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

Abstract

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.

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

“…This synergistic effect mainly changes the role of inflammatory cytokines in the process of chondrocyte degeneration through specific mediators (CD44, TGF-βRII), thereby promoting cartilage regeneration and inhibiting the inflammatory response 15 . Recent meta-analysis showed that intraarticular injection of PRP combined with HA has a unique advantage in the long-term relief of pain in patients with knee OA, which may suggest that the combination therapy may be a better treatment for patients with long-term knee pain in the future 38 .…”

Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function

“…Interestingly, it revealed that PRP combined with HA did provide better overall clinical improvement than HA in terms of symptom-function improvement at every follow-up visit or in terms of duration of effect. 29 In this study, the improvement of inflammation and joint function and pain for KOA was investigated in depth. Therefore, the goal of this study was to evaluate the effectiveness and explore the therapeutic mechanisms of PRP combined with HA as a treatment for KOA.…”

Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies’ Guidelines

“…There were no other differences between the two groups, indicating that the combined approach could be the method of choice for long-term pain relief in OA patients [ 87 ]. A meta-analysis by Zhao et al demonstrated the greater benefit of combined PRP and HA injection compared to single therapy for both pain scores at 6 months’ follow-up and function at 12 months’ follow-up [ 88 ]. Superior benefits of the combined therapy were corroborated in a systematic review and meta-analysis by Karasavvidis et al, who concluded that patients treated with a combination of PRP and HA had better clinical results for both pain and function (measured by VAS at 3, 6, and 12 months’ follow-ups and 12-month WOMAC physical function and stiffness score) compared to patients treated with HA only [ 89 ].…”