Is the Association of Platelet Rich Plasma and Hyaluronic Acid Useful for Severe Knee Arthrosis?

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect. Purpose: To systematically review the clinical literature examining the combined use of PRP + HA. Design: Systematic review. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs). Results: A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone. Conclusion: Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.

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Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association With Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial As Compared With Hyaluronic Acid

The American Journal of Sports Medicine ◽

10.1177/0363546520986867 ◽

2021 ◽

Vol 49 (2) ◽

pp. 487-496

Author(s):

Yong-Beom Park ◽

Jun-Ho Kim ◽

Chul-Won Ha ◽

Dong-Hyun Lee

Keyword(s):

Hyaluronic Acid ◽

Growth Factors ◽

Knee Osteoarthritis ◽

Clinical Outcomes ◽

Clinical Efficacy ◽

Global Assessment ◽

Platelet Rich Plasma ◽

Patient Global Assessment ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

Background: Although platelet-rich plasma (PRP) has potential as a regenerative treatment for knee osteoarthritis, its efficacy varies. Compositional differences among types of PRP could affect clinical outcomes, but the biological characterization of PRP is lacking. Purpose: To assess the efficacy of intra-articular PRP injection in knee osteoarthritis as compared with hyaluronic acid (HA) injection and to determine whether the clinical efficacy of PRP is associated with its biological characteristics. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 110 patients with symptomatic knee osteoarthritis received a single injection of leukocyte-rich PRP (1 commercial kit) or HA. Clinical data were assessed at baseline and at 6 weeks and 3 and 6 months after injection. The primary endpoint was an improvement in the International Knee Documentation Committee (IKDC) subjective score at 6 months, and the secondary endpoints were improvements in scores based on the Patient Global Assessment, the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Samsung Medical Center patellofemoral score. Cell counts and concentrations of growth factors and cytokines in the injected PRP were assessed to determine their association with clinical outcomes. Results: PRP showed significantly improvement in IKDC subjective scores at 6 months (11.5 in the PRP group vs 6.3 in the HA group; P = .029). There were no significant differences between groups in other clinical outcomes. The Patient Global Assessment score at 6 months was better in the PRP group ( P = .035). The proportion of patients who scored above the minimal clinically important difference (MCID) for VAS at 6 months was significantly higher in the PRP group ( P = .044). Within the PRP group, the concentrations of platelet-derived growth factors were high in patients with a score above the MCID for VAS at 6 months. The incidence of adverse events did not differ between the groups ( P > .05). Conclusion: PRP had better clinical efficacy than HA. High concentrations of growth factors were observed in patients who scored above the MCID for clinical outcomes in the PRP group. These findings indicate that concentration of growth factors needs to be taken into consideration for future investigations of PRP in knee osteoarthritis. Registration: NCT02211521 (ClinicalTrials.gov identifier).

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Efficacy of Platelet-Rich Plasma versus Hyaluronic Acid for treatment of Knee Osteoarthritis: A systematic review and meta-analysis

Electronic physician ◽

10.19082/2115 ◽

2016 ◽

Vol 8 (3) ◽

pp. 2115-2122 ◽

Cited By ~ 31

Author(s):

Hassan Niroomand Sadabad ◽

Masoud Behzadifar ◽

Farzad Arasteh ◽

Meysam Behzadifar ◽

Hamid Reza Dehghan

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis

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Hope, Hype, Hurdles & Future Perspective for PRP, PRP versus Hyaluronic Acid Injection in Osteoarthritis of Knee: A Review Article.

Biologic Orthopedics Journal ◽

10.22374/boj.v2i1.6 ◽

2020 ◽

Vol 2 (1) ◽

pp. e1-e12

Author(s):

Ashok Kumar ◽

Anikait Ghosh Kadamb ◽

Krish Ghosh Kadamb

Keyword(s):

Hyaluronic Acid ◽

Knee Joint ◽

Platelet Rich Plasma ◽

Future Perspective ◽

Osteoarthritis Of The Knee ◽

Stiff Knee ◽

Injection Interval ◽

One Year

BackgroundComparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results. PurposeA review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint. MethodsOut of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study. ResultsA standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.ConclusionPRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections & with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval & proper documentation of efficacy and complications in the regenerative registry.

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