Abstract:

Objective  To investigate the therapeutic effect and safety of debridement under arthroscopy combined with platelet-rich plasma(PRP) in patients with moderate to severe knee osteoarthritis(KOA), their impact on joint inflammation and oxidative stress and their correlation.

Methods  A total of 64 patients with moderate and severe KOA were selected as the research subjects. According to the treatment methods, they were divided into observation group and control group, with 32 cases in each group. The observation group was treated with arthroscopic debridement combined with PRP. The control group was treated with arthroscopic debridement. Visual analogue scale(VAS) score was used to evaluate the pain relief before operation, and at 3 months and 12 months after operation. Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) was used to evaluate the function of knee joint. The changes of tumor necrosis factor-α(TNF-α), interleukin-8(IL-8), superoxide dismutase(SOD) and nitric oxide(NO) were observed before and at 12 months after operation. The complications of the two groups were recorded. 

Results  All 64 patients were followed up for 12-14 months, with a mean of(13.0±0.82) months. There were significant differences of interaction between groups, time points, time points between groups before operation, and at 3 months and 12 months after operation(P＜0.05). There were significant differences of interaction between groups, time points, and time points between groups with respect to WOMAC scores before operation, and at 3 and 12 months after operation(P＜0.05). At 12 months after operation, the levels of TNF-α, IL-8 and NO in the observation group were lower than those in the control group, while SOD was higher than that in the control group. In the observation group, the levels of TNF-α, IL-8 and NO were lower than those before operation, and SOD was higher than that before operation, with significant difference(P＜0.05). There was no significant difference before and after operation in the control group(P＞0.05). There was 1 case of lower limb swelling, and 1 case of incision infection in the observation group, as well as 2 cases of lower limb swelling, 1 case of incision infection and 1 case of thromboembolism in the control group. After corresponding treatment, the symptoms and signs disappeared. There was no significant difference in the incidence of complications between the two groups(χ2=0.136, P＞0.05).

Conclusion  Compared with arthroscopic debridement, arthroscopic debridement combined with PRP in the treatment of moderate to severe KOA is more effective in relieving knee joint pain and improving knee function, and the incidence of complications is also lower. This may be related to the fact that arthroscopic debridement combined with PRP can reduce inflammation and oxidative stress in the joint cavity.

Key words: osteoarthritis, knee, debridement under arthroscopy, platelet-rich plasma