Platelet-Rich Plasma Injection for Painful Trapeziometacarpal Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial.

Key Takeaway

A single intra-articular PRP injection provided no statistically significant or clinically meaningful pain relief or functional improvement over saline placebo in thumb base osteoarthritis at six months.

K E., J V., J S., M W.. (2025). Platelet-Rich Plasma Injection for Painful Trapeziometacarpal Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial.

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What this study found

This double-blind Level 1 randomized controlled trial evaluated whether a single intra-articular injection of platelet-rich plasma (PRP) reduces pain and hand disability in patients with symptomatic trapeziometacarpal (thumb base) osteoarthritis. Ninety participants were assigned to receive either a single injection of PRP (n=45) or a saline placebo (n=45). At six months, there was no statistically significant difference in pain reduction during joint loading between the PRP group (median change -10 on a 100-point scale) and the placebo group (median change 0). Secondary measures—including resting pain, thumb range of motion, key and three-finger pinch strength, and patient-reported hand functional scores—also demonstrated no clinically relevant differences between groups.

Why it matters

Orthobiologic therapies like PRP have seen widespread clinical adoption despite limited high-level evidence for upper extremity joints. For physical medicine and rehabilitation physicians and hand specialists, these findings indicate that routine recommendation of a single PRP injection for basal thumb osteoarthritis is not supported by placebo-controlled data. Clinicians should continue prioritizing evidence-based conservative management, such as thumb spica orthoses, targeted hand therapy, joint protection strategies, and judicious use of conventional intra-articular injections when appropriate.

Limitations

Key clinical considerations regarding this study include:

Single-dose protocol: The study evaluated only a single PRP injection; whether multiple injections or specific cellular preparations (such as leukocyte-rich versus leukocyte-poor protocols) would yield different outcomes remains unproven.
Follow-up duration: Outcome measures were restricted to six months, leaving potential long-term structural or symptomatic trajectories beyond this window unexamined.

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