Comparison of clinical efficiency between intra-articular injection of platelet-rich plasma and hyaluronic acid for osteoarthritis: a meta-analysis of randomized controlled trials

Abstract

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are non-surgical treatments for osteoarthritis (OA), but the comparison of their efficiency is still inconclusive. Objectives: The objectives of this study were to compare the efficacy of PRP and HA in the treatment of OA by meta-analysis and to explore the effects of different injection times and leukocyte concentration on the efficacy of PRP. Design: Meta-analysis and subgroup analysis were conducted. The data were analyzed by Review Manager v5.4.1. Data sources and methods: Articles were retrieved and screened from PubMed, the Cochrane Library, Web of Science, and Embase. The outcome included the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS), adverse events (AEs), the International Knee Documentation Committee (IKDC), and the satisfaction rate. Results: A total of 30 articles involving 2733 patients were included. The total WOMAC score and IKDC score of the PRP group were better than those of the HA group at the last follow-up time, while there was no significant difference in AEs, satisfaction rate, and VAS between the two groups. In our subgroup analysis, there was no significant difference between single-injection PRP and triple-injection PRP. Leukocyte-poor PRP (LP-PRP) was better than leukocyte-rich PRP (LR-PRP) in IKDC, but there was no significant difference between them in the other scores. Conclusions: In the treatment of OA, compared with HA, PRP performed better in the improvement of the patient’s function. There was no significant difference in VAS and AEs between the two groups, and the safety was comparable. LP-PRP looked to be superior to LR-PRP in functional recovery, but there appeared to be no significant difference in pain relief between them. There was no significant difference between single PRP and triple PRP in the subgroup analysis.

Hyaluronic acid, platelet-rich plasma, bone marrow aspirate concentrate, the stromal vascular fraction, or mesenchymal stem cells: which is the best candidate for treating knee osteoarthritis?

“…In a recent publication, Chen et al (2023) analyzed the effects of PRP versus HA for knee OA based on 30 articles with 2733 patients. The results also confirmed that PRP injection was better than HA injection; in particular, the WOMAC and IKDC scores were better in the PRP group than in the HA group at the last follow-up timepoint 39 . Additionally, in this analysis, Chen et al showed that LP-PRP appeared to be superior to LR-PRP in terms of functional recovery but not in terms of pain relief.…”

“…Additionally, in this analysis, Chen et al showed that LP-PRP appeared to be superior to LR-PRP in terms of functional recovery but not in terms of pain relief. They also showed that there were no differences between single PRP injections and triple PRP injections 39 . However, in another analysis, Peng et al (2022) compared the effects of LR-PRP and HA and showed that although LR-PRP had no significant pain relief effect, LR-PRP injection demonstrated better overall outcomes than HA injection 40 .…”

Multifactorial Comparative Analysis of Platelet-Rich Plasma and Serum Prepared Using a Commercially Available Centrifugation Kit

“…PRP comprises a lot of components that may have various effects on anabolic and catabolic changes in tissues. It has generally shown positive clinical results, including pain relief and improved locomotive function in patients with osteoarthritis [4,8,9]. However, long-term studies are required to clarify its potential to inhibit disease progression.…”

“…Nonsteroidal anti-inflammatory drugs and corticosteroids are recommended as treatment strategies for this disease, along with patient education and exercise therapy as core treatment strategies [7]. Intra-articular hyaluronic acid injection is also used in outpatient practice; however, PRP has shown a better clinical outcome in a recent study comparing hyaluronic acid [8,9]. To elucidate the superior therapeutic mechanism of PRP, analyzing the biochemical factors contained in PRP may be needed, particularly considering the factors involved in the pathophysiology of osteoarthritis, which is not fully understood, although several studies have been conducted [10].…”

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts

“…According to their observation, the use of PRP provides results comparable or even superior to those provided by HA treatments [236]. Also, Chen and colleagues, more recently, published a meta-analysis comparing the results of different literature productions involving more than 2700 patients divided into PRP and HA groups [237]. Its result showed that reported Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain marks were higher for PRP-treated subjects, with comparable safety profiles.…”