Griffin, Xavier L., Achten, Juul, Parsons, Nicholas R. and Costa, Matthew L. (2013) Platelet-rich therapy in the treatment of patients with hip fractures: a single centre, parallel group, participant-blinded, randomised controlled trial. BMJ Open, Volume 3 (Number 6). Article number e002583. doi:10.1136/bmjopen-2013-002583 ISSN 2044-6055.

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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.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Library of Congress Subject Headings (LCSH):	Hip joint -- Diseases , Hip joint -- Surgery, Clinical medicine, Blood platelets, Orthopedics
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	25 June 2013
Dates:	Date Event 25 June 2013 Published
Volume:	Volume 3
Number:	Number 6
Page Range:	Article number e002583
DOI:	10.1136/bmjopen-2013-002583
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	24 December 2015
Date of first compliant Open Access:	24 December 2015
Funder:	BUPA Foundation, Orthopaedic Research UK

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