Intra-articular Pure Platelet-Rich Plasma combined with Open-Wedge High Tibial Osteotomy (HTO) improves Clinical Outcomes and Minimal Joint Space Width compared with HTO alone in knee osteoarthritis: A Prospective Study.

Abstract Purpose The purpose of this study was to compare the clinical efficacy of the patients with medial compartment knee osteoarthritis who underwent either opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and pure platelet rich plasma therapy (HTO-P-PRP). Methods Eighty patients were divided into two groups randomly, the HTO alone group (n=41) and the HTO combined with intra-articular P-PRP group (n=39). Patients were matched for preoperative age, sex and body mass index (BMI). The outcomes studies included Visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lysholm score. The minimum width of medial knee joint (MJSW), medial proximal tibial angle (MPTA), femoral tibial angle (FTA) and weight bearing line (WBL) were measured preoperatively, immediately postoperatively and 1, 6, 12 and 24 months postoperatively. Paired T-test and chi-square test were used for statistical analysis. Results All patients were followed up at 1, 6, 12 and 24 months postoperatively. At 1, 6 and 12 months, pain and function scores in the HTO-P-PRP group were better than those in the HTO alone groups, especially at 6 months in Lysholm score (HTO alone, 72.5 ±10.6, HTO-P-PRP, 83.1 ±14.7; P =.003, 95%CI=-14.13 to -10.42) and WOMAC score (HTO alone, 90.3 ±11.9, HTO-P-PRP, 75.6 ±15.4; P ＜.001, 95%CI=13.36 to 20.11). For both groups, no difference was found between preoperatively (HTO alone, varus 3.5 ± 3.9, HTO-P-PRP, varus 4.1 ± 4.0; P= 0.898) and postoperatively (HTO alone, valgus 6.7 ± 4.5; HTO-P-PRP, valgus 7.7 ± 2.3; P= 0.768) in FTA and WBL. The increase of the MJSW in the HTO-P-PRP group was significantly greater than which in the HTO alone group during the first year, especially at 6 months (HTO alone, 3.8 ±1.2mm, HTO-P-PRP, 4.6 ±1.1mm; P=0.001, 95%CI=-1.27 to -0.35). Conclusions Compared with HTO alone, HTO combined with intra-articular P-PRP improved the minimum medial knee joint space width during the first year postoperatively. Clinically, higher proportions of patients in HTO-P-PRP group exceeded minimal clinically important differences (MCID) in the first year, especially at 6 months in Lysholm score (HTO alone, 65.9%; HTO-P-PRP, 97.4%) and WOMAC score (HTO alone, 82.9%; HTO-P-PRP, 100.0%).