Joost Peerbooms

126 Chapter 8 patients with plantar fasciitis improves within 10 months of starting simple treatment methods. Among these methods is rest, ice, nonsteroidal anti-inflammatory medication, exercise, supportive shoes and orthotics, soft heel pads, night splints, physical therapy, extracorporeal shockwave therapy (ESWT) and corticosteroid injection. 25 In our plantar fasciitis study ( Chapter 7 ), patients in the PRP group showed significantly lower pain and disability scores than patients in the corticosteroid group. A larger percentage of patients showed an improvement of at least 25% between the baseline pain score and the one-year follow-up score in the PRP group (85%) than in the corticosteroid group (56%). In systematic reviews and meta-analyses which compare injections of PRP to corticosteroid injections, the use of PRP is supported mainly because of its superiority over corticosteroids, especially in providing long-term pain relief. 26-29 Ling and Wang concluded that PRP injections offered better effects than corticosteroids in American Orthopaedic Foot and Ankle Score (AOFAS), and their effects were sustained in the long term. 29 As described in lateral epicondylitis, PRP outperformed corticosteroid injections, but further studies are necessary to determine if the effect of PRP is better than a placebo injection. Therefore, there is no scientific basis yet to recommend PRP as a standard treatment option for plantar fasciitis. SECTION II: TOTAL KNEE ARTHROPLASTY Biological components used to enhance haemostasis and wound healing following total knee arthroplasty have been the subject of research. In 2000 Mooar et al. showed that using PRP for TKA resulted in a positive outcome. 30 In Chapter 3 we tested the hypothesis that the application of PRP would improve repair of wounds after total knee arthroplasty (TKA). In patients undergoing TKA, application of PRP to the wound site did not promote wound healing. Additionally, we found that it had no effect on pain, knee function or haemoglobin drop (as indicator of blood loss). In their two-year follow-up study, Guerreiro et al. showed that the PRP group, the tranexamic acid group and a combination of these two found better pain control post- operation. 31 Their study was in line with our study. Our own results are also supported by a meta-analysis by Li et al. 32 and by Ma et al. 33 Other than observing an improvement of the range of motion (ROM), there was no difference with respect to pain and the infection rate. Almost all of the reported studies had a short follow up. For TKA, in particular, a longer follow-up would be necessary to show the effects on knee function and periprosthetic infections.