Clinical therapy of hyaluronic acid combined with platelet‑rich plasma for the treatment of knee osteoarthritis

Yu, Wei; Xu, Peng; Huang, Guiling; Lin, Lizhu

doi:10.3892/etm.2018.6412

Cited by 66 publications

(112 citation statements)

References 40 publications

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“…This metaanalysis found that PRP combined with HA at 6 months after treatment was superior to PRP alone, which may suggest that PRP combined with HA may be a better treatment for patients with long-term knee pain in the future. Previous studies have shown that PRP combined with HA for KOA can reduce WOMAC pain scores more than PRP alone can, which is consistent with the present findings [18]. In terms of the improved WOMAC Function Score and WOMAC Total Score, intra-articular injection of PRP combined with HA, compared with PRP alone, can improve patients' knee joint function scores and overall WOMAC scores.…”

Section: Discussionsupporting

confidence: 92%

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

Zhao

Huang

Liang

et al. 2020

BMC Musculoskelet Disord

117

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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 the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA. Methods: The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation. (Continued on next page)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 (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 improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: − 0.54 to − 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 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; P < 0.05). 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, that of PRP combined with HA can improve the 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 is not significantly different from PRP or HA alone.

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Section: Discussionsupporting

confidence: 92%

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

Zhao

Huang

Liang

et al. 2020

BMC Musculoskelet Disord

117

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“…Furthermore, the synergy between combined PRP and HA treatment was further investigated and compared with each of them alone and with a placebo, via intra-articular injections in a total of 360 patients with knee osteoarthritis [145], demonstrating significantly reduced pain and decreased immune response, as well as PRP treatment compared with low and high molecular weight HA [143].…”

Section: Knee Osteoarthritismentioning

confidence: 99%

Platelet Concentrates in Musculoskeletal Medicine

Mariani

Pulsatelli

2020

IJMS

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Platelet concentrates (PCs), mostly represented by platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous biological blood-derived products that may combine plasma/platelet-derived bioactive components, together with fibrin-forming protein able to create a natural three-dimensional scaffold. These types of products are safely used in clinical applications due to the autologous-derived source and the minimally invasive application procedure. In this narrative review, we focus on three main topics concerning the use of platelet concentrate for treating musculoskeletal conditions: (a) the different procedures to prepare PCs, (b) the composition of PCs that is related to the type of methodological procedure adopted and (c) the clinical application in musculoskeletal medicine, efficacy and main limits of the different studies.

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“…These growth factors have a direct effect on the physical and biomechanical properties of the joint, cartilage biosynthesis and degradation. In addition, they possess anti-in ammatory effects and a direct analgesic effect related to interaction with pain receptors [42].…”

Section: Growth Factors -The Healing Promotersmentioning

confidence: 99%

Clinical Efficacy of a Single-dose of Platelet Rich Plasma in the Management of Early Knee Osteoarthritis: A Randomized Controlled Study With Mri Assessment and Evaluation of Optimal Dose

Bansal¹,

Leon

Pont³

et al. 2020

Preprint

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Background: Osteoarthritis (OA) causes substantial physical disability that limits a person's ability to indulge in daily activities. Non-steroidal anti-inflammatory drugs provide only minimal symptomatic benefit and are associated with mild to severe side effects, thus limiting its continuous use. This being the case, new alternate healing strategies with minimal adverse effects are being explored scientifically. In our study we have attempted to evaluate the clinical efficacy of a single dose of Platelet Rich Plasma (PRP) in treating osteoarthritis. Our primary objectives are:i) To optimise the correct dose of PRP preparation to achieve therapeutic relief in knee OAii) To identify the therapeutic efficacy of PRP in selected patients suffering from symptomatic primary knee OA through Randomized Clinical Trials and analyse the possible outcome using MRI analysis.Methods: A randomized, double-blind, 12-month, placebo-controlled study was conducted in 100 outpatients. PRP was prepared from the blood drawn from the subjects and administered intra-articularly guided by ultrasound. The degree of pain was assessed using WOMAC scores, the International Knee Documentation Committee score (IKDC) and six-minute pain free walking distance. The joint space width and articular cartilage thickness was evaluated through x-ray, ultrasonagraphy and MRI.Result: PRP with absolute count of approximately 100 billion platelets brings out significant therapeutic relief. The WOMAC scores showed reduction from 54.7 at baseline to 28.8 at one month, and 29.9 at 3 months showing efficacy of PRP over placebo. Improvement was evident in one month scores of IKDC tests (Baseline- 53.6; 1 month - 76.9) and VAS (Baseline - 5.8; 1 month - 2.46) followed by slight decline at 3, 6-month and one-year scores. Similarly, the pain-free distance covered during a 6-min walk was significantly improved at one month in both the groups (PRP-146 ft.; placebo-122 ft; p value <0.001). No change is seen on MRI and Joint space width.Conclusion: 7 times Concentration and absolute count of 100 billion platelets is crucial in a PRP formulation to be therapeutically effective in alleviating symptoms in moderate knee OA. The results indicate prevention of structural modification in the PRP group and better chondroprotective effects compared to placebo group.Trial Registration: This study has been registered in the US Clinical Trial Registry (U.S. National Library of Medicine) with Trial registration no. 04198467. Date of registration: December 13, 2019. (Retrospectively registered) URL - https://clinicaltrials.gov/ct2/show/NCT04198467?term=04198467&draw=2&rank=1

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Clinical therapy of hyaluronic acid combined with platelet‑rich plasma for the treatment of knee osteoarthritis

Cited by 66 publications

References 40 publications

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

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

Platelet Concentrates in Musculoskeletal Medicine

Clinical Efficacy of a Single-dose of Platelet Rich Plasma in the Management of Early Knee Osteoarthritis: A Randomized Controlled Study With Mri Assessment and Evaluation of Optimal Dose

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