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Autologous platelet gel in total knee arthroplasty: a prospective randomized study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Total knee arthroplasty (TKA) is often associated with major postoperative blood loss, postoperative pain, and impaired wound healing. The application of autologous platelet gel (APG), prepared from the buffy coat of a unit of autologous blood, has been advocated to improve haemostasis after surgery, to decrease perioperative blood loss, diminish postoperative pain and to enhance the wound healing process. This randomized controlled pilot study was developed to assess the effects of APG after total knee arthroplasty on blood loss, wound healing, pain, range of motion, and hospital stay.

Method

A prospective, randomized observer blind controlled trial was performed. Forty patients with only osteoarthritis of the knee were scheduled to have a TKA, and they were randomized into two groups. Patients in the treatment group were all treated with the application of autologous platelet gel after the prosthesis was implanted. Patients in the control group were treated with the same protocol but no APG was used.

Results

Preoperative and postoperative Hb levels showed no significant difference and allogenic blood transfusions were not given in either group. Haematomas were significantly larger in the control group than in the platelet gel group (P = 0.03). The pain score at rest was higher in the control group on the 3rd day (P = 0.04). Wound healing disturbances were seen in four patients in the control group and in no patients in the APG group (n.s.). Range of motion of the knee was similar postoperatively. Hospital stay was 6.2 days in the APG and 7.5 days in the control group (n.s.).

Conclusion

In this prospective randomized pilot study on APG in total knee arthroplasty, differences in favour of the use of platelet gel were found, but these were subjective evaluations, marginal in effect, or did not reach statistical significance. The use of drains might have decreased the concentration of delivered platelets and may have diminished the effect. However, in this study, a statistically significant clinically important effect in favour of platelet gel application was not found. Further studies with larger numbers of patients, and without the use of drains, are warranted to investigate the possible benefits of autologous platelet gel in total knee arthroplasty.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kennemer Gasthuis, Location E.G., P.O. Box 417, 2000 AK, Haarlem, The Netherlands

    Wieger G. Horstmann

  2. Perioperative Medicine Consultancy, Nijmegen, The Netherlands

    Robert Slappendel

  3. Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands

    Gijs G. van Hellemondt & Ate W. Wymenga

  4. Department of Anaesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands

    Nigel Jack

  5. Department of Peri-Operative Blood Management, Catharina Hospital, Eindhoven, The Netherlands

    Peter A. M. Everts

Authors
  1. Wieger G. Horstmann
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  2. Robert Slappendel
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  3. Gijs G. van Hellemondt
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  4. Ate W. Wymenga
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  5. Nigel Jack
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  6. Peter A. M. Everts
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Correspondence to Wieger G. Horstmann.

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Horstmann, W.G., Slappendel, R., van Hellemondt, G.G. et al. Autologous platelet gel in total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 19, 115–121 (2011). https://doi.org/10.1007/s00167-010-1207-0

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  • DOI: https://doi.org/10.1007/s00167-010-1207-0

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