Intra-articular injection of platelet-rich plasma in patients with hemophilia and painful knee joint cartilage degeneration

ABSTRACT

Introduction

Knee arthropathy causes pain to people with hemophilia (PWH). One of the current controversies is whether injections of intra-articular platelet-rich plasma (PRP) are effective in relieving the knee pain of PWH.

Areas covered

A narrative literature review was conducted on the efficacy of PRP injections in the knees of PWH.

Expert opinion

Intra-articular PRP knee injections are widely used in patients with knee osteoarthritis to relieve pain and delay total knee arthroplasty. Although numerous publications have supported the use of PRP in knee osteoarthritis, there is still major controversy regarding its true usefulness, given that a number of studies with a high degree of evidence have failed to show the efficacy of PRP. With respect to painful hemophilic arthropathy, the use of PRP injections is even more controversial, as there are only four publications on the subject supporting the use of PRP in hemophilia, all of them with a low degree of evidence. A publication with grade 1 evidence recommended against the use of PRP in hemophilic arthropathy because its efficacy has not been demonstrated. My opinion is that intra-articular PRP injections should not be used in hemophilia until there is more evidence of its benefits.

KEYWORDS:

• Knee
• hemophilia
• cartilage degeneration
• intra-articular injection
• platelet-rich plasma (PRP)

Article highlights

• Four publications of low evidence have reported that intraarticular PRP injections are useful, safe and inexpensive for treating chronic hemophilic synovitis. These publications reported that PRP injections caused no complications, either during blood collection or during PRP injection, even in inhibitor patients.

• A narrative literature review concluded that the efficacy of intraarticular PRP injections in hemophilic arthropathy remained to be confirmed, and its use was not recommended.

• A level 1 evidence study compared 3 PRP injections with 3 placebo injections in patients with knee hemophilic arthropathy. After a 24-month follow-up, the PRP injections did not reduce pain or increase function or quality of life with respect to placebo.

• This level 1 evidence study did not support the use of 3 weekly intraarticular PRP injections in patients with knee hemophilic arthropathy.

• It is this author’s considered opinion that, at this time, PRP injections should not be used in patients with hemophilia.

Declaration of Interest

The authors has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.