Joost Peerbooms

13 General Introduction WOUND HEALING One of the main concerns in total joint arthroplasty is wound healing because of the risk of wound separation and surgical site infections. 29 Identification of methods to enhance or accelerate wound healing and reduce infection may be important, especially for high- risk patients (e.g., patients who have diabetes mellitus, use tobacco, or have a high body mass index). Outside the field of orthopaedics, the application of PRP for wound healing has been explored in both in vivo and in vitro studies. 30,31,32 Combining platelet gel and fibrin sealant derived from PRP could theoretically reduce blood loss and promote wound healing in a surgical wound. 30 Moreover, the presence of leukocytes in PRP may have an additional effect because the leukocytes may have a local antimicrobial effect, leading a reduction of infections. 33-34 AIMS AND OUTLINE OF THIS THESIS This thesis aims to study the effectiveness of PRP in the treatment of some musculoskeletal disorders. We performed several clinical trials to investigate the effectiveness of PRP injection in our orthopaedic practice, focusing on tendinopathy and wound healing. To analyse the available techniques, we reviewed the literature on the available systems of PRP for musculoskeletal disorders ( Chapter 2 ). Wound healing is one of the major topics of interest regarding the use of PRP across several clinical fields. In Chapter 3 , we analyse the use of PRP and PPP for function, pain, wound healing, and blood loss in total knee arthroplasty in a randomised controlled trial (RCT). In Chapter 4 , we describe a literature review that we performed on the use of PRP in upper limb conditions, mainly focusing on tendinopathy. Based on this review, we conducted an RCT comparing the use of corticosteroids versus PRP in patients with chronic tennis elbow conditions and published the results after one year ( Chapter 5 ); this was followed by a second publication examining the long-term results after two years ( Chapter 6 ). Based on the positive findings in our elbow RCT and favourable results in a clinical setting with other upper limb conditions, we also studied the use of PRP in a lower limb condition. In Chapter 7 , we discuss our analysis of the use of corticosteroids versus PRP in plantar fasciitis in a double-blind RCT. We discuss the results of these studies and draw conclusions in Chapter 8 . We then formulate suggestions for further research in the same chapter. Chapters 9 and 10 provide summaries of this thesis in English and Dutch, respectively. 1