Purpose
To perform a systematic review of the outcomes of platelet-rich plasma (PRP) injections
as an in-office procedure versus surgical treatment for recalcitrant greater trochanteric
pain syndrome (GTPS).
Methods
The MEDLINE and Embase databases were searched in June 2019 following the Preferred
Reporting Items for Systematic Reviews and Meta-analyses statement. Clinical studies
on patients with recalcitrant GTPS treated with PRP or surgery were included. Demographic
characteristics, patient-reported outcomes (PROs), and complications were compared.
A qualitative analysis using the Methodological Index for Non-randomized Studies and
Cochrane Risk of Bias Tool scores was performed.
Results
A total of 5 PRP and 5 surgery studies met the inclusion criteria, contributing 94
and 185 patients, respectively. The mean follow-up time was shorter for the PRP studies
(range, 2-26 months) than with surgery (range, 12-70 months). The mean Methodological
Index for Non-randomized Studies scores for the PRP and surgery groups were 11.25
and 11.4, respectively, and the only randomized trial had a low risk of bias. Two
studies in the PRP group (n = 56) reported improvements in the modified Harris Hip
Score at final follow-up (from 53.8 to 82.6 and from 56.7 to 74.2). The other PRP
studies reported improvements using other measures. In the surgery group, 2 studies
reported improvements in the Harris Hip Score (from 53.0 to 80 and from 53.3 to 88)
whereas 3 used unique PROs (Oxford score, from 20.4 to 37.3; modified Harris Hip Score,
from 54.9 to 76.2; and Merle d’Aubigné and Postel score, from 10.9 to 16.7). Although
significant improvement was reported in all studies included, PRP showed a large effect
size whereas surgery showed a moderate to large effect size. No major complications
were associated with PRP treatment; however, the surgery group reported a higher rate
of complications including recurrent external snapping hip, retears resulting from
falls, trochanteric fracture, venous thrombosis, and wound-related problems.
Conclusions
Both PRP and surgical intervention for the treatment of recalcitrant GTPS showed statistically
and clinically significant improvements based on PROs. Although not covered by most
medical insurance companies, PRP injections for recalcitrant GTPS provides an effective
and safe alternative after failed physical therapy. If surgery is indicated, endoscopy
is safer than the open technique.
Level of Evidence
Level IV, systematic review of Level I to IV studies.
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Article info
Publication history
Published online: December 24, 2019
Accepted:
September 25,
2019
Received:
March 26,
2019
See commentary on page 889Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.C.L. receives grant and nonfinancial support (food and beverage, travel, and lodging) from Arthrex and nonfinancial support from Iroko (food and beverage), Medwest (education), Smith & Nephew (education), Stryker (food and beverage, travel, and lodging), Vericel (food and beverage), and Zimmer Biomet (food and beverage). B.G.D. reports grants to the American Orthopedic Foundation from Arthrex, Medacta, and Stryker; receives consulting fees from Adventist Hinsdale Hospital and Amplitude; receives research support, education support, consulting fees, royalties, and speaking fees from Arthrex; receives royalties from DJO Global and Orthomerica; receives research support from Kaufman Foundation; receives research support and consulting fees from Medacta and Pacira Pharmaceuticals; receives research support, consulting fees, and royalties from Stryker; and receives education support from Breg. In addition, the American Orthopedic Foundation pays staff and expenses related to all research. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2019 by the Arthroscopy Association of North America
