PRP Research for Osteoarthritis Shifts from Tissue Repair to Immune Modulation

Osteoarthritis affects over 500 million people worldwide, making it a leading cause of disability. This comprehensive bibliometric analysis examined two decades of research on platelet-rich plasma (PRP) therapy for osteoarthritis, revealing significant shifts in scientific focus and understanding.

Researchers analyzed 1,862 publications from the Web of Science database spanning 2004-2024, plus 148 clinical trials from PubMed. The field showed explosive growth after 2012, peaking at 254 publications in 2024. The United States and China emerged as research leaders, with key institutions including the Rizzoli Orthopaedic Institute and Hospital for Special Surgery driving innovation.

The analysis identified four major research themes: disease targets and tissue mechanisms, pathophysiological processes, comparative clinical treatments, and research methodologies. Importantly, recent research frontiers have shifted toward "macrophage polarization" and "exercise," indicating a fundamental change in how scientists understand PRP's therapeutic mechanisms.

This evolution represents a paradigm shift from viewing PRP primarily as a regenerative therapy to understanding it as an immunomodulatory treatment. Early research focused on observing clinical outcomes and tissue repair, while current investigations delve into complex immune-mediated mechanisms, particularly how PRP influences macrophage phenotypes and inflammatory mediators within joint environments.

The findings suggest future research should prioritize standardizing PRP protocols based on their immunomodulatory potential rather than just platelet concentration. This could lead to more precise, personalized treatments that target specific inflammatory pathways in osteoarthritis patients.