Could The Use Of Platelet-Rich Plasma Be A Better Treatment Option For Avascular Necrosis Of The Femoral Head? A Systematic Review

Background:Recent years,the innovation of ‘regenerative medicine' in the field of orthopaedics has offered an unconditional solution and hope to deal with several chronic diseases and disorders which are beyond treatment.Platelet-rich plasma(PRP),one of the main biologics in regenerative medicine could be an emerging milestone for orthopaedics related injuries and diseases including compromised clinical condition such as avascular necrosis of the femoral head(AVNFH).PRP,a blood derivative with a higher platelet concentrate than whole blood when activated releases biologically active multitude of autologous growth factors(GFs)and bioactive proteins,which have been found to be potentially effective for promoting tissue healing and bone regeneration.Regardless of many conventional surgical treatment paradigms like surgical core decompression,total hip arthroplasty;the quest for reliable nonsurgical treatment method to treat the disease,permitting fast recovery to normal function,and moreover preserving the hip joint is highly desirable.Therefore,this systematic review here intended to present the efficacy of PRP therapy,an emerging non-invasive novel treatment modality,simply with an injective procedure for the treatment of AVNFH,a common but serious pathologic progressive disease that leads a normal life to a disabling condition if not treated appropriately in an early stage.Objective:The purpose of this systematic review was to analyze the available evidence on the clinical application of platelet-rich plasma(PRP)for determining whether,and under what circumstances the use of this emerging non-invasive approach is a better treatment option for avascular necrosis of the femoral head(AVNFH).Methods:The systematic search was carried out in accordance with PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)mainly via Pubmed and Google search databases.The search strategy was conducted through January 2017 and restricted to English language manuscripts published from 2000 to 2017.After following the protocols of inclusion and exclusion criteria,only six relevant studies were extracted for this systematic review.Results:The selected six studies included three case report studies,two case series studies and one prospective randomized trial study,which assessed a total number of twenty-four patients.Despite of certain serious methodological flaws and limitations in these studies,all showed beneficial outcomes in relation to the treatment of AVNFH using PRP therapy;while one case report even confirmed a complete resolution of AVNFH.Five of the studies used the mixture of PRP with other cell-based adjuvant,whilst only one study was carried out with single PRP alone.Conclusions:Apart from the limitations of the studies,all the included studies revealed positive outcomes showing PRP therapy as a potentially promising treatment modality for AVNFH.More likely,the use of PRP along with other adjuvant suggested effective outcomes than PRP alone.However,in-depth comparative studies are the prerequisite for further consideration of this fact.There is still not adequate evidence to conclude if the use of PRP could replace the conventional invasive treatment methods for AVNFH and be a better treatment option.More vigorous experimental and randomized control trial studies are needed to perform for confirming the additional validity of this therapy.