Original Article| Volume 31, ISSUE 10, P1886-1892, October 2015

Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up


      The objective of this study is to evaluate the clinical and immunologic effects of intra-articular doses of platelet-rich plasma (PRP) in arthroscopic hip surgery for femoroacetabular impingement.


      Preoperatively, patients were randomized either to receive an intra-articular injection of PRP (group I, n = 30) or not to receive PRP (group II, n = 27) at the end of hip arthroscopic surgery. To evaluate the clinical outcome and follow-up, we used the modified Harris Hip Score (mHHS) 3, 6, and 24 months after surgery. Pain was evaluated using a visual analog scale 24 hours, 48 hours, 3 months, and 6 months after surgery. The radiologic outcome was analyzed using radiographs and magnetic resonance imaging (MRI) obtained before surgery and 6 months after surgery. Labral integration and joint effusion were evaluated with MRI at 6 months. For statistical analysis, an independent t test and the Wilcoxon rank sum test were used (P < .05 was considered statistically significant).


      The visual analog scale score 48 hours after surgery was 3.04 in group I compared with 5.28 in group II (P < .05). At the 3-month follow-up, the mHHS was 91.79 in group I versus 90.97 in group II (P = .65). At the 24-month follow-up, the mHHS was 93.41 in group I (P = .56) versus 92.32 in group II (P = .52). At the 6-month follow-up, MRI showed no effusion in 36.7% of patients in group I versus 21.1% of patients in group II (P = .013). Regarding labral integration, no statistical differences were observed between the groups (P = .76).


      In this randomized study, PRP resulted in lower postoperative pain scores at 48 hours and fewer joint effusions at 6 months. These findings suggest that PRP may have a benefit regarding postoperative inflammation; however, the long-term clinical benefit is unclear.

      Level of Evidence

      Level II, lesser-quality randomized controlled trial.
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        • Dahlgren L.A.
        • Mohammed H.O.
        • Nixon A.J.
        Temporal expression of growth factors and matrix molecules in healing tendon lesions.
        J Orthop Res. 2005; 23: 84-92
        • Fenwick S.A.
        • Curry V.
        • Harrall R.L.
        • Hazleman B.L.
        • Hackney R.
        • Riley G.P.
        Expression of transforming growth factor-beta iso-forms and their receptors in chronic tendinosis.
        J Anat. 2001; 199: 231-240
        • Tsubone T.
        • Moran S.L.
        • Amadio P.C.
        • Zhao C.
        • An K.N.
        Expression of growth factors in canine flexor tendon after laceration in vivo.
        Ann Plast Surg. 2004; 53: 393-397
        • Orrego M.
        • Larrain C.
        • Rosales J.
        • et al.
        Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel.
        Arthroscopy. 2008; 24: 1373-1380
        • Radice F.
        • Yánez R.
        • Gutiérrez V.
        • Rosales J.
        • Pinedo M.
        Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.
        Arthroscopy. 2010; 26: 50-57
        • Lopez-Vidriero E.
        • Goulding K.A.
        • Simon D.A.
        • Sanchez M.
        • Johnson D.H.
        The use of platelet-rich plasma in arthroscopy and sports medicine: Optimizing the healing environment.
        Arthroscopy. 2010; 26: 269-278
        • Dragoo J.L.
        • Braun H.J.
        • Durham J.L.
        • et al.
        Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons.
        Am J Sports Med. 2012; 40: 1274-1281
        • Anitua E.
        • Andía I.
        • Sanchez M.
        • et al.
        Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture.
        J Orthop Res. 2005; 23: 281-286
        • De Mos M.
        • van der Windt A.E.
        • Jahr H.
        • et al.
        Can platelet-rich plasma enhance tendon repair? A cell culture study.
        Am J Sports Med. 2008; 36: 1171-1178
        • Harris N.L.
        • Huffer W.E.
        • von Stade E.
        • et al.
        The effect of platelet-rich plasma on normal soft tissues in the rabbit.
        J Bone Joint Surg Am. 2012; 94: 786-793
        • Schnabel L.V.
        • Mohammed H.O.
        • Miller B.J.
        • et al.
        Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons.
        J Orthop Res. 2007; 25: 230-240
        • Lyras D.N.
        • Kazakos K.
        • Georgiadis G.
        • et al.
        Does a single application of PRP alter the expression of IGF-I in the early phase of tendon healing?.
        J Foot Ankle Surg. 2011; 50: 276-282
        • Boswell S.G.
        • Cole B.J.
        • Sundman E.A.
        • Karas V.
        • Fortier L.A.
        Platelet-rich plasma: A milieu of bioactive factors.
        Arthroscopy. 2012; 28: 429-439
        • Mishra A.
        • Harmon K.
        • Woodall J.
        • Vieira A.
        Sports medicine applications of platelet rich plasma.
        Curr Pharm Biotechnol. 2012; 13: 1185-1195
        • Virchenko O.
        • Fahlgren A.
        • Skoglund B.
        • Aspenberg P.
        CDMP-2 injection improves early tendon healing in a rabbit model for surgical repair.
        Scand J Med Sci Sports. 2005; 15: 260-264
        • Murray D.H.
        • Kubiak E.N.
        • Jazrawi L.M.
        • et al.
        The effect of cartilage-derived morphogenetic protein 2 on initial healing of a rotator cuff defect in a rat model.
        J Shoulder Elbow Surg. 2007; 16: 251-254
        • Eppley B.
        • Wodell J.
        • Higgins J.
        Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing.
        Plast Reconstr Surg. 2004; 114: 1502-1508
        • Barber F.A.
        Platelet-rich plasma for rotator cuff repair.
        Sports Med Arthrosc. 2013; 21: 199-205
        • Peerbooms J.C.
        • Colaris J.W.
        • Hakkert A.A.
        • et al.
        No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study.
        Int Orthop. 2012; 36: 2113-2119
        • DeLong J.M.
        • Russell R.P.
        • Mazzocca A.D.
        Platelet-rich plasma: The PAW classification system.
        Arthroscopy. 2012; 28: 998-1009
        • Kaux J.F.
        • Le Goff C.
        • Renouf J.
        • et al.
        Comparison of the platelet concentrations obtained in platelet-rich plasma (PRP) between the GPS™ II and GPS™ III systems.
        Pathol Biol (Paris). 2011; 59: 275-277
        • Philippon M.J.
        • Schenker M.L.
        • Briggs K.K.
        • Kuppersmith D.A.
        • Maxwell R.B.
        • Stubbs A.J.
        Revision hip arthroscopy.
        Am J Sports Med. 2007; 35: 1918-1921
        • Mardones R.M.
        • Gonzalez C.
        • Chen Q.
        • Zobitz M.
        • Kaufman K.R.
        • Trousdale R.T.
        Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection.
        J Bone Joint Surg Am. 2005; 87: 273-279
        • Anitua E.
        • Muruzabal F.
        • Alcalde I.
        • Merayo-Lloves J.
        • Orive G.
        Plasma rich in growth factors (PRGF-Endoret) stimulates corneal wound healing and reduces haze formation after PRK surgery.
        Exp Eye Res. 2013; 115: 153-161
        • Hall M.P.
        • Band P.A.
        • Meislin R.J.
        • Jazrawi L.M.
        • Cardone D.A.
        Platelet-rich plasma: Current concepts and application in sports medicine.
        J Am Acad Orthop Surg. 2009; 17: 602-608
        • Lyras D.N.
        • Kazakos K.
        • Verettas D.
        • et al.
        The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing.
        Foot Ankle Int. 2009; 30: 1101-1106
        • Visser L.C.
        • Arnoczky S.P.
        • Caballero O.
        • Egerbacher M.
        Platelet-rich fibrin constructs elute higher concentrations of transforming growth factor-b1 and increase tendon cell proliferation over time when compared to blood clots: A comparative in vitro analysis.
        Vet Surg. 2010; 39: 811-817
        • Werner S.
        • Grose R.
        Regulation of wound healing by growth factors and cytokines.
        Physiol Rev. 2003; 83: 835-870
        • Kajikawa Y.
        • Morihara T.
        • Sakamoto H.
        • et al.
        Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing.
        J Cell Physiol. 2008; 215: 837-845
        • Bosch G.
        • Moleman M.
        • Barneveld A.
        • van Weeren P.R.
        • van Schie H.T.M.
        The effect of platelet-rich plasma on the neo-vascularization of surgically created equine superficial digital flexor tendon lesions.
        Scand J Med Sci Sports. 2011; 21: 554-561
        • Tohidnezhad M.
        • Varoga D.
        • Wruck C.J.
        • et al.
        Platelet-released growth factors can accelerate tenocyte proliferation and activate the anti-oxidant response element.
        Histochem Cell Biol. 2011; 135: 453-460
        • Jo C.H.
        • Kim J.E.
        • Yoon K.S.
        • Shin S.
        Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears.
        Am J Sports Med. 2012; 40: 1035-1045
        • Guler O.
        • Mutlu S.
        • Isyar M.
        • Seker A.
        • Kayaalp M.E.
        • Mahirogullari M.
        Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients.
        Eur J Orthop Surg Traumatol. 2015; 25: 509-513
        • Battaglia M.
        • Guaraldi F.
        • Vannini F.
        • et al.
        Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis.
        Orthopedics. 2013; 36: e1501-e1508
        • Guler O.
        • Mutlu S.
        • Isyar M.
        • et al.
        Normal values of the hip joint for the evaluation of X-rays in children and adults.
        Clin Orthop Relat Res. 1976; 119: 39-47
        • Notzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560