Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Winter, R.
Injection of platelet rich plasma and autologous fat into the thumb carpometacarpal joint for the evaluation of their potential filling effect in patients with osteoarthritis.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2022. pp.
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Friesenbichler Jörg
- Girsch Werner
- Kamolz Lars-Peter
- Altmetrics:
- Abstract:
- Abstract Background With a prevalence of 7-17% in men and 15-27% in women, rhizarthrosis is a common disorder of the hand. Because surgical therapies such as resection arthroplasty or endoprosthesis implantation permanently alter the anatomy of the hand, the indication for surgery should not be made frivolously. Infiltration therapies represent an alternative therapeutic concept. In recent years, autologous substances such as autologous fat and also platelet-rich plasma (PRP) have been increasingly used for infiltration into the thumb saddle joint in patients with carpometracarpal arthritis of the thumb. In this thesis, a systematic review with metaanalysis was performed to evaluate the evidence in this area. In this metaanalysis, all studies dealing with the therapy of carpometracarpal arthritis of the thumb with autologous substances were analyzed. Further, the first prospective randomized, blinded and placebo controlled trial was conducted with the aim to evaluate the therapeutic effect of autologous fat & PRP as a filling material in the thumb saddle joint. Material & Methods A systhematic review and metanalsysis were performed using PRISMA criteria. The available literature in the Cochrane Library, Pubmed Central, Embase, Pubmed, and Web of Science was searched until February 1, 2021. Further, in the prospective randomized, blinded, and placebo-controlled trial, patients between the ages of 18 and 90 years with carpometacarpal arthritis of the thumb were assigned to 4 groups after stratified randomization. Depending on group allocation, patients were injected with 1.5 ml of autologous fat, PRP; autologous fat & PRP; or saline 0.9% into the thumb saddle joint under unilateral blinding. Follow-up visits to collect VAS score, medical examination, physiotherapy examination, SF-36 questionnaire, Quick-Dash questionnaire were performed after 2 weeks, 1 month, 2 months and 3 months. After a mean follow-up of 24 months, a final telephone visit was performed and the VAS score was queried again. Results Eight studies were included in the metaanalysis. Pain relief and reduction of the (Quick-) DASH score and thus improvement of upper extremity function were found for autologous substances. In the prospective randomized, blinded, and placebo-controlled trial 95 patients were randomized and infiltrated after blinding. Group allocation was as follows: 21 patients were in the control group and received saline 0.9%, 25 patients received autologous fat, 24 patients received PRP, and 25 patients received the combination of autologous fat & PRP. All groups showed a reduction in VAS score after infiltration. The most significant reduction in VAS score was seen in the autologous fat & PRP group, followed by the autologous fat group, the placebo group, and the PRP group. Autologous fat & PRP in combination showed significantly greater pain reduction than the placebo group (p=0.003). This group was also the only one to show a clinically relevant decreased Quick-Dash Score compared to the placebo group. Furthermore, the physical component summary of the SF-36 questionnaire was significantly higher in the autologous fat & PRP group than in the placebo group (p=0.016). At a final telephone visit, after a mean follow-up of 24 months, a reduction in VAS score at motion and rest was still observed compared to baseline. Furthermore, the autologous fat &PRP group showed the greatest reduction in pain. In conclusion, autologous fat&PRP as a filler substance into the thumb saddle joint leads to a significant reduction in pain in patients with carpometracarpal arthritis of the thumb. This therapy method is a good alternative to infiltration with glucocorticoids.