Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis

Abstract Purpose The purpose of this meta-analysis was to compare platelet-rich plasma (PRP) and hyaluronic acid (HA) in patients with knee osteoarthritis (KOA). Methods Randomized controlled trials (RCTs) comparing the use of PRP and HA in KOA patients were retrieved from each database from the establishment date to April 2018. Outcome measurements were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog scale (VAS), International Knee Documentation Committee, and Lequesne Index scores and adverse events. The pooled data were evaluated with Review Manager 5.3.5. Results Fifteen RCTs (N = 1,314) were included in our meta-analysis. The present meta-analysis indicated that PRP injections reduced pain more effectively than HA injections in patients with KOA at six and 12 months of follow-up, as evaluated by the WOMAC pain score; the VAS pain score showed a significant difference at 12 months. Moreover, better functional improvement was observed in the PRP group, as demonstrated by the WOMAC function score at three, six, and 12 months. Additionally, PRP injections did not display different adverse event rates compared with HA injections. Conclusion In terms of long-term pain relief and functional improvement, PRP injections might be more effective than HA injections as a treatment for KOA. The optimal dosage, the timing interval and frequency of injections, and the ideal treatment for different stages of KOA remain areas of concern for future investigations.

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Platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: A meta-analysis with the consistent ratio of injection

Journal of Orthopaedic Surgery ◽

10.1177/2309499019887660 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901988766 ◽

Cited By ~ 5

Author(s):

Qipeng Wu ◽

Xuefen Luo ◽

Yuan Xiong ◽

Guohui Liu ◽

Junwen Wang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Randomized Clinical Trials ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

International Knee Documentation Committee ◽

Joint Disease ◽

Functional Improvement ◽

Current Evidence ◽

Cochrane Library

Osteoarthritis (OA) is an extremely common form of chronic joint disease which can affect the knees and other joints of older adults, leading to debilitating disability in the knee and consequent reduction in quality of life. Intra-articular platelet-rich plasma (PRP) or hyaluronic acid (HA) injections are effective for maintaining long-term beneficial effects without increasing the risk of intra-articular infection. However, few studies have compared the relative value of HA and PRP for OA treatment. PRP is more effective than HA for OA treatment in recent studies of this topic. We systematically searched Medline, SpringerLink, Embase, Pubmed, Clinical Trials.gov, the Cochrane Library, and OVID for all articles published through May 2018. Any study was included that compared the effect of HA and PRP (consistent treatment cycle and frequency of injection) on patient’s pain levels and functionality improvements. Review Manager 5.3 was used to analyze data regarding these two primary outcomes. We included 10 total studies in the present meta-analysis. International Knee Documentation Committee (IKDC; MD: 10.37, 95% confidence interval (CI): 9.13 to 11.62, p < 0.00001), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC; MD: −20.69, 95% CI: −24.50 to −16.89, p < 0.00001, I2 = 94%), and Visual Analogue Scale (VAS; MD: −1.50, 95% CI: −1.61 to −1.38, p < 0.00001, I2 = 90%) differed significantly between the PRP and HA groups. Knee Osteoarthritis Outcome Scores (KOOSs) did not differ significantly ( χ2 = 23.53, I2 = 41%, p = 0.11). Our hypothesis appears not to be confirmed because PRP and HA did not differ significantly with respect to KOOS score. However, the IKDC, WOMAC, and VAS scores differed significantly. Thus, based on the current evidence, PRP appears to be better than HA at achieving pain relief and self-reported functional improvement. Ia, meta-analyses of randomized clinical trials.

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Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01919-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jia Zhu Tang ◽

Ming Jun Nie ◽

Jian Zhong Zhao ◽

Guang Cheng Zhang ◽

Qing Zhang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Adverse Events ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Womac Pain ◽

Significant Difference ◽

Vas Scores ◽

Eq Vas

Abstract Background This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for patients undergoing knee osteoarthritis. Methods We systematically searched electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library on January 23, 2020 to identify relevant studies issued in English languages. The outcomes evaluating the efficacy of knee osteoarthritis (KOA) treatment were Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC pain, function, stiffness, and total scores) at 1, 3, 6, and 12 months; International Knee Documentation Committee (IKDC) scores, Lequesne Index score, Visual Analog Scale (VAS) scores, EQ-VAS scores, and KOOS scores. The pooled data were analyzed by Stata 12.0. Results A total of 20 RCTs were enrolled in the present meta-analysis. The pooled results demonstrated that platelet-rich plasma (PRP) injection reduced pain more effectively than hyaluronic acid (HA) injection at 6-month and 12-month follow-up evaluated by WOMAC pain scores and VAS scores. EQ-VAS in the patients treated with PRP injection was lower than that in patients with HA injection at 12 months. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1-month, 3-month, 6-month, and 12-month follow-up, as evaluated by WOMAC function scores. WOMAC total scores showed significant difference at 6-month and 12-month follow-up. The IKDC scores indicated PRP injection was significantly more effective than HA injection at 3 months and 6 months. However, the Lequesne Index scores, KOOS scores, and adverse events did not show any significant difference between groups. Conclusion Intra-articular PRP injection appeared to be more efficacious than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection did not increase the risk of adverse events compared to HA injection.

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How to Choose Platelet-Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis in Overweight or Obese Patients: A Meta-Analysis

Pain Research and Management ◽

10.1155/2020/7587936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Pan Luo ◽

Zhencheng Xiong ◽

Wei Sun ◽

Lijun Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

Obese Patients ◽

Knee Oa ◽

Significant Difference ◽

Better Than

Objective. The purpose of this meta-analysis was to determine whether platelet-rich plasma (PRP) was better than hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA) in overweight or obese patients. Design. Two reviewers independently used the keywords combined with free words to search English-based electronic databases according to Cochrane Collaboration guidelines, such as PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.3. Results. Ten randomized controlled trials (RCTs) with 1096 patients were included. During the first two months of follow-up, there was no significant difference between the two groups. At the 3rd, 6th, and 12th months of follow-up, the pooled analysis showed that PRP was better than HA for the treatment of knee OA in overweight or obese patients. There were significant differences between the two groups at Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (3 months: MD = −1.35, [95% CI: −2.19 to −0.50], P=0.002, I2 = 0%; 6 months: MD = −7.62, [95% CI: −13.51 to −1.72], P=0.01, I2 = 88%; 12 months: MD = −12.11, [95% CI: −20.21 to −4.01], P=0.003, I2 = 94%). Conclusions. For overweight or obese patients with knee OA, intra-articular injection of PRP in a short time was not necessarily superior to HA, but long-term use was better than HA in pain and functional relief.

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Efficacy of Balneotherapy and Mud Therapy in Patients with Knee Osteoarthritis: A Systematic Literature Review

Aktuelle Rheumatologie ◽

10.1055/a-1157-8570 ◽

2020 ◽

Author(s):

Hafiz Muhammad Asim Raza ◽

Grazina Krutulyte ◽

Inesa Rimdeikiene ◽

Raimondas Savickas

Keyword(s):

Knee Osteoarthritis ◽

Pain Score ◽

Clinical Studies ◽

Meta Analysis ◽

Womac Pain ◽

Function Score ◽

Womac Pain Score ◽

Womac Function ◽

Significant Difference ◽

Mud Therapy

Abstract Objectives To identify literature reporting on thermal mineral water and mud therapy effectiveness on pain, stiffness and knee function in patients with knee osteoarthritis. Design Systematic evidence scan of MEDLINE and PubMed was performed to identify the randomized controlled trial studies published from 2004 to December 2018. Study selection Papers reporting the effect of balneotherapy and mud therapy for treating knee OA, a duration of ≥2 weeks and in which Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as an outcome measure. Data extraction Not RCT, Studies not in English. Results A quantitative meta-analysis of ten studies (831 patients) was performed. Five clinical studies (407 patients) measured effectiveness of balneotherapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of balneotherapy. Six clinical studies (500 patients) measured effectiveness of mud therapy and there was significant difference between the groups in WOMAC pain score, WOMAC stiffness score and WOMAC function score, with the differences in favour of mud therapy. Conclusion This meta-analysis indicates that balneotherapy and mud therapy were clinically effective in relieving pain, stiffness, and improving function, as assessed by WOMAC score.

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Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in Treatment of Knee Osteoarthritis (Systematic Review and Meta-analysis)

QJM ◽

10.1093/qjmed/hcab104.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Atef Mohamed El-beltagy ◽

Zeiad M Zakaria ◽

; Mohamed Abdel-Samei Ibrahim

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Observational Studies ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Knee Oa ◽

Vas Score ◽

Significant Difference ◽

Meta Analyses

Abstract Background Although PRP is one of the options in the management of knee OA, its effectiveness and wide application is still controversial. Therefore, we conducted the present systematic review and meta-analysis to compare the safety and effectiveness of PRP versus HA injection for knee OA. Objective The purpose of this study is to compare between the efficacy of intra-articular injections of Platelet-Rich Plasma versus Hyaluronic Acid in treatment of knee osteoarthritis. Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The overall effect favoured PRP over HA for WOMAC function score, WOMAC pain score, WOMAC stiffness score, and WOMAC total score; mostly 6 and 12 months after treatment. According VAS score, we found that the overall effect favoured PRP over HA at 12 months only. In contrary, the overall effect did not favour PRP over HA for VAS score at 3 and 6 months. PRP is superior to HA for IKDC scores at 6 and 12 months with similar results at 3 months. Conclusion Intra-articular PRP injection is more effective in terms of pain relief and function improvement at short-term follow-up in the treatment of knee OA than HA, and there is no significant difference in the risk of adverse events between PRP and HA. A randomized controlled trial with larger group sizes is necessary to find the predictors of the response to PRP and HA intra-articular injection.

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Effects of Platelet Rich Plasma in Combination with Hyaluronic Acid in the Treatment of Primary Knee Osteoarthritis

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43018 ◽

2019 ◽

Vol 5 (2) ◽

pp. 137-142

Author(s):

Md Saydur Rahman ◽

Syed Ariful Islam ◽

Md Jobayer Hossain ◽

Muhammad Shamsul Arefin ◽

Md Imrul Islam ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Synergistic Effects ◽

Platelet Rich Plasma ◽

Visual Analogue Score ◽

Pain Clinic ◽

Functional Improvement ◽

Control Group ◽

Significant Difference

Background: Platelet Rich Plasma (PRP) is increasingly applied in clinical practice to treat knee degenerative pathology. Both PRP and hyaluronic acid (HA) have been extensively used to improve lubrication, modulate inflammation and modify the catabolic micro-environment of the joint. Objective: This study was aimed to evaluate the potential synergistic effects of PRP in combination with hyaluronic acid in primary knee osteoarthritis. Methodology: This randomized control trial was carried out on adult patients with primary knee osteoarthritis who attended the Pain Clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during the period of September 2015 to August 2017. The patients were randomly assigned to one of the two groups designated as group P (control group) who were only treated with PRP and group PH (experimental group) who were treated with the combination of PRP and hyaluronic acid. After providing the allocated treatment, all patients were undergone follow-up examination at 1st week, 1st month and 3rd month for pain improvement by VAS scale and for functional improvement by International Knee Documentation Committee (IKDC) score. Results: A total number of 34 patients were recruited for this study. Visual analogue score 1st month (5.85±0.83) and 3rd month (3.01±0.12) follow up showed statistically significant difference among two group (p=0.001). Inter group comparison showed that, mean VAS score of group PH (3.01±0.12) decreased more than Group P (4.01±1.01). In case of functional improvement, group PH also showed statistically better improvement during 1st month (45.76±3.25) and 3rd month (62.06±5.37) follow up than Group P. Conclusion: In conclusion articular platelet rich plasma in combination with hyaluronic acid provide better pain relief and improvement of functional status than PRP therapy alone in primary knee osteoarthritis. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 137-142

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