• Orthopaedics Clinical Trials
• Soft Tissue Disorders
• Hip & Knee Conditions

• Orthopaedics
• Orthopaedics Clinical Trials
• Soft Tissue Disorders
• Hip & Knee Conditions

A single-center, prospective, randomized, longitudinal study with blinded evaluation has shown that platelet-rich plasma (PRP), compared with the corticosteroid methylprednisolone (MP), provided a greater and more durable improvement in pain relief in patients with chronic greater trochanteric bursitis (GTB).

PRP has shown promise in other musculoskeletal injuries, such as lateral epicondylitis and anterior cruciate ligament, and its use is being studied in other clinical settings [Zhang N et al. Scientific World Journal 2013; Bava ED, Barber FA. Phys Sportsmed 2011]. Raymond Rocco Monto, MD, Nantucket Cottage Hospital, Nantucket, Massachusetts, USA, examined the use of PRP in his sports medicine practice to treat GTB, which is common but often not amenable to traditional treatment of rest, physical therapy, nonsteroidal anti-inflammatory drugs, and local nonsurgical modalities. Chronic tendonopathies, such as GTB, are associated with treatment failure rates ranging from 10% to 31% [Davies H et al. Hip Int 2009; Ege Rasmussen KJ, Fano N. Scan J Rheumatol 1985; Schapira D et al. Arch Phys Med Rehabil 1986].

Although the mechanism of action of PRP is unknown, Dr. Monto hypothesized that bioactive components in the some 11,000 proteins and cytokines in the concentrated platelets drives repair of the damaged tissue.

A total of 40 patients were evenly randomized to MP or PRP. The two groups were similar, with an average age of 64 years (range, 43 to 74) and 66 years (range, 47 to 77), 13 and 15 women, and refractory to 10 and 11 months of traditional treatment (minimum of 6 months required for inclusion), respectively.

All patients underwent magnetic resonance imaging to distinguish GTB from other musculoskeletal injuries such as arthritis and complex nerve syndrome, and to primarily identify injuries to the gluteus medius tendon. A single ultrasound-guided injection at the injury site was given to each patient: 4 mg of MP or 3 cc of unbuffered, unactivated autologous PRP.

The primary outcome measures of benefit were the Harris Hip Score (HHS) to assess hip function before and after treatment and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to measure pain, stiffness, and functional limitation.

The average pretreatment HHS was similar at 50.52 in the MP and 51.67 in the PRP groups (Table 1) [Monto RR. AAOS 2014 (paper 778)]. At 3 months, HHS improved to 75.32 and 84.23 in the MP and PRP groups, respectively. At 6 months, the difference between the groups increased, and at 12 months the HHS was near the pretreatment level in the MP group (58.81) although it had continued to improve in the PRP group (87.42).

The average pretreatment WOMAC score was 58.3 in the MP and 58.8 in the PRP groups, and improved to 83.6 and 91.4 at 3 months, respectively (Table 2) [Monto RR. AAOS 2014 (paper 778)]. Again, at 6 months the improvement with MP was diminished while the improvement with PRP was maintained. At 12 months, the WOMAC score in the MP group was near the pretreatment level (63.4) and the improvement was maintained (89.3) in the PRP group.

PRP provided short- and long-term improvement in pain and function scores. A limitation of the study, noted Dr. Monto, is the subjective patient-driven scoring systems used to assess outcomes. There were no complications in the study and no patients were lost to follow-up. Treatment with PRP and MP are similarly safe and simple. Ultimately, he stated, the currently unknown balance of cost versus efficacy will determine the use of this experimental approach to treating GTB.

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