Platelet-rich therapy in the treatment of patients with hip fractures: a single centre, parallel group, participant-blinded, randomised controlled trial
Open Access
- 25 June 2013
- Vol. 3 (6), e002583
- https://doi.org/10.1136/bmjopen-2013-002583
Abstract
Objective To quantify and draw inferences on the clinical effectiveness of platelet-rich therapy in the management of patients with a typical osteoporotic fracture of the hip. Design Single centre, parallel group, participant-blinded, randomised controlled trial. Setting UK Major Trauma Centre. Participants 200 of 315 eligible patients aged 65 years and over with any type of intracapsular fracture of the proximal femur. Patients were excluded if their fracture precluded internal fixation. Interventions Participants underwent internal fixation of the fracture with cannulated screws and were randomly allocated to receive an injection of platelet-rich plasma into the fracture site or not. Main outcome measures Failure of fixation within 12 months, defined as any revision surgery. Results Primary outcome data were available for 82 of 101 and 78 of 99 participants allocated to test and control groups, respectively; the remainder died prior to final follow-up. There was an absolute risk reduction of 5.6% (95% CI −10.6% to 21.8%) favouring treatment with platelet-rich therapy (χ2 test, p=0.569). An adjusted effect estimate from a logistic regression model was similar (OR=0.71, 95% CI 0.36 to 1.40, z test; p=0.325). There were no significant differences in any of the secondary outcome measures excepting length of stay favouring treatment with platelet-rich therapy (median difference 8 days, Mann-Whitney U test; p=0.03). The number and distribution of adverse events were similar. Estimated cumulative incidence functions for the competing events of death and revision demonstrated no evidence of a significant treatment effect (HR 0.895, 95% CI 0.533 to 1.504; p=0.680 in favour of platelet-rich therapy). Conclusions No evidence of a difference in the risk of revision surgery within 1 year in participants treated with platelet-rich therapy compared with those not treated. However, we cannot definitively exclude a clinically meaningful difference. Trial registration Current Controlled Trials, ISRCTN49197425, http://www.controlled-trials.com/ISRCTN49197425This publication has 16 references indexed in Scilit:
- Platelet rich therapies for long bone healing in adultsEmergencias, 2012
- Platelet-Rich Plasma Therapy: A Systematic Literature Review and Evidence for Clinical UseThe Physician and Sportsmedicine, 2011
- The use of platelet-rich plasma in bone reconstruction therapyBiomaterials, 2009
- Platelet-rich Plasma: Current Concepts and Application in Sports MedicineJournal of the American Academy of Orthopaedic Surgeons, 2009
- The biology of platelet-rich plasma and its application in trauma and orthopaedic surgeryThe Journal of Bone and Joint Surgery. British volume, 2009
- Platelet-rich plasma preparation using three devices: Implications for platelet activation and platelet growth factor releaseGrowth Factors, 2006
- Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly: A randomised trial of 455 patientsThe Journal of Bone and Joint Surgery. British volume, 2002
- Modeling Valuations for EuroQol Health StatesMedical Care, 1997
- Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.The Journal of Bone & Joint Surgery, 1994
- Garden grading of intracapsular fractures: meaningful or misleading?Injury, 1993