Thank you, thank the AOSSM for selecting our paper, and I want to thank Kunal Varshnaya who is a medical student working with us on this project and was the main driver. It's not moving forward, there we go. So these are my potential conflicts of interest, they don't really have anything to do with this study. So generally people use PRP for multiple reasons, for non-operative treatment to either augment or stimulate soft tissue healing, which is used in arthritis as well, and then sometimes it's used in conjunction with surgery to help potentially speed repair. The problem is when you look on the websites and all, look through Google, it's the wild west out there. People are using PRP for all sorts of things, shoulders, all sorts of soft tissue injuries, pigment, muscle, musculoskeletal cartilage types of injuries, arthritis, but it's also being used, the so-called vampire facelift, it's being used for hair restoration, for chronic pain, for reproductive health, anti-aging benefits, you can find all sorts of things and uses for the PRP. So as we're going along here and we're talking about 50th anniversary edition, so the good, bad, and the ugly, the good about PRP is that there's some basic science that may support its use. There's certainly increasing clinical science, but we're still, I think, a bit behind. The bad, it's being used for many things without really any scientific support, and I think the ugly is that sometimes the reasons for using it are quite dubious. One of the things that you don't hear much about when we talk about PRP are what are the potential complications. So the goal of this study was to compare the complication rates in patients undergoing hip arthroscopy both with and without PRP. So this was a retrospective analysis of an insurance claims database, the MarketScan Truven database, which is an extremely large database looking from 2007 to 2015. This database includes commercial inpatient, outpatient, and pharmaceutical claims, involves 75 million lives of those individuals that have employer-sponsored insurance. There's 28 billion patient records that are involved in this database. It's updated quarterly. It's publicly available. And there's a pretty quick turnaround in that 91% of the claims are listed within five months on this database. So what we did for our inclusion criteria, we looked at all the patients in the database that had hip arthroscopy using the multiple codes for hip arthroscopy, and that came up with 35,263 patients. And then they looked to see which patients also had the CPT code for orthobiologic use, and this was 253, or 0.7%, that also had PRP. We were able to control and confirm laterality, and so those were the individuals that were included. If we could not confirm laterality, they were not included in the study. And then we looked at demographics and comorbidities with this complication study. So the outcomes that were measured was the 90-day postoperative complication rate. Those are—we looked at things like bursitis, infection, hematoma, nerve injury, wound complications, DVT and PE, as well as ipsilateral hip fracture, hip dislocation, and heterotopic ossification. So this is a busy slide, but just to kind of show the comorbidity status. In all reality, the comorbidity status between the arthroscopy-only group and the arthroscopy with PRP group was a slightly higher rate of osteoporosis in the PRP group. But when you look at the procedure types, basically, they're more of chondroplasties, femoroplasties, labral repairs, loose body removals, synovectomies, and acetabuloplasties in the PRP group. When you look at the complication rate, though, specifically, overall complication rate in the arthroscopy group was 7.9% versus 14.2% in the PRP group. Obviously, this was statistically significant. When you looked at the specific complications, this was mostly driven by heterotopic ossification. 5.7% in the non-PRP group and 10.7% in the PRP group. And looking at reoperation at two years, that also was slightly more in the individuals that had PRP versus those that did not. When you look at complications by procedure, what you see is that those that had femoroplasties, labral repairs, and acetabuloplasties had a higher complication rate with the PRP versus those that did not have the PRP. So I think those would indicate more advanced procedures in individuals that have PRP, which may confound part of the problem. So PRP does seem to be associated with an increased complication rate after hip arthroscopy. And most of that difference is driven by the presence of heterotopic ossification postoperatively. But it's unclear why. These were more advanced surgical procedures, more femoroplasties, more bony debris in those individuals. So is it related to more surgical trauma associated with labral repairs or because you have more bony debris with the acetabuloplasties and femoroplasties? Could it be that we, at least I in my practice, routinely give nonsteroidals postoperatively to reduce the risk of heterotopic ossification? Generally when I'm giving patients PRP for things, you don't want them to have nonsteroidals because that is a counter effect to the PRP itself. So maybe people are withholding the nonsteroidals, and that may be why there's a higher complication rate. Or possibly that the PRP may promote the heterotopic ossification. And I think this is just more an investigation that's going to be needed to help solve and sort that out. Thank you.

platelet-rich plasma

PRP

medical treatments

soft tissue healing

arthritis