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

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

Pain Medicine ◽

10.1093/pm/pnz011 ◽

2019 ◽

Vol 20 (7) ◽

pp. 1418-1429 ◽

Cited By ~ 29

Author(s):

Yanhong Han ◽

Hetao Huang ◽

Jianke Pan ◽

Jiongtong Lin ◽

Lingfeng Zeng ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Pain Score ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

International Knee Documentation Committee ◽

Functional Improvement ◽

Womac Pain ◽

Optimal Dosage ◽

Significant Difference

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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Effects and safety of platelet-rich plasma (PRP) and hyaluronic acid (HA), alone and in combination, in the treatment of knee osteoarthritis: A systematic review and meta-analysis.

10.21203/rs.2.23232/v1 ◽

2020 ◽

Author(s):

Jinlong Zhao ◽

Hetao Huang ◽

Guihong Liang ◽

Ling-feng Zeng ◽

Weiyi Yang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Womac Function ◽

Lequesne Index

Abstract Background Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of PRP combined with HA in the treatment of KOA compared with intra-articular injection of PRP or HA alone. Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators include the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Results Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (standardized mean difference (SMD): -0.31; 95% confidence interval (CI): -0.55 to -0.06; P=0.01 <0.05). PRP combined with HA for KOA achieved better improvement in WOMAC Function Score (SMD: -0.32; 95% CI: -0.54 to -0.10) and WOMAC Total Score (SMD: -0.42; 95% CI: -0.67 to -0.17) at the 12-month follow-up than the application of PRP alone. In a comparison of Lequesne Index scores at a 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: -0.67 to -0.17). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P>0.05). Conclusions Compared with intra-articular injection of PRP alone, PRP combined with HA can improve WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA was not significantly different from PRP or HA alone.

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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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Comparison of the Effectiveness of Platelet-Rich Plasma (PRP), Hyaluronic Acid and the Combination of Both in the Treatment of Mild and Moderate Osteoarthritis of the Knee

Journal of Dhaka Medical College ◽

10.3329/jdmc.v28i2.51153 ◽

2021 ◽

Vol 28 (2) ◽

pp. 172-178

Author(s):

Farzana Khan Shoma ◽

Md Mahmudur Rahman ◽

Ziaur Rahman Chowdhury ◽

Muhammad Kamrul Hassan ◽

Farzana Hossain ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Functional Outcome ◽

Platelet Rich Plasma ◽

Osteoarthritis Of The Knee ◽

Womac Pain ◽

Medical College ◽

Pain Scores ◽

Vas Scores ◽

Medical University

Osteoarthritis (OA) is by far the most common form of arthritis characterized by focal loss of articular cartilage, subchondral osteosclerosis, osteophyte formation at the joint margin, and remodeling of joint contour with enlargement of affected joints. This randomized, clinical trial aimed to compare the effectiveness of Platelet Rich Plasma (PRP) and Hyaluronic Acid (HA) as individual treatments and PRP in combination with HA in the treatment of mild to moderate knee Osteoarthritis (OA). The study was conducted among 89 patients with mild to moderate knee osteoarthritis in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients were randomly allocated to one of the three interventions: HA (n=30), PRP (n=30), or HA+PRP (n=29). Patients in HA group received 3 intra-articular knee injections with 1 week interval while patients in PRP group and PRP+HA group received 2 intra-articular knee injections with 2 week interval. Functional outcome of the treatment were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale (VAS) questionnaire at baseline and after 1,3,6 and 9 months of treatment. Majority of the patients in all groups were female where mean age of the patients were about 50 years. Pain scores in VAS scale significantly reduced in PRP group when compared to HA group and also in PRP+HA when compared to HA group which persist till nine months (p<0.05). No significant statistical difference was found in VAS scores between PRP and PRP+ HA group. WOMAC pain scores also significantly reduced in PRP group when compared to HA group and also in PRP+HA when compared to HA group (p<0.05). WOMAC stiffness significantly reduced in PRP+ HA group when compared to HA group at three month (p<0.001) and at six month (p=0.011). At nine month, physical activity scores significantly reduced in PRP group compared to HA group (p=0.002) and in PRP+HA when compared to HA group (p<0.001). No significant reduction was observed in WOMAC scores when the outcome of PRP+HA was compared with PRP alone. PRP provides better functional outcome than HA. The combination of PRP and HA also provides better outcome than HA alone but does not provide better outcome than PRP alone. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 172-178

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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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Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The American Journal of Sports Medicine ◽

10.1177/0363546520909397 ◽

2020 ◽

Vol 49 (1) ◽

pp. 249-260 ◽

Cited By ~ 9

Author(s):

John W. Belk ◽

Matthew J. Kraeutler ◽

Darby A. Houck ◽

Jesse A. Goodrich ◽

Jason L. Dragoo ◽

...

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Symptomatic Relief ◽

Cochrane Library ◽

Knee Oa ◽

Level 1

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are 2 nonoperative treatment options for knee osteoarthritis (OA) that are supposed to provide symptomatic relief and help delay surgical intervention. Purpose: To systematically review the literature to compare the efficacy and safety of PRP and HA injections for the treatment of knee OA. Study Design: Meta-analysis of level 1 studies. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 studies that compared the clinical efficacy of PRP and HA injections for knee OA. The search phrase used was platelet-rich plasma hyaluronic acid knee osteoarthritis randomized. Patients were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) scale. A subanalysis was also performed to isolate results from patients who received leukocyte-poor and leukocyte-rich PRP. Results: A total of 18 studies (all level 1) met inclusion criteria, including 811 patients undergoing intra-articular injection with PRP (mean age, 57.6 years) and 797 patients with HA (mean age, 59.3 years). The mean follow-up was 11.1 months for both groups. Mean improvement was significantly higher in the PRP group (44.7%) than the HA group (12.6%) for WOMAC total scores ( P < .01). Of 11 studies based on the VAS, 6 reported PRP patients to have significantly less pain at latest follow-up when compared with HA patients ( P < .05). Of 6 studies based on the Subjective IKDC outcome score, 3 reported PRP patients to have significantly better scores at latest follow-up when compared with HA patients ( P < .05). Finally, leukocyte-poor PRP was associated with significantly better Subjective IKDC scores versus leukocyte-rich PRP ( P < .05). Conclusion: Patients undergoing treatment for knee OA with PRP can be expected to experience improved clinical outcomes when compared with HA. Additionally, leukocyte-poor PRP may be a superior line of treatment for knee OA over leukocyte-rich PRP, although further studies are needed that directly compare leukocyte content in PRP injections for treatment of knee OA.

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Efficacy and safety of sprifermin injection for knee osteoarthritis treatment: a meta-analysis

Arthritis Research & Therapy ◽

10.1186/s13075-021-02488-w ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Ni Zeng ◽

Xin-Yuan Chen ◽

Zhi-Peng Yan ◽

Jie-Ting Li ◽

Tao Liao ◽

...

Keyword(s):

Adverse Events ◽

Knee Osteoarthritis ◽

Meta Analysis ◽

Placebo Treatment ◽

Cartilage Volume ◽

Cartilage Thickness ◽

Random Effects Models ◽

Structural Progression ◽

Significant Difference ◽

Mean Differences

Abstract Objective To perform a meta-analysis comparing the structural progression and clinical symptom outcomes as well as adverse events experienced from intra-articular injections of sprifermin compared to a placebo treatment for patients with knee osteoarthritis (KOA). Method We systematically searched the literature for studies that compared long-term outcomes between sprifermin and placebo injections for KOA treatment. Meta-analysis was performed with RevMan5.3 using an inverse variance approach with fixed or random effects models. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results Eight studies were included. Overall, there was significantly less improvement of WOMAC total scores in patients receiving sprifermin, compared with the placebo (mean difference (MD) = 3.23, 95% CI 0.76–5.69; I2 = 0%; P = 0.01). Further, sprifermin injection patients gained more, and lost less, cartilage thickness and volume in total femorotibial joint (cartilage thickness: standardized mean differences (SMD) = 0.55, 95% CI 0.26–0.84; I2 = 78%; P = 0.0002; cartilage volume: SMD = 0.39, 95% CI 0.20–0.58; I2 = 49%; P < 0.0001). Changes in the cartilage surface morphology of the medial tibio-femoral joint (MD = −0.30, 95% CI −0.44 to −0.16; I2 = 0%; P < 0.0001) and patello-femoral joint (MD = −0.22; 95% CI −0.37 to −0.07; I2 = 0%; P = 0.004) showed a significant difference between the sprifermin and placebo injections. Moreover, there were no significant differences between sprifermin and the placebo in the risk of treatment-emergent adverse events (OR = 1.05; 95% CI 0.52–2.14; I2 = 48%; P = 0.89). Conclusion The data from the included studies provide strong evidence to determine the effect of intra-articular sprifermin on joint structure in individuals with KOA and show no specific adverse effects. Nevertheless, intra-articular sprifermin did not likely have any positive effect on symptom alleviation.

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