THE USE OF PLATELET DERIVED GROWTH FACTORS IN TOTAL KNEE ARTHROPLASTY, A RANDOMIZED TRIAL.

Abstract

Introduction: The short-term functional recovery after a total knee arthroplasty (TKA) is largely dependent on initial wound healing. Haematoma formation may lead to prolonged wound drainage and tissue necrosis, which can have a negative effect on early range of motion, post-operative pain and infection rate.

To decrease haematoma formation, primary soft tissue homeostasis and adequate tissue repair are essential. Growth factors, especially PDGF (platelet derived growth factor) and TGF-β (transforming growth factor-beta), play a crucial role in the biochemical cascade at the site of repair. These growth factors are mostly derived from platelets.

The objective of this study was to evaluate the effect of autologous platelet concentrate on blood loss (postoperative decrease of haemoglobin concentration), wound healing complications, range of motion, pain reduction and outcome scores when used in total knee arthroplasty.

Method: 96 patients undergoing primary total knee arthroplasty were included and randomized in two groups. In the study group, autologous platelet concentrate was applied at wound closure. Treatment with autologous platelet concentrate involves direct application of concentrated platelets, growth factors and fibrin in the operation wound. A small volume (55–110 ml) of the patient’s own blood is taken to derive a platelet rich gel which can be sprayed directly into the wound.

The peri-operative haemoglobin concentration, peri-operative range of motion, haematoma formation, number of days of wound drainage and complications were collected. The pain score (VAS), IKSS, 12 questionaire score and SF-36 score were recorded at regular intervals.

Results: There was no significant difference between the groups in post-operative haemoglobin decrease, range of motion, haematoma formation, wound drainage or pain scores. In the study group there were 3 deep infections. In the control group we had no infections.

Conclusion: We found no benefit in the use of autologous platelet concentrate in total knee arthroplasty. Furthermore, it is of concern that we had three deep infections with use of the autologous platelet concentrate.