Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis

Abstract

Intraarticular hyaluronan or platelet-rich plasma (PRP) is widely used in the treatment of knee osteoarthritis (OA). The efficacy of combined hyaluronan with PRP remained inconclusive. This study aimed to investigate the efficacy of combined a single crosslinked hyaluronan (HYAJOINT Plus) and a single PRP versus a single PRP in patients with knee OA. In a prospective randomized-controlled trial, 85 patients with knee OA (Kellgren-Lawrence 2) were randomized to receive a single intraarticular injection of HYAJOINT Plus (3 ml, 20 mg/ml) followed by 3 ml PRP (the combined-injection group, N = 43) or a single injection of 3 ml PRP (the one-injection group, N = 42). The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0–00 mm) at 6 months. Secondary outcomes included The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert Scale), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patient satisfaction at 1, 3 and 6 months. Seventy-eight patients were available for the intention-to-treat analysis at 6 months. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at each follow-up visit (p < 0.001). Patients receiving a single PRP experienced significantly greater improvements in VAS pain than patients receiving combined injections at 1-month follow-up (adjusted mean difference: − 5.6; p = 0.017). There were no significant between-group differences in several of the second outcomes at each follow-up visit, except the WOMAC-pain and WOMAC-stiffness scores favoring the one-injection group at 1 month (p = 0.025 and p = 0.011). However, at 6-month follow-up, the combined-injection group achieved significantly better VAS pain reduction (p = 0.020). No serious adverse events occurred following injections. In conclusion, either combined injections of HYAJOINT Plus and PRP or a single PRP alone was safe and effective for 6 months in patients with Kellgren-Lawrence 2 knee OA. Combined injections of HYAJOINT Plus and PRP achieved better VAS pain reduction than a single PRP at 6 months. The results indicating a long term benefit effect of a combination of HYAJOINT Plus and PRP in a particular subset of patients with moderate knee OA need to be replicated in larger trials.ClinicalTrials.gov number NCT04315103.

Comparing the efficacy of dual Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: a systematic review and meta-analysis

“…To impede OA, PRP therapy utilizes its anti-inflammatory properties for stimulation of growth factors that encourage cartilage matrix synthesis and inhibition of innate immune response cytokines linked to cartilage erosion [ 10 , 36 ]. In addition, PRP reverses the senescence process of chondrocytes, restoring the self-renewing capacity of cartilages [ 37 ].…”

“…Conservative treatment, which can be broadly categorised into pharmacological and nonpharmacological methods, aims to retain patient mobility and reduce pain. Non-pharmacological treatment includes preventive and rehabilitative measures such as weight loss and diet control as KOA is highly related to obesity [ 37 ]. Such measures, being heavily dependent on patient compliance, are often out of the jurisdiction of clinicians and are often used concurrently with pharmacological treatment such as oral analgesics and non-steroidal anti-inflammatory drugs [ 37 ].…”

“…Non-pharmacological treatment includes preventive and rehabilitative measures such as weight loss and diet control as KOA is highly related to obesity [ 37 ]. Such measures, being heavily dependent on patient compliance, are often out of the jurisdiction of clinicians and are often used concurrently with pharmacological treatment such as oral analgesics and non-steroidal anti-inflammatory drugs [ 37 ]. Pharmacological modalities have seen varying success depending on the stage of the disease, and despite their efficacy in controlling the disease in its early stages and slowing its progression, these drugs come with various contraindications and side effects.…”

Efficacy and Safety of Focused Low-Intensity Pulsed Ultrasound Therapy Versus Pulsed Shortwave Diathermy for the Management of Knee Osteoarthritis: A Randomized Controlled Trial

“…Opaque randomization envelopes with sequentially numbered allocation were generated by a person who was not clinically involved in the study. When a patient consented to the trial, the patient selected one of the envelopes and then was given the allocated therapy 7 .…”

Injections in the osteoarthritic knee: a review of current treatment options

“… 48 Similar results were found in a study comparing PRP and HA against HA and PRP alone, where the combined therapy achieved better clinical outcomes. 49 , 50 Preliminary results on a PRP + MSCs combination showed significant reduction of symptoms up to 12 months after the procedure. 51 However, besides the preliminary encouraging results, combination therapy should be proposed with caution, especially when adopting biologic products, and further data should be collected before endorsing its routine application.…”