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Osteoarthrosis of the knee joints is a common disease that leads to deterioration of physical condition, loss of working capacity, as well as social and psychological problems.
Osteoarthrosis is a chronic arthropathy characterized by damage and destruction of joint structures, as well as hypertrophy of bone tissue, which manifests itself in the development of osteophytes.
Osteoarthrosis is one of the most common joint diseases that can lead the patient to disability.
As a rule, gonarthrosis affects all three elements of the joint: subchondral bone tissue, synovial membrane and cartilage.
Clinically, osteoarthritis has a gradual manifestation – develops with pain, stiffness and swelling of the joint.
Up to 50 years of age, men are more likely to suffer from this disease, and after 65 years of age, women are twice as likely as men.
The aim of our study was to assess the condition of patients suffering from osteoarthritis of the knee joints during therapy by injection of platelet-rich plasma.
Autologous plasma therapy is a treatment method based on the injection of autologous platelet-rich plasma. Platelets are sources of FR (growth factors), chemokines, cytokines (serotonin, histamine, dopamine, prostaglandins), they also contain ions Ca ++, K +, ATP, ADP, clotting factors, elastase, lysozyme, proteases, fungicidal and antibacterial proteins.
Platelets contain about 1500 proteins, thereby they are able to influence various reparative and physiological processes in tissues.
The normal concentration of platelets in human blood ranges from 150,000 units / μl to 400,000 / μl.
When receiving platelet-rich plasma, the number of platelets increases from 2 to 4 times (depending on the method and duration of enrichment) and usually reaches 1,000 000 units / μl.
The following growth factors play a direct role in regeneration:
As a result of treating joints with autologous platelet-rich plasma, we expect the following biological effects: migration of stem cells to the site of damage, increased cell reproduction and synthetic activity of cells, anti-inflammatory, antimicrobial and analgesic effects. All of the above biological effects are reflected in the general condition of patients, through the appearance of visible results, such as: reduction and cessation of synovitis, reduction in the intensity and nature of pain, healing of cartilage damage, normalization of synovial fluid production.
Our study involved 50 outpatients (30 men and 20 women) with knee joint pathology. 35 people were diagnosed with grade II deforming osteoarthritis of the knee joints and 15 people with grade III DOA of the knee joints.
From the anamnestic data of the patients, it is clear that the duration of the pathological process varies from 2-15 years. At the time of treatment, the patients complained of pain in the knee joints, at rest and during loads, limited movement, and swelling.
All patients were examined according tobut to the protocols, which include: general clinical examinations, complete blood count, complete urine test, rheumatology tests, as well as imaging diagnostics (radiography, MRI).
Platelet-rich plasma was obtained by single centrifugation of the patient’s own venous blood. Each patient was sampled in an amount of 9-10 ml of venous blood, from which up to 4 ml of plasma was isolated. The obtained platelet-rich plasma was injected intra-articularly through medial or lateral access. Intra-articular injections were performed once every 10 days, in the amount of 6 procedures.
It is worth noting that the group did not include patients with conditions that are contraindications to platelet-rich plasma therapy, such as: moderate and severe anemia, thrombocytopenia (less than 100,000 / μl), taking anticoagulants, acute infectious processes, oncological diseases, pregnancy. Also before the procedure, patients were recommended to stop taking anticoagulants (2 weeks in advance), stop taking nonsteroidal anti-inflammatory drugs a week in advance, limit the use of analgesics 2-3 days before and after the procedure, stop smoking and drinking alcohol, eating fried and fatty foods, and also stop playing sports and visiting the sauna 2 days before the procedure.
All patients were divided into two groups by age. The first group included patients aged 25-45 years, the second group included patients over 45 years.
Results and their discussion.
The analysis of the assessment of the effectiveness of the treatment of deforming osteoarthritis of the knee joints was carried out using a clinical examination, using the patient’s assessment of pain at rest and movement according to VAS from 0 to 100 mm.
35 patients had a II radiological stage of osteoarthritis of the knee joints and 15 patients had a III radiological stage of the disease.
Most patients (84%) had a limitation of the range of motion, mainly flexion, in the affected knee joints.
According to VAS The pain intensity ranged from 37 to 100 mm.
Starting from the first week of treatment, patients began to notice an average reduction in pain of 15-20%. However, significant positive dynamics were observed in patients after 4 procedures.
According to the VASH pain at rest scale
| first group | second group | |
| before treatment | 37.3 mm | 43.3 mm |
| on day 10 | 36.4 mm | 40.2 mm |
| on day 20 | 31.44 mm | 35.5 mm |
| on day 30 | 26.2 mm | 29.9 mm |
| at 40 days | 18.6 mm | 25.4 mm |
| on 50 day | 15.4 mm | 20.2 mm |
| on 60 day | 11.3 mm | 18.3 mm |
On the scale YOUR pain when moving
| first group | second group | |
| before treatment | 64.8 mm | 84.3 mm |
| on day 10 | 59.8 mm | 74.2 mm |
| on day 20 | 43.4 mm | 54.2 mm |
| on the 30th day | 39.5 mm | 40.3 mm |
| at 40 days | 33.2 mm | |
| at 50 days | 20.1 mm | 30.5 mm |
| at 60 days | 14.3 mm | 27.7 mm |
Conclusions.
Osteoarthrosis is a pressing problem in traumatology. The main treatment for this disease is the use of NSAIDs and chondroprotectors. Along with reducing pain and improving joint mobility, NSAIDs cause undesirable side effects, mainly from the gastrointestinal tract. In this regard, platelet-rich plasma therapy is becoming increasingly popular. The onset of a stable therapeutic effect occurs after 7-14 days and lasts from 6-9 months.
In patients in the second group, analgesia after intra-articular plasma injections was noted later. We dare to assume that this is associated with a longer period of the disease and the transition to a chronic stage.
Treatment with platelet-rich plasma is a modern, safe, affordable method that does not require significant material costs, which can be used in the outpatient practice of a doctor.