Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial

Abstract

Background Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA. Methods In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction. Results Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study. Conclusions A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results. Trial registration The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021. Name of trial registry Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis. Level of evidence Therapeutic Level 1.

Clinical Outcome of Multiple Platelet-Rich Plasma Injection and Correlation with PDGF-BB in the Treatment of Knee Osteoarthritis

“…On the contrary, the HA group witnessed a decline of 21 points, or approximately 61%, as opposed to the initial count of 55. According to established criteria, a pain reduction of at least 30% is indicative of significant clinically relevant changes, which means that the study had a positive outcome [28,29]. The present data suggest that m-PRP is superior to the m-HA preparation used in this study.…”

The efficacy of extracorporeal shock wave combined with platelet rich plasma in the treatment of knee osteoarthritis with meniscus injury: A retrospective analysis

“…The higher the score, the more severe the condition and the worse the functional condition. 17 Simultaneously, Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) was used to evaluate patients’ bone and joint pain, stiffness, and physical dysfunction. This scale contains 24 questions and is divided into three subcategories: pain (five items), stiffness (two items), and physical dysfunction (17 items).…”

What’s New in Adult Reconstructive Knee Surgery

“…Various nonoperative treatments for knee osteoarthritis were evaluated in the last year. An RCT comparing the efficacy of a single intra-articular injection of platelet-rich plasma combined with 2 different hyaluronans (platelet-rich plasma and hyaluronan #1 compared with platelet-rich plasma and hyaluronan #2) for the treatment of Kellgren-Lawrence grade-2 knee osteoarthritis showed significant improvements in pain reduction (change in visual analog scale [VAS] pain score from baseline to 6 months after the injections) for both groups 4 , whereas a systematic review and meta-analysis evaluating the efficacy of intra-articular platelet-rich plasma combined with mesenchymal stem cells also revealed that such a combination significantly reduces knee pain 5 . However, none of these studies included a placebo control group.…”