Knee OsteoarthritisEarly Phase 1NCT05080075
Platelet Rich Plasma in Knee Osteoarthritis
A Early Phase 1 study testing Platelet Rich Plasma Injection in people with Knee Osteoarthritis, run by University of Toledo Health Science Campus at 1 site in United States.
Trial summary
In this study, the investigators will be performing intra-articular platelet rich plasma (PRP) injections for patients experiencing pain related to osteoarthritis of the knee. The investigators will be following clinical outcomes, and how they relate to concentrations of the PRP samples as well as following opioid and… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Knee Osteoarthritis
- What is being tested?
- Platelet Rich Plasma Injection
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 33 participants
- Where
- 1 siteUnited States
- Study dates
- 2 Dec 2021to 6 Nov 2023
- Phase
- Early Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Knee pain or swelling that has been present for greater than 3 months
- Knee pain greater than or equal to 3 out of 10 on the visual analog scale
- Previous radiological evidence (X-ray) of osteoarthritis
- Age 18 or older
Who cannot join
- Unable to provide consent for enrollment in the study
- Unable to avoid NSAIDs during the study (must stop 7 days before injection)
- Age less than 18
- Confirmed rheumatologic disease affecting the knee
- Significant trauma to the knee within 2 months that resulted in pain and/or swelling
- Active malignancy
Show all 21Show fewer
- Pregnancy
- Local injections to the knee within the last 3 months
- Previous knee surgery
- Other causes of knee pain (nerve pain, referred pain, infection of the knee joint, etc)
- History of platelet disorder
- History of thrombocytopenia
- History of severe anemia
- Severe cardiovascular disease
- Active infection
- Immunosuppression/immunodepression
- Currently taking anticoagulant/antiaggregant
- History of severe psychiatric disorder with psychosis
- Assistive device required for household ambulation within the previous 3 months
- Current IV drug user
- Additionally this study requires that, for safety purposes, enrolled patients live within 2 hours driving distance from the study site.
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Toledo, Health Science Campus
Toledo, Ohio, 43606
About this study
Official title: Platelet Rich Plasma in Knee Osteoarthritis: Establishing Clinical Guidelines to Predict and Maximize Outcomes
In this study, the investigators will be performing intra-articular platelet rich plasma (PRP) injections for patients experiencing pain related to osteoarthritis of the knee. The investigators will be following clinical outcomes, and how they relate to concentrations of the PRP samples as well as following opioid and emergency room utilization pre and post-injection.
Read the detailed description
Osteoarthritis is the most common form of arthritis and results in pain and stiffness in the affected area and, depending on the joint, can lead to difficulty with mobility as well as with performing basic activities of daily living. Conservative management of this condition includes physical therapy, activity modification, bracing, medications, and corticosteroid injections. When conservative treatment measures have failed, patients are often left with a choice between surgery, specifically total knee arthroplasty, and long-term pain medications, including opioid medications. In the midst of the opioid epidemic, physicians are seeking non-opioid alternatives for treating pain when other conservative treatments have failed. One such alternative treatment option is an intraarticular platelet rich plasma (PRP) injection.
The goal of PRP is to stimulate the body's existing regenerative capabilities. Since it is known that platelets play a key role in the body's natural healing processes, multiple clinical trials have been conducted to determine if injecting the affected joint with a platelet rich sample of their own blood promotes healing and thus improves pain and function for patients suffering from osteoarthritis. The studies involving PRP have yielded some promising outcomes, however much remains unknown about maximizing outcomes using this technology and a clear and defined protocol for this intervention does not yet exist.
This study aims to clarify some of the factors that affect clinical outcomes, such as platelet and cell concentrations (both in a serum sample and in the centrifuged PRP sample) and patient demographics. Determining if higher platelet counts in the serum sample are associated with better outcomes could potentially be used to prognosticate patient outcomes and candidacy for the procedure. The investigators are examining if PRP injections reduce the costly utilization of emergency room care and use of opioid pain medications before and after the procedure. The investigators are correlating how specific PRP cell and substance concentrations (platelet, monocytes, etc.) affect clinical outcomes as well. Ultimately, our hope is that this study will contribute to the growing evidence that PRP is a safe and effective treatment option for debilitating knee osteoarthritis, that it can improve pain and function and reduce opioid use and emergency room utilization.
This study takes place at the University of Toledo Physical Medicine and Rehabilitation outpatient clinic. 50 subjects is the minimum required to answer the aims of this study but 100 will be the target number for this study over the course of one year. Members of the study will be recruiting patients by informing physicians in the area about the study and requesting referrals to the clinic for anyone that might meet criteria and expresses interest in the study (focusing on orthopaedics, rheumatology, internal medicine and family medicine). Study members will also be sending out brochures to inform local health care providers as well as the surrounding public about the study, and information on how to arrange a clinic visit to evaluate candidacy. Brochures may be sent in the form of paper copies, FAX or email with an attached brochure. Additionally, the investigators will be informing patients already established with providers from our clinics about the study. These patients may be contacted at any of the physicians' sites of service.
Patients meeting criteria, including documented knee osteoarthritis and associated pain, will have pre and post intra-articular PRP injection visits where information will be gathered for future analysis. The patient will initially be asked to come in to the Physical Medicine and Rehabilitation clinic after expressing interest in being a part of the study. During that initial visit, the patient will be given the initial screening form with inclusion criteria and exclusion criteria and it will be determined if they are a candidate for the study. If they do meet the criteria for inclusion, they will then be informed of the risks and benefits of the study as well as what would be required of them should they choose to enroll. The patient will then be given the consent form. If the patient signs the consent form and would like to join the study, the investigators will schedule a follow-up visit which will include the injection. At that visit, the patients who are physically able to bear children will be screened for pregnancy with a urine pregnancy test. Once the pregnancy tests are confirmed negative, they, along with all other patients, will be given the initial surveys to fill out including a review of their past medical history, the Visual Analog Scale (VAS) pain score questionnaire, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Once the patients have filled these all out, they will undergo a blood draw of approximately 60 mL of their blood. Some of this sample will then be sent up to a lab where a complete blood count will be run. The remaining portion of the sample will be used for preparation of the platelet-rich plasma (PRP) using the Tortland Protocol developed by Paul Tortland, DO. After centrifugation, the PRP will be loaded into a syringe to be injected into the patient's knee. During preparation of the PRP, small samples will be obtained from the whole blood, PRP, and concentrated PRP while in the biosafety cabinet and analyzed for quantification of the cell types present and for characterization of the platelets (activation status, functionality assays). All immunology lab space stated on this protocol is BSL2 certified for use of untested human blood products. Once the concentrated PRP is obtained it will be brought back to the clinic for the injection.
While the patient is waiting for the platelet-rich plasma to be prepared, the Timed-Up-and-Go (TUG) test will be performed in the clinic to assess the patient's baseline functional ability prior to receiving the injection. Within 1 hour of the patient providing the sample of blood, the platelet-rich plasma sample will be brought back down from the lab. At that time, the patient will be brought to an exam room and the platelet-rich plasma injection will be performed on the affected knee under ultrasound-guidance. A trained physician will perform the injection using a 2.5 inch, 22-gauge needle and freeze spray will be used as a topical anesthetic for the 4-6 mL injection of platelet-rich plasma into the affected knee.
Post-procedure, the patient will be contacted to set-up a 4 week, 3 month, 6 month, and 1 year follow-up appointment at which time they will be brought back into the Physical Medicine and Rehabilitation clinic. At the 4 week appointment, the patient will be filling out a post-injection survey to explain if they experienced any adverse effects from the injection. In addition, the patient will have the opportunity at this appointment to ask any questions or voice any concerns that may have come up after the injection. At the 3 month, 6 month, and 1 year appointments, the patients will fill out post-injection surveys (Post-Injection Medical Survey) regarding Emergency Department and opioid medication utilization since the injection as well as updated VAS pain score and WOMAC questionnaires. The patient will also have the TUG test performed again during these appointments. After the 1 year follow-up, the patient will no longer be followed for purposes of this study. It is important to note that only treating physicians and nurses, medical students obtaining consent, and medical assistants rooming patients will see identifiable information. All other study related data or information will be de-identified using a number system. All study personnel will be informed that information, included protected health information, is confidential.
The results from the follow-up appointment will be compared to the patient's baseline results using the key code to match the de-identified information. These will results will all be compiled into the data collection spreadsheet. Descriptive statistics will be used to summarize the patients' clinical scores by demographic variables. Repeated measures ANOVA will be used to test for changes in VAS pain score, Timed Up and Go, Opioid utilization, Emergency Room Utilization and WOMAC questionnaires over time.
- Conditions
- Knee Osteoarthritis
- Being tested
- Platelet Rich Plasma Injection
- Keywords
- Platelet rich plasma, PRP, Knee osteoarthritis, Platelet concentration
- Medical subject headings
- Osteoarthritis, Knee
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Platelet Rich Plasma InjectionBiological
Also called PRP Injection
Research participants own blood will be used to prepare the platelet rich plasma injectate, which will be injected into the affected knee using ultrasound guidance.
| Study group | Role | What they receive |
|---|---|---|
| Participants receiving a platelet rich plasma injection | Experimental | All patients in the study will be receiving a platelet rich plasma injection, and we will be following their clinical outcomes Receives: Biological: Platelet Rich Plasma Injection |
What is being measured
The primary outcome is the main question the study is designed to answer.
Initial Pain outcomes
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain. These will be performed on the day of the platelet rich plasma injection, shortly before the procedure is performed.
Measured: Start of the study, pre-injection
Pain outcomes, 3 months
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Measured: 3 months
Pain outcomes, 6 months
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Measured: 6 months
Pain outcomes, 1 year
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Measured: 1 year
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), initial
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Measured: Start of the study, pre-injection
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), 3 months
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Measured: 3 months
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), 6 months
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Measured: 6 months
Functional status outcome using the Timed up and go (TUG) test, initial
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Measured: Start of the study, pre-injection
Functional status outcome using the Timed up and go (TUG) test, 3 months
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Measured: 3 months
Functional status outcome using the Timed up and go (TUG) test, 6 months
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Measured: 6 months
Functional status outcome using the Timed up and go (TUG) test, 1 year
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Measured: 1 year
Correlation of outcomes with whole blood and platelet rich plasma (PRP) concentrations
The investigators will be determining if there is a correlation between the pain (VAS) and all functional outcomes (WOMAC and TUG) listed above, and whole blood and platelet rich plasma (PRP) concentrations. For PRP concentrations the investigators will be assessing platelet (and platelet activation), monocyte, neutrophil levels using flow cytometry. For whole blood concentrations the investigators will be using the hospitals lab system. These concentrations will be measured once on the day of the injection for each participant.
Measured: Through study completion, 1 year
Secondary outcomes (9)
Opioid utilization, initial
Research participants will fill out a questionnaire before the platelet rich plasma injection asking about opioid use prior to the injection. The questionnaire is titled "Pre-Injection Medical Survey" and asks a question regarding what medications are used to treat knee pain (opioids are included in this list)
Measured: Start of the Study, pre-injection
Opioid utilization, 3 months
Research participants will fill out a questionnaire after the platelet rich plasma injection asking about opioid use after the injection. The questionnaire is titled "Post-Injection Medical Survey" and asks a question indicating whether or not the participant reduced their opioid use for knee pain following the injection.
Measured: 3 months
Opioid utilization, 6 months
Research participants will fill out a questionnaire after the platelet rich plasma injection asking about opioid use after the injection. The questionnaire is titled "Post-Injection Medical Survey" and asks a question indicating whether or not the participant reduced their opioid use for knee pain following the injection.
Measured: 6 months
Opioid utilization, 1 year
Research participants will fill out a questionnaire after the platelet rich plasma injection asking about opioid use after the injection. The questionnaire is titled "Post-Injection Medical Survey" and asks a question indicating whether or not the participant reduced their opioid use for knee pain following the injection.
Measured: 1 year
Emergency room utilization, initial
Research participants will fill out a questionnaire regarding emergency room utilization. The questionnaires are titled "Pre-Injection Medical Survey" and asks a questions regarding the number of emergency room visits the research participants have had for their knee pain
Measured: Start of the study, pre-injection
Emergency room utilization, 3 months
Research participants will fill out a questionnaire regarding emergency room utilization. The questionnaires is titled "Post-Injection Medical Survey" and asks a question regarding the number of emergency room visits the research participants have had since the injection
Measured: 3 months
Emergency room utilization, 6 months
Research participants will fill out a questionnaire regarding emergency room utilization. The questionnaires is titled "Post-Injection Medical Survey" and asks a question regarding the number of emergency room visits the research participants have had since the injection
Measured: 6 months
Emergency room utilization, 1 year
Research participants will fill out a questionnaire regarding emergency room utilization. The questionnaires is titled "Post-Injection Medical Survey" and asks a question regarding the number of emergency room visits the research participants have had since the injection
Measured: 1 year
Correlation of outcomes and patient demographics and co-morbidities
The investigators will be determining if there is a correlation between clinical outcomes (pain scores (VAS) and functional measures (WOMAC and TUG) as described above) and patient demographics (Age, height/weight (BMI), gender, smoking history, alcohol history, allergies, race/ethnicity) as well as co-morbidities (diabetes, CKD, hypertension, COPD, CHF, CAD, peripheral vascular disease, anemia with hemoglobin < 9 in the previous 12 months). This information will be gathered by utilizing a self administered questionnaire prior to the injection, and then correlating outcomes to these demographics and co-morbidities. The questionnaire is titled "Pre-Injection Medical Survey"
Measured: Through study completion, 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Oct 2021
- Study start2 Dec 2021
- Primary completion6 Nov 2023
- Study completion6 Nov 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (20)Papers the sponsor has linked to this study.
- Other trials for Knee OsteoarthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Early Phase 1
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- This study involves a single group, all of whom will be receiving the same treatment (platelet rich plasma injection into the knee)
- Masking
- None (open label)
- Enrolment
- 33 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Toledo Health Science Campus
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Christian Wuescher, University of Toledo Health Science Campus
- Investigators
- Christian Wuescher, MD, Principal investigator, University of ToledoAshley Schneider, MD, Study director, University of ToledoLeah Wuescher, PhD, Study director, University of Toledo
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05080075
- Sponsor's protocol ID
- 301106-UT
- Status last verified
- May 2024
- First submitted
- 17 Sep 2021
- Last updated
- 7 May 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2021 Jan;49(1):249-260. doi: 10.1177/0363546520909397. Epub 2020 Apr 17.
PubMed 32302218Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-346. doi: 10.1177/0363546516665809. Epub 2016 Oct 21.
PubMed 28146403Dernek B, Kesiktas FN, Duymus TM, Aydin T, Isiksacan N, Diracoglu D, Aksoy C. Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations. J Phys Ther Sci. 2017 May;29(5):896-901. doi: 10.1589/jpts.29.896. Epub 2017 May 16.
PubMed 28603367Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, Kon E, Filardo G. Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial. Am J Sports Med. 2019 Feb;47(2):347-354. doi: 10.1177/0363546518814532. Epub 2018 Dec 13.
PubMed 30545242Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E. Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial. Am J Sports Med. 2015 Jul;43(7):1575-82. doi: 10.1177/0363546515582027. Epub 2015 May 7.
PubMed 25952818Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2082-91. doi: 10.1007/s00167-011-1837-x. Epub 2011 Dec 28.
PubMed 22203046Ghai B, Gupta V, Jain A, Goel N, Chouhan D, Batra YK. [Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: double blind, randomized comparative study]. Braz J Anesthesiol. 2019 Sep-Oct;69(5):439-447. doi: 10.1016/j.bjan.2019.06.003. Epub 2019 Oct 28.
PubMed 31672420Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):958-965. doi: 10.1007/s00167-015-3705-6. Epub 2015 Aug 2.
PubMed 26233594Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. doi: 10.1007/s00167-009-0940-8. Epub 2009 Oct 17.
PubMed 19838676Lana JF, Macedo A, Ingrao ILG, Huber SC, Santos GS, Santana MHA. Leukocyte-rich PRP for knee osteoarthritis: Current concepts. J Clin Orthop Trauma. 2019 Oct;10(Suppl 1):S179-S182. doi: 10.1016/j.jcot.2019.01.011. Epub 2019 Jan 14.
PubMed 31700210Lin KY, Yang CC, Hsu CJ, Yeh ML, Renn JH. Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial. Arthroscopy. 2019 Jan;35(1):106-117. doi: 10.1016/j.arthro.2018.06.035.
PubMed 30611335O'Connell B, Wragg NM, Wilson SL. The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res. 2019 May;376(2):143-152. doi: 10.1007/s00441-019-02996-x. Epub 2019 Feb 13.
PubMed 30758709Park YB, Kim JH, Ha CW, Lee DH. Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association With Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial As Compared With Hyaluronic Acid. Am J Sports Med. 2021 Feb;49(2):487-496. doi: 10.1177/0363546520986867.
PubMed 33523756Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013 Feb;41(2):356-64. doi: 10.1177/0363546512471299. Epub 2013 Jan 8.
PubMed 23299850Raeissadat SA, Rayegani SM, Babaee M, Ghorbani E. The effect of platelet-rich plasma on pain, function, and quality of life of patients with knee osteoarthritis. Pain Res Treat. 2013;2013:165967. doi: 10.1155/2013/165967. Epub 2013 Dec 9.
PubMed 24386565
Study at a glance
From the registry record, last updated by the sponsor on 7 May 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Platelet Rich Plasma in Knee Osteoarthritis: Establishing Clinical Guidelines to Predict and Maximize Outcomes
- ClinicalTrials.gov ID
- NCT05080075
- Acronym / sponsor ID
- 301106-UT
- Conditions
- Knee Osteoarthritis
- Keywords
- Platelet rich plasma, PRP, Knee osteoarthritis, Platelet concentration
- Phase
- Early Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 33 participants (actual)
- Lead sponsor
- University of Toledo Health Science CampusUniversity, hospital or other
- Study start
- 2 Dec 2021 (actual)
- Primary completion
- 6 Nov 2023 (actual)
- Study completion
- 6 Nov 2023 (actual)
- First posted
- 15 Oct 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In this study, the investigators will be performing intra-articular platelet rich plasma (PRP) injections for patients experiencing pain related to osteoarthritis of the knee. The investigators will be following clinical outcomes, and how they relate to concentrations of the PRP samples as well as following opioid and emergency room utilization pre and post-injection.
Detailed description
Osteoarthritis is the most common form of arthritis and results in pain and stiffness in the affected area and, depending on the joint, can lead to difficulty with mobility as well as with performing basic activities of daily living. Conservative management of this condition includes physical therapy, activity modification, bracing, medications, and corticosteroid injections. When conservative treatment measures have failed, patients are often left with a choice between surgery, specifically total knee arthroplasty, and long-term pain medications, including opioid medications. In the midst of the opioid epidemic, physicians are seeking non-opioid alternatives for treating pain when other conservative treatments have failed. One such alternative treatment option is an intraarticular platelet rich plasma (PRP) injection.
The goal of PRP is to stimulate the body's existing regenerative capabilities. Since it is known that platelets play a key role in the body's natural healing processes, multiple clinical trials have been conducted to determine if injecting the affected joint with a platelet rich sample of their own blood promotes healing and thus improves pain and function for patients suffering from osteoarthritis. The studies involving PRP have yielded some promising outcomes, however much remains unknown about maximizing outcomes using this technology and a clear and defined protocol for this intervention does not yet exist.
This study aims to clarify some of the factors that affect clinical outcomes, such as platelet and cell concentrations (both in a serum sample and in the centrifuged PRP sample) and patient demographics. Determining if higher platelet counts in the serum sample are associated with better outcomes could potentially be used to prognosticate patient outcomes and candidacy for the procedure. The investigators are examining if PRP injections reduce the costly utilization of emergency room care and use of opioid pain medications before and after the procedure. The investigators are correlating how specific PRP cell and substance concentrations (platelet, monocytes, etc.) affect clinical outcomes as well. Ultimately, our hope is that this study will contribute to the growing evidence that PRP is a safe and effective treatment option for debilitating knee osteoarthritis, that it can improve pain and function and reduce opioid use and emergency room utilization.
This study takes place at the University of Toledo Physical Medicine and Rehabilitation outpatient clinic. 50 subjects is the minimum required to answer the aims of this study but 100 will be the target number for this study over the course of one year. Members of the study will be recruiting patients by informing physicians in the area about the study and requesting referrals to the clinic for anyone that might meet criteria and expresses interest in the study (focusing on orthopaedics, rheumatology, internal medicine and family medicine). Study members will also be sending out brochures to inform local health care providers as well as the surrounding public about the study, and information on how to arrange a clinic visit to evaluate candidacy. Brochures may be sent in the form of paper copies, FAX or email with an attached brochure. Additionally, the investigators will be informing patients already established with providers from our clinics about the study. These patients may be contacted at any of the physicians' sites of service.
Patients meeting criteria, including documented knee osteoarthritis and associated pain, will have pre and post intra-articular PRP injection visits where information will be gathered for future analysis. The patient will initially be asked to come in to the Physical Medicine and Rehabilitation clinic after expressing interest in being a part of the study. During that initial visit, the patient will be given the initial screening form with inclusion criteria and exclusion criteria and it will be determined if they are a candidate for the study. If they do meet the criteria for inclusion, they will then be informed of the risks and benefits of the study as well as what would be required of them should they choose to enroll. The patient will then be given the consent form. If the patient signs the consent form and would like to join the study, the investigators will schedule a follow-up visit which will include the injection. At that visit, the patients who are physically able to bear children will be screened for pregnancy with a urine pregnancy test. Once the pregnancy tests are confirmed negative, they, along with all other patients, will be given the initial surveys to fill out including a review of their past medical history, the Visual Analog Scale (VAS) pain score questionnaire, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Once the patients have filled these all out, they will undergo a blood draw of approximately 60 mL of their blood. Some of this sample will then be sent up to a lab where a complete blood count will be run. The remaining portion of the sample will be used for preparation of the platelet-rich plasma (PRP) using the Tortland Protocol developed by Paul Tortland, DO. After centrifugation, the PRP will be loaded into a syringe to be injected into the patient's knee. During preparation of the PRP, small samples will be obtained from the whole blood, PRP, and concentrated PRP while in the biosafety cabinet and analyzed for quantification of the cell types present and for characterization of the platelets (activation status, functionality assays). All immunology lab space stated on this protocol is BSL2 certified for use of untested human blood products. Once the concentrated PRP is obtained it will be brought back to the clinic for the injection.
While the patient is waiting for the platelet-rich plasma to be prepared, the Timed-Up-and-Go (TUG) test will be performed in the clinic to assess the patient's baseline functional ability prior to receiving the injection. Within 1 hour of the patient providing the sample of blood, the platelet-rich plasma sample will be brought back down from the lab. At that time, the patient will be brought to an exam room and the platelet-rich plasma injection will be performed on the affected knee under ultrasound-guidance. A trained physician will perform the injection using a 2.5 inch, 22-gauge needle and freeze spray will be used as a topical anesthetic for the 4-6 mL injection of platelet-rich plasma into the affected knee.
Post-procedure, the patient will be contacted to set-up a 4 week, 3 month, 6 month, and 1 year follow-up appointment at which time they will be brought back into the Physical Medicine and Rehabilitation clinic. At the 4 week appointment, the patient will be filling out a post-injection survey to explain if they experienced any adverse effects from the injection. In addition, the patient will have the opportunity at this appointment to ask any questions or voice any concerns that may have come up after the injection. At the 3 month, 6 month, and 1 year appointments, the patients will fill out post-injection surveys (Post-Injection Medical Survey) regarding Emergency Department and opioid medication utilization since the injection as well as updated VAS pain score and WOMAC questionnaires. The patient will also have the TUG test performed again during these appointments. After the 1 year follow-up, the patient will no longer be followed for purposes of this study. It is important to note that only treating physicians and nurses, medical students obtaining consent, and medical assistants rooming patients will see identifiable information. All other study related data or information will be de-identified using a number system. All study personnel will be informed that information, included protected health information, is confidential.
The results from the follow-up appointment will be compared to the patient's baseline results using the key code to match the de-identified information. These will results will all be compiled into the data collection spreadsheet. Descriptive statistics will be used to summarize the patients' clinical scores by demographic variables. Repeated measures ANOVA will be used to test for changes in VAS pain score, Timed Up and Go, Opioid utilization, Emergency Room Utilization and WOMAC questionnaires over time.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- This study involves a single group, all of whom will be receiving the same treatment (platelet rich plasma injection into the knee)
| Arm | Type | Receives |
|---|---|---|
| Participants receiving a platelet rich plasma injection | Experimental | Biological: Platelet Rich Plasma InjectionAll patients in the study will be receiving a platelet rich plasma injection, and we will be following their clinical outcomes |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Knee pain or swelling that has been present for greater than 3 months
- Knee pain greater than or equal to 3 out of 10 on the visual analog scale
- Previous radiological evidence (X-ray) of osteoarthritis
- Age 18 or older
Key exclusion criteria (21 listed)
- Unable to provide consent for enrollment in the study
- Unable to avoid NSAIDs during the study (must stop 7 days before injection)
- Age less than 18
- Confirmed rheumatologic disease affecting the knee
- Significant trauma to the knee within 2 months that resulted in pain and/or swelling
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Platelet Rich Plasma InjectionAlso: PRP InjectionResearch participants own blood will be used to prepare the platelet rich plasma injectate, which will be injected into the affected knee using ultrasound guidance. | Biological | Participants receiving a platelet rich plasma injection |
Primary outcome
Initial Pain outcomes
Time frame: Start of the study, pre-injection
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain. These will be performed on the day of the platelet rich plasma injection, shortly before the procedure is performed.
Pain outcomes, 3 months
Time frame: 3 months
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Pain outcomes, 6 months
Time frame: 6 months
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Pain outcomes, 1 year
Time frame: 1 year
The investigators will have patients rate pain levels using the visual analog scale (VAS), which measures pain on a 1-10 point scale. A score of 10 indicates the highest level of pain.
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), initial
Time frame: Start of the study, pre-injection
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), 3 months
Time frame: 3 months
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Functional status outcomes using the Western Ontario and McMaster University Arthritis Index (WOMAC), 6 months
Time frame: 6 months
Research participants will fill out a the WOMAC questionnaire. The WOMAC is a self administered questionnaire consisting of 24 items divided into subscales including pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse pain, stiffness and functional limitations.
Functional status outcome using the Timed up and go (TUG) test, initial
Time frame: Start of the study, pre-injection
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Functional status outcome using the Timed up and go (TUG) test, 3 months
Time frame: 3 months
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Functional status outcome using the Timed up and go (TUG) test, 6 months
Time frame: 6 months
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Functional status outcome using the Timed up and go (TUG) test, 1 year
Time frame: 1 year
The investigators will have participants perform a TUG test. The TUG test is an investigator administered test measuring the time it takes research participants to stand from a chair, walk three meters, turn around, walk back and sit down. It is timed in seconds, and a longer time to perform this task indicates a lower level of function.
Correlation of outcomes with whole blood and platelet rich plasma (PRP) concentrations
Time frame: Through study completion, 1 year
The investigators will be determining if there is a correlation between the pain (VAS) and all functional outcomes (WOMAC and TUG) listed above, and whole blood and platelet rich plasma (PRP) concentrations. For PRP concentrations the investigators will be assessing platelet (and platelet activation), monocyte, neutrophil levels using flow cytometry. For whole blood concentrations the investigators will be using the hospitals lab system. These concentrations will be measured once on the day of the injection for each participant.
9 secondary outcomes
Opioid utilization, initial
Time frame: Start of the Study, pre-injection
Opioid utilization, 3 months
Time frame: 3 months
Opioid utilization, 6 months
Time frame: 6 months
Opioid utilization, 1 year
Time frame: 1 year
Emergency room utilization, initial
Time frame: Start of the study, pre-injection
Emergency room utilization, 3 months
Time frame: 3 months
Emergency room utilization, 6 months
Time frame: 6 months
Emergency room utilization, 1 year
Time frame: 1 year
Correlation of outcomes and patient demographics and co-morbidities
Time frame: Through study completion, 1 year
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 May 2024.
- Background: PubMed 32302218Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2021 Jan;49(1):249-260. doi: 10.1177/0363546520909397. Epub 2020 Apr 17.
- Background: PubMed 28146403Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-346. doi: 10.1177/0363546516665809. Epub 2016 Oct 21.
- Background: PubMed 28603367Dernek B, Kesiktas FN, Duymus TM, Aydin T, Isiksacan N, Diracoglu D, Aksoy C. Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations. J Phys Ther Sci. 2017 May;29(5):896-901. doi: 10.1589/jpts.29.896. Epub 2017 May 16.
- Background: PubMed 30545242Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, Kon E, Filardo G. Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial. Am J Sports Med. 2019 Feb;47(2):347-354. doi: 10.1177/0363546518814532. Epub 2018 Dec 13.
- Background: PubMed 25952818Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E. Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial. Am J Sports Med. 2015 Jul;43(7):1575-82. doi: 10.1177/0363546515582027. Epub 2015 May 7.
- Background: PubMed 22203046Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2082-91. doi: 10.1007/s00167-011-1837-x. Epub 2011 Dec 28.
- Background: PubMed 31672420Ghai B, Gupta V, Jain A, Goel N, Chouhan D, Batra YK. [Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: double blind, randomized comparative study]. Braz J Anesthesiol. 2019 Sep-Oct;69(5):439-447. doi: 10.1016/j.bjan.2019.06.003. Epub 2019 Oct 28.
- Background: PubMed 26233594Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):958-965. doi: 10.1007/s00167-015-3705-6. Epub 2015 Aug 2.
- Background: PubMed 19838676Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. doi: 10.1007/s00167-009-0940-8. Epub 2009 Oct 17.
- Background: PubMed 31700210Lana JF, Macedo A, Ingrao ILG, Huber SC, Santos GS, Santana MHA. Leukocyte-rich PRP for knee osteoarthritis: Current concepts. J Clin Orthop Trauma. 2019 Oct;10(Suppl 1):S179-S182. doi: 10.1016/j.jcot.2019.01.011. Epub 2019 Jan 14.
- Background: PubMed 30611335Lin KY, Yang CC, Hsu CJ, Yeh ML, Renn JH. Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial. Arthroscopy. 2019 Jan;35(1):106-117. doi: 10.1016/j.arthro.2018.06.035.
- Background: PubMed 30758709O'Connell B, Wragg NM, Wilson SL. The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res. 2019 May;376(2):143-152. doi: 10.1007/s00441-019-02996-x. Epub 2019 Feb 13.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Christian Wuescher, MD principal investigator
University of Toledo
Ashley Schneider, MD study director
University of Toledo
Leah Wuescher, PhD study director
University of Toledo
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Early Phase 1 study testing Platelet Rich Plasma Injection in people with Knee Osteoarthritis, run by University of Toledo Health Science Campus at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 21 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 May 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Initial Pain outcomes (time frame: Start of the study, pre-injection). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05080075, which also lists 20 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 May 2024.