, we checked for WOMAC score VAS score and. After receiving 3 injections one month apart, patients were called after 6 months for clinical evaluations through WOMAC, VAS, and Lequesne Index.

Results

It was found that there was significant change of WOMAC Score pre-injection (56.175) to post-Injection follow-up at 6 months (38.581). The VAS Score changed significantly from 6.76 pre-injection to 2.15 at 6-month follow- up. The Lequesne Index changed significantly form pre-injection 7.20 ± 0.789 to 4.60 ± 0.966 at 6 months and results were significant in both KL grade 2 as well as KL Grade 3.

Conclusions

6 months follow up of 3 doses of PRP injection has been shown to yield promising results in terms of pain and functional outcomes in mild to moderate grade of OA Knee.

Osteoarthritis (OA) is a progressive, degenerative condition that is characterized by pain and stiffness, leading to decreased physical function and quality of life [1]. Recent studies have led to the conclusion that OA is not just “wear and tear” of cartilage, but rather a disorder of the whole synovial joint [2]. The prevalence of increased biomechanical stress, such as with an injury or obesity, may lead to intensified bone metabolic activity. As OA progresses, there is a loss of cartilage, hypertrophic changes in local bone and synovial capsule, synovial inflammation and degenerative changes in the menisci, ligaments, and tendons, which may lead to pain and loss of physical function [1][2].

Articular cartilage plays a vital role in joint mechanics by providing a smooth, relatively friction-free surface between the 2 bones that constitute the joint [1]. When mechanical loads are placed on the joint, cartilage provides shock absorption. Patients with gradual loss of cartilage develop joint inflammation, resulting in bony overgrowth, ligament laxity and progressive weakness and atrophy that are accompanied by joint pain [3].

As the cartilage wears, mechanical stresses begin to load onto other structures of the joint and eventually, the cartilage can become so thin that there is exposure of the subchondral bone. This leads to joint space narrowing with increased density and sclerosis of subchondral bone as new bone is laid down in response to increased mechanical stresses. Osteophytes may also form at the joint margins, with the end result being mechanical joint failure and various degrees of functional loss [1][2].

Risk factors associated with KOA include obesity, sports, ligament injury or repair, meniscectomy, heavy weight lifting and repetitive kneeling or squatting [2] Clinical signs associated with OA Knee are limited range of motion, crepitus, joint effusion, joint tenderness, joint deformity, and malalignment. OA pain is often described as a deep ache that is worsened with activity and alleviated with rest.

Knee OA is diagnosed by a combination of subjective history, physical examination, laboratory tests (to rule out rheumatic disease), and radiographic imaging [4][5]. It should be noted that there is a poor correlation between self-reported knee pain and radiographic findings of KOA [6]. Many patients with severe OA resort to total knee replacement after failed non- operative treatments to reduce pain.

Although total knee arthroplasty is an effective and definitive solution for many KOA patients, there is a significant risk of surgical and post-surgical complications [6][7]. Without Surgery, the treatment of OA Knee can be to physical therapy, bracing, oral non-steroidal anti-inflammatory drugs (NSAIDs), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation and intra- articular injections at the knee joint including corticosteroids and hyaluronic acid (HA) [8]. There are several studies examining the effectiveness of these treatments on pain and function, however there are varying conclusions and little consensus on the “gold standard” for treatment of OA Knee.

PRP is a blood product prepared from autologous material via centrifuge consisting of a limited volume of plasma enriched in platelets and administered by local injection. In some preparations, this concentrate is activated via thrombin or calcium, which releases a multitude of growth factors at concentrations significantly greater than baseline blood levels. Growth factors found in PRP include transforming growth factor-b (TGF- b), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), basic fibroblast growth factors, vascular endothelial growth factor (VEGF), epidermal growth factors, and many others. Many of these cytokines are cartilage promoting and cartilage protective. PRP also contains an assortment of plasma proteins, which are known to be critical components in the healing mechanism of connective tissues [9].

Tissue changes in OA are the result of an imbalance between anabolic and catabolic joint remodeling processes. Interleukin-1b (IL-1b) is a known catabolic factor that contributes to these changes, promoting inflammation and disrupting chondrocyte synthesis pathways [10][11]. In OA, there is a relative decrease in the formation of the interleukin-1 receptor antagonist (IL-1ra), which is the natural inhibitor of IL-1b [8]. There are evidences in literature suggesting that PRP can reduce the IL-1b-induced inflammatory response in chondrocytes [9][10]. Growth factors present in platelets, like TGF- beta, stimulate chondrocyte synthetic activity and decrease the catabolic activity of IL-1b. This indicates that therapy with PRP could reduce pain and inflammation by inhibiting the inflammatory effects of IL- 1b.

There are 2 main types of PRP, leukocyte-rich (LR-PRP) and leukocyte-poor (LP-PRP). As the name suggests, LR-PRP is plasma that contains white blood cells, which are known to play a role in immune regulation, promotion of angiogenesis and have anti-infectious properties [14]. LP-PRP contains less leukocytes than its counterpart and less than whole blood. There are several relevant studies demonstrating a significant pain reduction and an improvement in knee joint physical function in patients with OA Knee treated by 3 weekly infiltrations of PRP [15]. The mechanism/s by which osteoarthritis pain remain yet to be fully identified as do the proposed mechanisms of PRP effectiveness. Two mechanisms might likely link the pain reduction to PRP treatment. The first is the suppression of NFkβ on intraarticular inflamed cells, leading to the reduction of proinflammatory cytokines that otherwise, might contribute to pain by stimulating hyperalgesia and sensitizing joint nociceptors to other stimuli. The second is the reported significant amount of endogenous cannabinoids within PRP that might act as ligands for cannabinoid receptor 1 and 2 of chondrocytes, synovium cells, and bone cells of OA patients, thereby supporting both a pain and inflammation reduction by targeting the endogenous cannabinoid systems [16].

Although, there are multiple benefits of PRP in literature, still the dilemma exists about the dosing and therapeutic effectiveness of Intra-articular PRP in OA Knee.

Aims and objectives

To study the change in severity of pain and functional outcome of Intra- articular PRP in OA Knee using VAS and WOMAC score

To asses functional outcome of therapeutic intervention using Lequesne Index

The patients attending the OPD of Orthopaedics Department at our tertiary care hospital with complaints of bilateral or unilateral knee pain were screened and those diagnosed as Knee Osteoarthritis were chosen for the study.

All eligible patients within the period of October 2020 to September 2021 visiting to the Department of Orthopaedics Surgery OPD of Apex hospital were considered for the study, with a sample of 100 knees.

Inclusion criteria

Patients with age > 40 years

Radiographically proven OA

K-L grade 1‐3

Exclusion criteria

Major Axial deviation of more than 5 degrees measured radiologically by Hip Knee Ankle Scannogram

Patient with systemic disorders such as uncontrolled diabetes, rheumatoid arthritis, hematological disorder, severe cardiovascular disorders, thyroid disorders, infections or immunodeficiencies

Patients who are on anticoagulants or NSAIDS (for at least 7 days)

Knee instability

Recent intra-articular injections of corticosteroids (within 30 days) and prior treatment with hyaluronic acid in last 6 months.

Study Population

All patients visiting the Orthopedic OPD in our tertiary care Referral Centre since October 2020 to September 2021, who had a history of chronic pain in either knees with radiographically documented grades I to III Osteoarthritis (graded according to the Kellgren–Lawrence classification scale for tibiofemoral joint degeneration) were evaluated for study.

Sample Size

Sample size was calculated using formula. N = {Z /2 × P × (1 – p) × D² }/ E²

where

N - sample size

P - prevalence or proportion of event

E - precision (or margin of error) with which a researcher wants to measure something

D - design effect reflects the sampling design used in the survey type of study. Z /2–1.96 for alpha 0.05.

Using the values in this study the standard population for our study comes out to be minimum 98 at 95% Confidence Interval. 100 knees (including patients with unilateral or bilateral OA) were included in the study after evaluation. We therefore registered 76 patients for our study- 52 with unilateral OA and 24 with Bilateral OA.

Study Technique

10 cc of blood was collected into tube A containing sodium - citrate and the tube was inverted slowly to ensure homogenization. After the centrifugation was complete, the tube was removed from the centrifuge and three layers were obtained. The bottom layer was rich in erythrocytes, the middle layer was the buffy coat (leukocyte + thrombocyte), and the top layer comprises plasma. The plasma and the buffy coat were transferred to tube B using a 3ml injector. Tube B was inverted, and the activation was achieved by the 10% calcium chloride found in the tube. In the second step, the B tube was placed in the centrifuge and spun for five minutes at 4,000 rpm. The tube was removed from the centrifuge after completing centrifugation. At the end of the second procedure, the bottom layer was PRP. Cell counting was conducted to determine whether the platelet count is sufficient. After confirming adequate platelet of at least 3‐4 times than the normal plasma level, the prp was injected using a 21-gauge needle through the supero‐lateral approach over the knee joint. The patient was kept in supine position with flexed knee to ensure proper distribution. Patients were discharged 1 hour after injections and were advised to take relative rest for one day and refrain from strenuous physical activity which could initiate pain. They were allowed to take oral paracetamol 650 mg tablets in case of pain and cold compression. However, any form of NSAIDs was not permitted. Patients were called for next session on month later.

Study Design

It is a prospective cohort study with assessment of 100 knees (including unilateral and bilateral OA knee patients) for sample size of 76 patients.

Study area

Outpatients in the Department of Orthopaedics Surgery of Apex hospital, Varanasi

Study assessment

At first visit patients were analyzed with WOMAC score, VAS Score, K-L grading and Lequesne Index. At second visit after one month (4 weeks) they were checked for WOMAC and VAS score. On third visit after 2 months (8 weeks) we checked for WOMAC score VAS score and. After receiving 3 injections one month apart, patients were called after 6 months (24 weeks) for clinical evaluations through WOMAC, VAS, and Lequesne Index

Sample Technique

After meeting the inclusion criteria and getting enrolled for the study after signing the consent form, patients were given printed format of the questionnaires of WOMAC Score and the VAS Score and Lequesne Index in each visit. All the data was then compiled up and noted on the Microsoft Excel Sheet. After 6 month follow up, statistical data analysis was carried using IBM SPSS Software.

Statistical Data analysis

All statistical analysis was done using paired T Test. Statistical significance reports were considered when the p value was less than 0.05. The analysis was performed using the IBM SPSS Software.

The study was conducted in the Department of Orthopaedics Surgery at Apex Superspeciality Hospital, Varanasi from October 2020 till September 2021. The study subjects comprised of 100 knees of symptomatic and radiographically proven Osteoarthritis. The subjects were given three doses 4ml of autologous intra-articular PRP one month apart and outcome was followed using pain and functional scoring systems

Table 1

Age Distribution
Age	No.	Percentage
40–45	2	2.6
46–50	11	14.5
51–55	10	13.2
56–60	32	42.1
61–65	9	11.8
66–80	12	15.8
Total	76	100.0

In the study, those patients were included who were more than 40 years of age and having symptomatic OA. Out of 76 patients, 42.1% patients were between 56–60 years of age and 2.6 percent patients were between 40–45 years of age. The mean age was 54.28 ± 11.5 years

Table 2

Gender Distribution
Sex	No.	Percentage
Male	25	32.9
Female	51	67.1
Total	76	100.0

In the study, out of 76 patients, 51 patients were female and 25 patients were male

Unilateral/Bilateral	No.	Percentage
Unilateral	52	68.4
Bilateral	24	31.6
Total	76	100.0

In the study out of 76 patients 52 patients were having unilateral Osteoarthritis and 24 patients were having bilateral Osteoarthritis.

WOMAC	Mean ± SD n = 100	p-value
Pre injection	56.175 ± 4.0842	-
At 1 Month	48.705 ± 5.3211	< 0.001
At 2 Month	40.136 ± 4.4355	< 0.001
At 6 Month	38.581 ± 3.1532	< 0.001

In our Study it was found that the WOMAC Score changed from Pre-Injection mean of 56.175 to 38.581 at 6 month with significant P- value using paired t-test

VAS	Mean ± SD n = 97	p-value
Pre injection	6.76 ± 1.491	-
At Month1	4.43 ± 1.314	< 0.001
At Month 2	3.87 ± 1.239	< 0.001
At Month 6	2.15 ± 1.341	< 0.001

In our study it was found that pre injection VAS Score mean was 6.76 which changed to 2.15 at 6 month after injection of Prp. The p-value using paired t test was significant.

Mean ± SD

N = 100

p-value

pre

At 6 Month

3.00 ± 0.000

Lq index

7.11 ± 1.302

5.15 ± 1.690

< 0.001

In our study it was found that the Lequesne Index mean was 7.11 which changed to 5.15 after three doses of PRP injection. P-value using paired t-test was significant. However, the KL grading mean did not change and p-value was not significant.

	Mean±Sd N = 29	p-value
WOMAC_pre injection	55.77241±3.226	-
WOMAC_1 month	48.46552±4.444	< 0.001
WOMAC_2 month	39.77586±5.001	< 0.001
WOMAC_6 month	37.41379±3.054	< 0.001
vas_pre injection	6.482759±1.734	-
Vas_1 month	4.37931±1.495	< 0.001
vas_2 month	3.758621±1.193	< 0.001
vas_6 month	2.586207±1.608	< 0.001
Lq index_pre injection	6.62069±1.270	< 0.003
LQ index_6 month	5±1.575	< 0.003

It was found that in K-L grade 2 patients the outcome analysis using the paired t-test for VAS Score, WOMAC Score and LQ Index was significant after 3 injections. The t-value is 4.31 for LQ index and this denotes that there is improvement in the functional outcome

	Mean±Sd N = 47	p-value
WOMAC_pre injection	56.606±4.767	-
WOMAC_1 month	48.968±5.096	< 0.001
WOMAC_2 month	40.166±3.752	< 0.001
WOMAC_6 month	39.574±3.893	< 0.001
vas_pre injection	6.808±1.160	-
Vas_1 month	4.723±0.763	< 0.001
vas_2 month	3.808±1.123	< 0.001
vas_6 month	1.978±0.699	< 0.001
Lq index_pre injection	7.553±1.365	< 0.001
LQ index_6 month	5.357±1.493	< 0.001

It was found that in K-L grade 3 patients the outcome analysis using the paired t-test for VAS Score, WOMAC Score and LQ Index was significant after 3 injections. Also, the t-value is 9.66 for LQ index and this denotes that there is improvement in functional outcome before and after injection.

	Mean ± SD
	Male		Female
	N = 25	p-value	N = 51	p-value
WOMAC_pre injection	55.088 ± 2.9029	-	56.800±4.4351	-
WOMAC_1 month	48.000 ± 3.0208	< 0.001	48.833±6.1528	< 0.001
WOMAC_2 month	40.324 ± 5.3645	< 0.001	40.402±3.9281	< 0.001
WOMAC_6 month	38.616 ± 3.5571	< 0.001	38.780±3.1082	< 0.001
vas_pre injection	5.78 ± 1.413	-	7.16±1.286	-
Vas_1 month	3.48 ± 1.377	< 0.001	4.96±0.958	< 0.001
vas_2 month	3.74 ± 1.054	< 0.001	4.08±1.294	< 0.001
vas_6 month	1.61 ± 0.722	< 0.001	2.35±1.454	< 0.001
Lq index_pre injection	7.36 ± 1.411	< 0.001	7.02±1.208	< 0.001
LQ index_6 month	5.44 ± 1.325	< 0.001	5.20±1.855	< 0.001

In our study it was found that in both male and females, there was significant change of pre injection VAS, WOMAC Score and Lq index at 1 month, 2 month and 6 months. P value using paired t-test was significant.

Table 10

Age 40–45 years
	Mean±SD	N
womac_pre injection	58.000^a±0.0000	2
Womac_1 month	48.000^a±0.0000	2
womac_2 month	46.000^a±0.0000	2
womac_6 month	34.000^a±0.0000	2
vas_pre injection	6.00^a±0.000	2
Vas_1 month	5.00^a±0.000	2
vas_2 month	4.00^a±0.000	2
vas_6 month	3.00^a±0.000	2
Lq index_pre injection	5.00^a±0.000	2
LQ index_6 month	6.00^a±0.000	2

Due to small sample size the statistical analysis in this age group was not applicable.

Table 11

**Age 46–50 years**
	Mean±SD (N = 11)	p-value
womac_pre injection	54.727±2.4121	-
Womac_1 month	46.364±5.0452	< 0.001
womac_2 month	35.364±2.1106	< 0.001
womac_6 month	37.091±2.5867	< 0.001
vas_pre injection	5.27±1.489	-
Vas_1 month	3.36±1.567	< 0.001
vas_2 month	4.27±0.647	0.019
vas_6 month	3.00±2.449	< 0.001
Lq index_pre injection	6.45±0.522	0.002
LQ index_6 month	3.91±1.514	0.002

In the age group of 46–50 years it was found that the VAS Score, Womac Score and Lq Index had shown significant change from Pre injection to follow up at 6 months. P value calculated using paired t-test was significant.

Table 12

**Age 51–55 years**
	Mean±SD N = 10	p-value
womac_pre injection	57.240±6.2129	-
Womac_1 month	52.000±5.1640	0.051
womac_2 month	37.450±4.0719	< 0.001
womac_6 month	40.180±2.3710	< 0.001
vas_pre injection	7.50±0.972	-
Vas_1 month	5.00±0.000	< 0.001
vas_2 month	3.00±1.054	< 0.001
vas_6 month	2.60±0.516	< 0.001
Lq index_pre injection	7.20±0.789	< 0.001
LQ index_6 month	4.60±0.966	< 0.001

In the age group of 51–55 years it was found that the VAS Score, Womac Score and Lq Index had shown significant change from Pre injection to follow up at 6 month. P-value was significant using paired t-test.

Table 13

Age 56–60 years
	Mean±Sd N = 32	p-value
womac_pre injection	57.362±3.5696	-
Womac_1 month	51.062±4.6277	< 0.001
womac_2 month	40.797±3.1848	< 0.001
womac_6 month	38.809±3.4240	< 0.001
vas_pre injection	6.80±1.472	-
Vas_1 month	4.77±1.223	< 0.001
vas_2 month	3.97±1.326	< 0.001
vas_6 month	1.83±1.147	< 0.001
Lq index_pre injection	7.28±1.442	< 0.001
LQ index_6 month	5.59±1.864	< 0.001

In the age group of 56–60 years it was found that the VAS Score, Womac Score and Lq Index had shown significant change from Pre injection to follow up at 6 months. P-value was significant using paired t-test.

Table 14

Age 61–65 years
	Mean±SD N = 9	p-value
womac_pre injection	57.333±1.8028	-
Womac_1 month	46.944±2.9202	< 0.001
womac_2 month	40.622±4.7376	< 0.001
womac_6 month	39.333±3.3166	< 0.001
vas_pre injection	6.00±0.866	-
Vas_1 month	4.67±0.500	0.011
vas_2 month	4.44±0.527	0.002
vas_6 month	2.22±0.441	< 0.001
Lq index_pre injection	7.22±1.394	< 0.001
LQ index_6 month	5.00±0.707	< 0.001

In the age group of 61–65 years it was found that the VAS Score, Womac Score and Lq Index had shown significant change from Pre injection to follow up at 6 month. P-value was significant using paired t-test.

Table 15

Age 66–80 years
	Mean±SD N = 12	p-value
womac_pre injection	52.667±3.8455	-
Womac_1 month	42.333±1.8007	< 0.001
womac_2 month	45.167±2.4802	< 0.001
womac_6 month	39.125±3.2692	< 0.001
vas_pre injection	7.92±0.669	-
Vas_1 month	4.25±1.712	< 0.001
vas_2 month	4.17±1.642	< 0.001
vas_6 month	1.42±0.515	< 0.001
Lq index_pre injection	7.58±1.240	0.009
LQ index_6 month	6.33±1.614	0.009

In the age group of 66–80 years it was found that the VAS Score, Womac Score and Lq Index had shown significant change from Pre injection to follow up at 6 months. P-value was significant using paired t-test.

Osteoarthritis is a disorder of synovial joints characterized by focal loss of hyaline cartilage with new bone proliferation and remodeling of joint contour, mainly due to uncoupling of balance between cartilage regeneration and degeneration. PRP has been tried in many researches for improving functional outcome in OA Knee.

The preparation of PRP has been a controversial matter of research and various literature have shown leucocyte depleted PRP to be effective than Leucocyte rich PRP. However, several studies have already pointed out the key role of leucocytes in PRP for their anti-infectious action, immune regulation, and promotion of angiogenesis [17]. In our study we did not use Leucocyte filter for our study. We included Leucocyte rich PRP for Intra‐articular injection. It was comparable to the study by Spakova et al [18] in which Leucocyte rich PRP was used for the study of OA Knee and significantly better functional outcomes were found. However, since our study was not comparative, we cannot claim that Leucocyte rich PRP is better than Leucocyte Depleted ones.

Most trials used the 3 doses of injections on one, two or three weekly basis. In a study conducted by Subramanyam et al [19], in which 90 patients were studied with multiple doses of PRP and its functional outcome, it was concluded that 3 doses, 2 weeks apart were having better functional outcome as compared with single dose of 4 ml PRP in OA Knee in a 1 year follow up. We used 3 doses of Intra-articular PRP four weeks apart and studied its outcome at 6 months which was found to be significantly better. Similar outcomes were noted as with the previous study. In his study [19] it was also found that OA Knee was seen commonly in female age group. 75 percent of patients were females. This was similar to our study in which 67 percent of patients were females.

It is evident from many studies that Osteoarthritis is a disease of the geriatric population. The mean age group in our study was found to be 54 years. This was comparable to study by Spakova et al [18] in which the mean age group was 53 years. In our study the maximum patients were in between the age group of 56-60 years. In that study [18] it was also evident that 3 doses given one week apart were having significant improvement in WOMAC Score at 6 month follow up where the pre injection mean of WOMAC Score changed from 38.76 ± 16.50 to 18.85 ± 14.09 at 6 month follow up. It was similar to our study where the mean WOMAC score pre injection was 56.175 ± 4.0842 which improved to 38.581 ± 3.1532 after 6 month. The p value using paired t‐test was significant.

The mean VAS Score pre injection was 6.76 ± 1.491 which came down to 2.15 ± 1.341 after 6 month. The p value was calculated using paired test which was significant. Subramanyam et al [19] got similar result in his study where he found that 3 doses of PRP improved the VAS score in OA Knee patients. In his study the pre injection VAS score changed from 7.6 ± 1.0 pre injection to 1.0 ± 0.8 at 6 month follow up.

The Lequesne Index pre injection was 7.11 ± 1.302 which changed to 5.15 ± 1.690 at 6 months follow up and p value using paired t test was significant. The findings were comparable with the study by Wang-Saegusa et al [20] where statistically significant results were found after 3 doses of Intra‐articular PRPat 6 months follow up.

It was also observed that the t-value for Lequesne index was significant improvement in K‐L grade 2 as well as K‐L Grade 3 patients. This signifies that Intra‐articular PRP in knee is effective in patients with K‐L grade 3 as well.

However, a greater number of patients must be evaluated for better establishment of this result. Nair et al [21] showed better outcome in patients with K-L grade 1 and 2 as compared with K‐L Grade with 3. However, in that study there were patients with chronic symptoms ranging more than 1 years. Also, in that study there were many patients in K‐L Grade 1 and K‐L grade 4 as well.

Using the pre injection and 6 month mean values of WOMAC Score, VAS Score and Lequesne Index we also found that there were significant changes in both the male and female patients. P value using paired t-test was significant in both males and females.

Age related comparison of the pre injection VAS Score, WOMAC Score and Lequesne Index showed that there was significant change in all age groups. P value calculated using paired t-test was significant in all age groups.

Complications

In this study the post procedure complication is negligible except for one patient who presented with septic arthritis of knee after receiving 2 doses of injections and excluded from the study. He was managed with Arthrotomy and Intravenous Antibiotics and responded well to the treatment.

Limitations

This study was conducted during the COVID-19 pandemic outbreak. This had led to lower outpatients and follow up. Hence lower sample size is a limitation of this study. More Study is required in patients with severe OA Knee for establishment of the therapy and dosing of PRP

Longer follow up is required to see for long term effectiveness of this therapy.

Comparative study is required to compare with other modalities of Intra- articular injections for OA Knee.

Osteoarthritis is a disease of older population with symptoms mainly in 4th to 6th decade of life and mainly involving female gender.

After following up patients with Osteoarthritis of knee for 6 months after receiving 4ml of intra-articular PRP injection for 3 doses one month apart, this study concludes that the result was significant in decreasing the VAS Score, Womac score and Lequesne Index in mild to moderate grade of Osteoarthritis.

Also, there was no gender and age biasing of the effects of PRP in treatment of the symptoms of OA knee.

It was also evident from the study that functional outcome was better outcome observed in K-L grade 3 patients as well as K‐L grade 2 patients.

Hence this study concludes that Intraarticular PRP injection is a safer and reliable method for pain and functional disability management for both male and female patients with OA in all age groups.

Ethical Approval – This study was approved by the internal review boards of the Hospital.

Competing interests – The author shares no competing interest in any financial or personal nature.

Authors' contributions – Dr Ankit Chaubey – as corresponding author of the study.

Dr Amit Kumar Jha – as Co author for providing scientific basis of this study and data collection and statistical analysis

Dr Swaroop Patel – As co-author and guide for scientific analysis

Dr Santosh Kumar Singh – As Co-author and Chief guide of the study.

Dr Amit Singh – As Co-author and helping hand for data management.

Funding – This Study was not associated with any funding

Availability of data and materials – Not Applicable

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No competing interests reported.

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Outcome of three dose of Intra articular PRP in OA Knee

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