Autologous Platelet Gel and Platelet-Poor Plasma Reduce Pain With Total Shoulder Arthroplasty

Background: The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by activating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postoperatively.

Methods: After Institutional Review Board (IRB) approval, 40 patients undergoing TSA at our institution were prospectively enrolled in our study. They were randomized into either a control (n = 20) or study (n = 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measurements, and postoperative lengths of stay were recorded for each group.

Results: The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4.64 +/- 4.46 vs. 1.88 +/- 2.44, p < .05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84.54 +/- 5.32 vs. 79.87 +/- 8.73) and 72 hours (87.46 +/- 16.03 vs. 76.70 vs. 5.96), but neither difference reached statistical significance. The treatment group had significantly lower pain scores (p = .007) and total fentanyl requirements (p < .05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative internal rotation index) was significantly higher in the treatment group vs. the control group (p < .05).

Conclusion: Although it did not reach statistical significance, the treatment group was discharged almost 9 hours earlier than the control group (64.44 +/- 15.23 vs. 73.39 +/- 15.37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively.