Platelet-Rich Plasma Augmentation for Hip Arthroscopy

Abstract

Biological augmentation and therapeutics are being increasingly used in musculoskeletal and orthopaedic care. Platelet-rich plasma (PRP) is produced from centrifugation of peripheral blood, a process that concentrates platelets within autologous plasma. The process of PRP preparation is fundamental in controlling the contents, and it influences its therapeutic potential. Platelets contain alpha granules that store and release a variety of growth factors and other proteins that may augment the healing environment; PRP also has the added benefit of promoting postsurgical hemostasis. The purpose of this report was to detail our institutional preparation protocol and method of administration of PRP during hip arthroscopy.

Fig 1

Patient blood drawn from antecubital fossa with 60-mL syringe. A rubber tourniquet should be applied proximal to the antecubital fossa to facilitate vasculature visualization. After preparation of the site with alcohol, peripheral intravenous access is established with insertion of an 18-gauge, 1.5-inch needle.

Fig 2

Whole blood from patient placed into centrifuge tube. Care must be taken to not contaminate the sample during transfer from the 60-mL syringe to the centrifuge tube. For platelet-rich plasma to be augmented in a unilateral procedure, 60 mL of blood is drawn from a peripheral vein in the arm.

Fig 3

The whole blood sample is taken to the centrifuge and centrifuged for 2 cycles. The first centrifugation is performed at 2,600 rotations per minute for 10 minutes. The second centrifugation is commenced at 3,400 rotations per minute for 6 minutes.

Fig 4

Centrifugation tube and contents after first centrifugation. After the completion of the first centrifugation, the 2 conical tubes are taken under a biosafety hood for manual extraction of separated blood components. The top fraction of platelet-poor plasma is extracted with a pipette and added to a separate 50-mL conical tube. Then, the remaining buffy layer, also known as the white blood cell layer, and red blood cell (RBC) layer are consolidated into one 50-mL conical tube.

Fig 5

The remaining 5 to 6 mL of the red blood cell and buffy layer is resuspended in the conical tube, and 1.0 mL of the platelet-rich plasma product is pipetted into a 2.0-mL microcentrifuge tube for hematologic analysis.

Fig 6

Hematology analyzer displaying the cell counts in the final platelet-rich plasma (PRP) product. If the final PRP product is above the desired leukocyte count, the PRP is diluted with a minimal fraction of platelet-poor plasma. The final preparation of diluted PRP is then loaded into a sterile dual-syringe system with the 5 to 6 mL of inactivated PRP.

Fig 7

(A) Viscous platelet-rich plasma loaded into 30-mL syringe, being injected into arthroscopic cannula in left hip. (B) Inactivated platelet-rich plasma and platelet-rich plasma releasate loaded into dual-syringe system before injection into left hip.