Intraarticular ACP therapy for severe osteoarthritis

AIMS AND OBJECTIVES: Knee osteoarthritis is a major problem in the European population from a medical as well as from an economical point of view. Surgical treatment implicates a long absence from work. Alternative treatments postponing major surgery to the age of retirement from work would be beneficial. The aim of the study is to evaluate the therapeutic value of intraarticular ACP for this purpose. MATERIALS AND METHODS: Patients with severe knee osteoarthritis qualifying for knee replacement but not yet ready for major surgery are treated by four intraarticular injections of ACP (double syringe system, Arthrex). Injections are performed once a week. Lequesne and VAS score before and four weeks after treatment are evaluated. Two years after treatment patients are contacted via telephone. Those not having had a knee replacement or other major surgery in the meantime and not requiring pain killers in daily living are considered as mid term success. RESULTS: As far 164 patients were treated, 69 men and 95 women aged 64.0 +/- 10.8 years. 23 (14.0%) showed no effect. Lequesne score was 11.6 +/- 3.4 before and 3.9 +/- 2.7 (p<0.001) after treatment. Regarding the Lequesne classes 105 patients were classified to the extremely severe and severe group before treatment whereas after treatment 149 patients were classified as mild or moderate (p<0.001). Consequently, the VAS score dropped from 6.4 +/- 1.9 before to 2.2 +/- 1.5 after treatment (p<0.001). Two years after treatment 139 patients were contacted (no one lost for follow up). 93(66.9%) of them being classified as mid term success (no knee replacement, no necessity of pain killers). CONCLUSION: Intraarticular ACP therapy shows excellent short term results reducing significantly the Lequesne score and class as well as the VAS pain score. Furthermore the majority of the patients does not require major surgery for another two years, thus often postponing the time of surgery to the age of retirement and avoiding higher costs from incapacity to work.