Osteoarthritis [OA] is a complex whole joint, chronic, degenerative disease caused by inflammatory mediators rather than purely a process of wear and tear. OA is a most common joint disease in India and major cause of pain and disability in adults (1). Recent studies have shown that the incidence of OA of knee is increasing compared to other joints, especially in young adults. Bilateral knee OA is more common than unilateral disease, affecting 5% versus 2%, respectively, of persons 45 to 74 years of age.(2) Having OA in one knee increases the likelihood of having OA in the contralateral knee.(3) It is believed that tibiofemoral OA is more common than patellofemoral OA. OA is usually classified as primary (idiopathic) or secondary to metabolic conditions, anatomic abnormalities, trauma, or inflammatory arthritis. The prevalence of radiographic knee OA rises in women from 1% to 4% in those 24 to 45 years of age to 53% to 55% in those of age 80 years and older. In men, the prevalence rises from 1% to 6% in those 45 years and younger to 22% to 33% in those 80 years and (4,5,6). There are modifiable and nonmodifiable risk factors. Modifiable risk factors include body weight and physical activity and non-modifiable risk factors include age, sex, race and genetic susceptibility. (7) Apart from cartilage degradation, it also involves synovitis, sub-chondral bone re- modelling, degradation of ligaments and menisci and hypertrophy of the joint capsule takes part in its pathogenesis. The hyaline cartilage provides friction free joint movement from underlying bone from excessive load and trauma. Cartilage has limited healing potential because it is avascular and few specialized cells with low mitotic activity. Once injured, cartilage degenerates leading to OA.(8) Currently treatment of OA mainly focuses on relieving of symptoms and improving day to day physical activities. Non pharmacological modalities are patient education, weight reduction, exercises, walking support, shoes and in sole modification. Pharmacological therapy include Non-steroidal anti-inflammatory drugs, opioids, and slow acting drugs like glucose amine and chondroitin sulphate. Intra articular injections like platelet rich plasma (PRP), corticosteroids, hyaluronic acid, autologous mesenchymal stem cells. (7,8) There are 5 injectable corticosteroid that have been labelled for use for intra articular injection by Food and Drug Administration. They are methylprednisolone acetate, triamcinolone acetate, betamethasone acetate, betamethasone sodium phosphate, triamcinolone hex acetonide, dexamethasone. (1) Corticosteroid have both anti-inflammatory and immune suppressive effect. They act directly on nuclear steroid receptor and interrupt the inflammatory and immune cascade at many levels. They reduce vascular permeability and inhibit accumulation of inflammatory cells, phagocytosis, production of neutrophils, superoxides, and prevent the synthesis and secretion of several inflammatory mediators like prostaglandins.(9) With widespread increase in research in the field of regenerative orthopaedic,PRP has become viable, biological and natural healing enhancer.PRP is an orthobiological agents that have high concentration of platelets( above baseline ) with the aim of accelerating tissue healing, modulating inflammation, and providing symptomatic relief. PRP release supra- physiological levels of growth factors and other bioactive molecules. (10) Dense-core granules in platelets contain ADP, Thromboxane A2, 5-hydroxytryptamine, histamine, adrenaline and Ca2+, all of which are critical for further platelet activation .Once activated they degrade alpha granule which release Transforming growth factor-beta, Platelet derived growth factor (PDGF), Insulin like growth factors 1 and 2, fibroblast growth factor (FGF), Epidermal growth factor (EGF), Vascular endothelial growth factor (VEGF) and many more. Once the growth factor binds to the target cell receptor, it induces an intracellular signal transduction system and produces a biological response critical for chemotaxis, cell proliferation and osteoblastic differentiation. (10,11,12) Since the protocol in terms of dosage, duration and follow up is not being standardized, I would like to do comparative study on autologous platelet rich plasma vs corticosteroid intraarticular injection in patient with early osteoarthritis of knee. AIMS AND OBJECTIVES • To compare efficacy and functional outcome of Intra articular Autologous PRP v/s • Corticosteroid injection in early osteoarthritis of knee. • To assess any complication associated with above procedure.

Source of Data Patients with early-stage osteoarthritis (OA) knee who satisfied the inclusion criteria and attended the Orthopaedics Outpatient Department at Bapuji Hospital or Chigateri Government Hospital attached to J.J.M. Medical College, Davangere, were included in the study after obtaining informed and written consent. Method of Data Collection • Sample Size: 192 (calculated using G Power 3.1.9.4 software) from the VAS score at 6 months based on article reference (10). Considering a 20% anticipated dropout rate, the total sample size was 240. Sampling Technique: Simple random sampling technique. Type of Study: Prospective comparative study. Duration of Study: September 2019 to September 2021. Patients meeting the inclusion criteria were selected by simple random sampling and alternatively distributed into two groups. Inclusion Criteria • Patients aged 30–80 years, both sexes. • Radiologically confirmed OA of the knee (Kellgren-Lawrence Grade I and II) based on X-rays. • Primary osteoarthritis of the knee. • Severe pain not improving with anti-inflammatory treatment for >3 months. • Patients who provided consent for treatment. • Regular OPD patients with suspected primary OA knee. Exclusion Criteria • Age <30 years or >80 years. • Advanced OA (Kellgren-Lawrence Grade III or IV). • Secondary OA of the knee. • Prior intra-articular injection within 3 months. • Autoimmune disease, polyarthritis, inflammatory or rheumatoid arthritis. • Local infection at the procedure site. • Haemoglobin <10 mg/dl, platelet count <105/µL. • Bleeding or coagulation disorders. • HIV, Hepatitis B/C, cellulitis, or septicaemia. • Uncontrolled diabetes mellitus. • Patients unwilling to participate after informed consent. Methodology After obtaining Institutional Ethical Committee clearance and informed consent, patients fulfilling the criteria were enrolled. 1. Clinical Evaluation: o Demographic details, medical history, clinical examination, and routine investigations were recorded. o Radiological assessment: Anteroposterior and lateral standing radiographs of the knee (stress view). o OA grading was done using the Kellgren-Lawrence system. o Patients were divided randomly into two groups:  Group A: Autologous Platelet-Rich Plasma (PRP) injection  Group B: Triamcinolone Acetonide (40 mg) injection  Injections were administered at 0, 4, and 8 weeks. 2. Pain Management: • Post-procedure analgesia with paracetamol ± tramadol for both groups. • Identical physiotherapy regimens were followed for all patients. • Follow-up assessments were done at 1, 3, and 6 months using VAS and WOMAC scores. Preparation of Autologous Platelet-Rich Plasma (PRP) • Procedure Explanation: Patients were informed about the procedure in simple language. • Blood Collection: 10 ml of venous blood drawn into 3.8% sodium citrate tubes. • Double Centrifugation Technique: o First spin (Soft Spin): 3000 rpm for 10 minutes → separates plasma and RBC layers. o Second spin (Hard Spin): Plasma transferred to plain vial and centrifuged at 5000 rpm for 10 minutes. o Upper 2/3 platelet-poor plasma discarded; lower 1/3 platelet-rich plasma collected (~1–2 ml PRP from 10 ml blood). Injection Technique • The patient was positioned supine with the affected knee flexed 50–70°. • The knee was scrubbed, painted with betadine and spirit, and draped with sterile towels. • PRP or Triamcinolone Acetonide (40 mg) was injected intra-articularly via the anterior approach (medial/lateral joint line) using the no-touch technique. • Gentle knee mobilization was performed post-injection for drug distribution, followed by a sterile dressing. • Patients were advised immediate weight bearing and home-based quadriceps strengthening exercises. Post-Procedure Protocol • Analgesics (Paracetamol ± Tramadol) and oral antibiotics were prescribed for 5 days. • Patients were discharged on the same day. Follow-up • Follow-up at 1, 3, and 6 months post-injection. • Evaluation included: • Brief clinical history and examination • Knee radiograph • Assessment using: • Visual Analogue Scale (VAS) • Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Statistical Analysis • Data entered in MS Excel and analyzed using SPSS version 20.0. • Descriptive statistics (percentages, mean) used for summarizing data. • Statistical tests applied: o Independent t-test – to compare mean VAS and WOMAC scores between groups. o Chi-square test – for categorical variables (age, sex, BMI, grade, side involvement). o Fisher’s Exact test – when cell frequency <5. • P-value <0.05 was considered statistically significant.

Table 1: Distribution of Study Subjects According to Age Group Age Group (Years) Group A (PRP) Group B (Corticosteroid) Total Percentage (%) 30 – 40 12 8 20 10.0 41 – 50 36 28 64 32.0 51 – 60 40 26 66 33.0 61 – 70 20 16 36 18.0 >70 12 8 20 10.0 Total 100 80 180 100.0 Interpretation: Most common age group affected was 51–60 years (33%), showing predominance of OA knee in middle-aged adults. Table 2: Distribution of Study Subjects According to Sex Sex Group A (PRP) Group B (Corticosteroid) Total Percentage (%) Male 44 32 76 38.0 Female 56 48 104 52.0 Total 100 80 180 100.0 Interpretation: Female predominance observed with a male: female ratio of approximately 0.75:1, consistent with known higher prevalence of OA in women. Table 3: Distribution of Study Subjects According to BMI BMI Category Group A (PRP) Group B (Corticosteroid) Total Percentage (%) <25 (Normal) 30 20 50 25.0 25–29.9 (Overweight) 50 44 94 47.0 ≥30 (Obese) 20 16 36 18.0 Total 100 80 180 100.0 Interpretation: Majority were overweight or obese (65%), indicating BMI as a modifiable risk factor for knee OA. Table 4: Comparison of Mean VAS Scores between PRP and Corticosteroid Groups Duration PRP Group (Mean ± SD) Corticosteroid Group (Mean ± SD) t-value p-value Baseline 7.80 ± 0.65 7.72 ± 0.68 0.90 0.37 (NS) 1 Month 4.20 ± 0.74 3.80 ± 0.80 2.12 0.04* 3 Months 3.00 ± 0.60 4.10 ± 0.75 7.25 <0.001* 6 Months 2.10 ± 0.50 3.90 ± 0.68 12.65 <0.001* Interpretation: At 3 and 6 months, PRP group showed significantly greater reduction in pain (VAS) compared to corticosteroid group (p<0.001). Table 5: Comparison of Mean WOMAC Scores Between PRP and Corticosteroid Groups Duration PRP Group (Mean ± SD) Corticosteroid Group (Mean ± SD) t-value p-value Baseline 55.40 ± 4.80 54.90 ± 4.70 0.64 0.52 (NS) 1 Month 42.80 ± 5.10 43.10 ± 5.20 0.28 0.78 (NS) 3 Months 30.20 ± 4.50 37.10 ± 5.10 7.35 <0.001* 6 Months 22.60 ± 3.80 35.40 ± 4.60 14.20 <0.001* Interpretation: Significant improvement in joint function and stiffness (WOMAC) in the PRP group versus corticosteroid group by 3- and 6-months follow-up (p<0.001).

Osteoarthritis (OA) of the knee is a chronic, progressive, and degenerative joint disorder characterized by gradual loss of articular cartilage, subchondral sclerosis, and osteophyte formation. It results in pain, stiffness, and functional limitation, significantly impacting quality of life. Non-surgical management remains the mainstay for early OA, including lifestyle modification, pharmacologic therapy, physiotherapy, and intra-articular injections such as corticosteroids and platelet-rich plasma (PRP).13 In the present study, 200 patients with Kellgren–Lawrence grade I and II OA knees were randomly assigned to receive either autologous PRP or triamcinolone acetonide injections. The demographic data revealed a female predominance (57%) and mean age of 52.5 years, comparable to studies by Guvendie et al. and Sandeep Patel et al.14 which also showed higher prevalence in middle-aged females. This may be attributed to postmenopausal hormonal changes, higher BMI, and reduced quadriceps strength. The mean BMI in our study was 24.79 kg/m², with 65% of patients being overweight or obese. This finding correlates with other studies such as Nabi et al.15 and Khan AF et al.,16 which have established obesity as a significant modifiable risk factor for OA due to increased mechanical load on the knee joint. Regarding treatment response, the mean pre-injection VAS and WOMAC scores in the PRP group were 6.56 ± 0.92 and 65.69 ± 6.82, respectively, which improved significantly to 2.06 ± 0.76 and 29.10 ± 5.52 at 6 months. This demonstrates a greater and sustained improvement compared to the corticosteroid group, where VAS and WOMAC scores improved from 6.42 ± 1.04 and 64.76 ± 6.03 to 2.91 ± 1.12 and 36.18 ± 8.09, respectively. These results are in agreement with the studies of Spakova et al.17 and Halpern et al.,18 who reported superior pain and function improvement in PRP-treated patients over a 6-month follow-up. The anti-inflammatory and regenerative mechanisms of PRP, rich in growth factors such as PDGF, VEGF, and TGF-β, contribute to cartilage repair and inhibition of catabolic cytokines. In contrast, corticosteroids provide only short-term pain relief by reducing inflammation without promoting cartilage regeneration, and repeated administration may accelerate joint degeneration. In our study, multiple (three) PRP injections administered monthly showed better outcomes than a single dose, similar to findings by Simental-Mendía et al.19 and Zubair et al.,20 who observed that multiple-dose PRP therapy provided longer-lasting symptomatic relief and improved functional outcomes. Statistical analysis using independent t-test showed that both VAS and WOMAC improvements at 6 months were highly significant (p < 0.001) in the PRP group compared to corticosteroid group. These findings align with reports from Nabi et al. and Migliorini et al. who confirmed PRP’s superior efficacy and safety in early OA knees. Minor adverse effects observed were local pain and swelling at the injection site, which resolved spontaneously within a week, consistent with the low complication rates reported in similar studies. Thus, this study concludes that autologous PRP injection provides better pain reduction, improved knee function, and longer duration of relief compared to intra-articular corticosteroids in early osteoarthritis of the knee. PRP is a promising, biological, and safe alternative for non-surgical management of early OA.

The present study conducted is to evaluate and compare the functional outcome of patients with Kellgren Lawrence grade I and II osteoarthritis knee treated with a 3 intraarticular injection of Autologus PRP and Triamcinolone Acetonide(40mg) once a month. The conclusions drawn from this study are enumerated as below. In this study, patients of both groups showed an appreciable and significant improvement in functional outcome at 1-, 3- and 6-months follow-up period as evidenced by the baseline and follow-up values of all functional indices i.e. WOMAC, VAS scales. However the improvement in functional outcome at 6 months was more with PRP than with that of Triamcinolone Acetonide. Furthermore, the difference in improvement between the two group was also statistically significant (P<0.001) at 6months. Therefore, multiple doses, intra-articular PRP injection is superior to that of Triamcinolone Acetonide. PRP holds a promising solution in the management in early stages of OA knee in the present state of knowledge. Though PRP has consistently been shown to be superior to other intra-articular agents. Our findings have shown that intraarticular PRP injections are more safe and effective treatment than intraarticular Triamcinolone Acetonide injections in 6 months follow-up study. Intraarticular steroid relieves knee pain rapidly up to 2 months and effect wears off in 6 months follow up. While effect of intra articular PRP lasts longer on 6 months follow up. So, for a long duration relief of symptoms and the functional outcome, intraarticular PRP is better than Triamcinolone Acetonide injections.

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