Artikel
Perioperative platelet-rich plasma treatment to the reinsertion site of gluteus medius in total hip arthroplasty via Hardinge approach
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Autoren
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Jani Puhakka
- Department of Orthopaedics, Töölö Hospital, Helsinki, Finland
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Juha Kukkonen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
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Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
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Jussi Kosola
- Department of Orthopaedics, Töölö Hospital, Helsinki, Finland
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: Although the possible benefits of platelet-rich plasma (PRP) in an acute tendon trauma, there has been no studies concerning perioperative use of PRP in order to enhance the healing of gluteus medius re-insertion site in total hip arhtroplasty (THA) done via Hardinge approach. Our 3-month pilot study is a part of upcoming multicenter study which is planned to launch 2017 with 1-year follow-up. This 3-month trial aims to address the safety and possible benefits of PRP use in THA procedure as well as acknowledge whether full length study is appropriate and feasible to conduct in clinical settings.
Methods: We present a prospective pilot study where 60-75 - year old THA patients (n=15) received either 9ml PRP or placebo perioperatively to the re-insertion site of gluteus medius at the closure of Hardinge approach. The pilot protocol was double-blinded randomized trial. Outcome measures were possible adverse events regarding the use of PRP, Oxford Hip Score (OHS) and the measurements of hip abduction strength with dynamometer (kg). The pilot design of the study included pre-trial statistical power analyses and the follow-up of the outcome measures preoperatively (baseline) and postoperatively at 3 months.
Results: The recruitment phase of the pilot study took 4 months. 2 patients were lost in follow-up and 1 patient had perioperative trochanter fracture (placebo group) which concluded the final cohorts to 6 patients per both PRP and placebo groups. Average OHS increased 23.5 points in the PRP group compared to an increase of 20.2 points in the placebo group in 3 months. Also the PRP group seemed to have higher average increase in the maximum strength abduction compared to placebo group (39.1 vs. 6.2 %). These preliminary results are in line with the power analysis, where significant differences (p<0.05) could be seen with 40 patients per study groups.
Conclusions: The perioperative use of PRP seems to have no adverse events in short term follow-up after THA procedure. Also the pilot study demonstrates possible benefits of perioperative PRP treatment in OHS and maximal hip abduction strength. However, these pilot study findings should be addressed using higher number of participants and long-term follow-up (Figure 1 [Fig. 1]).
