Platelet-rich plasma or PRP is probably the most popular orthobiologic treatment nowadays. Advocates of PRP claim that it can heal and promote healing of various orthopedic conditions. None of these claims are, however, backed by good clinical evidence. Some studies show that PRP is almost a miracle drug, but these studies often have major methodological concerns and unreliable results. Then there is an increasing number of studies showing that PRP is no better than placebo. And yet again, we have another such study!
The HIPPO trial, published yesterday by Atchia et al., investigated the benefit of PRP in treating greater trochanter pain syndrome or “trochanteric bursitis.” They did a placebo-controlled study and concluded:
This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition.
It was best that they did not use Arthrex’s PRP system. It produces PRP with a platelet count twice that in the blood. Advocates of PRP say that this ratio should be at least 3, preferably 5. Of course, no credible research supports this claim. I tried to determine the platelet count for the system used in the study as mentioned above. This was the only reference I could find: http://www.seawonmt.com/wp-content/uploads/2017/09/SW-PRP-Catalogue.pdf. It may very well be that the system used in the HIPPO trial produces PRP with a platelet count five times that in the blood!
Orthobiologics remain a popular treatment for chronic diseases. However, high-quality evidence does not support its use, and hopefully, we will see more placebo-controlled trials in the near future.
