Joost Peerbooms

60 Chapter 4 SHOULDER OSTEOARTHRITIS The use of PRP for total shoulder arthroplasty (TSA) has not been well documented. The only publication so far know is by Zavadil et al. 39 They described that the recovery of patients undergoing TSA can be adversely affected by a number of complications. Their study examines the effect of autologous platelet gel (APG) and PPP treatment on TSA patients post-operatively. Forty patients underwent TSA. They were enrolled in either a study group (n = 20) or a control group (n = 20), with the study group receiving APG and PPP. The patients and all affected parties in the post-operative care were blinded. Pre-operative demographic data, pre- and post-operative laboratory data, pain scores, pain medication, pre- and post-operative range of motion scores, complications and post-operative length of stay was recorded for each patient in each group. The treatment group had significantly lower pain and medication scores compared with the control group. The internal rotation index improvement factor was significantly higher in the treatment group. Zavadil et al. 39 showed that the use of APG in combination with PPP has a beneficial outcome regarding pain control and range of motion after TSA. CONCLUSION Acceleration of tendon healing with PRP appears to be promising, although there is currently little clinical evidence available to support its use. Well-designed, controlled clinical trials are under way and are necessary to determine the therapeutic value of PRP. More substantiated, clinical data are needed to determine its efficacy; standardized preparation and composition will be necessary to compare results. Post-procedure rehabilitation protocols must also be established to determine optimal tendon healing. Further laboratory research must be performed to determine the optimal activation in addition to growth factor, platelet, and leukocyte concentrations. Several PRP preparation systems are now available, and orthopaedic surgeons and sports medicine physicians must be aware of their differences. Given its excellent safety profile and ease of preparation, the use of PRP in orthopaedic surgery will likely continue to grow; however, clinical use should proceed cautiously because there is little, if any, high-level clinical evidence supporting the efficacy of this therapeutic modality.