Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Abstract

Background This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for patients undergoing knee osteoarthritis. Methods We systematically searched electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library on January 23, 2020 to identify relevant studies issued in English languages. The outcomes evaluating the efficacy of knee osteoarthritis (KOA) treatment were Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC pain, function, stiffness, and total scores) at 1, 3, 6, and 12 months; International Knee Documentation Committee (IKDC) scores, Lequesne Index score, Visual Analog Scale (VAS) scores, EQ-VAS scores, and KOOS scores. The pooled data were analyzed by Stata 12.0. Results A total of 20 RCTs were enrolled in the present meta-analysis. The pooled results demonstrated that platelet-rich plasma (PRP) injection reduced pain more effectively than hyaluronic acid (HA) injection at 6-month and 12-month follow-up evaluated by WOMAC pain scores and VAS scores. EQ-VAS in the patients treated with PRP injection was lower than that in patients with HA injection at 12 months. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1-month, 3-month, 6-month, and 12-month follow-up, as evaluated by WOMAC function scores. WOMAC total scores showed significant difference at 6-month and 12-month follow-up. The IKDC scores indicated PRP injection was significantly more effective than HA injection at 3 months and 6 months. However, the Lequesne Index scores, KOOS scores, and adverse events did not show any significant difference between groups. Conclusion Intra-articular PRP injection appeared to be more efficacious than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection did not increase the risk of adverse events compared to HA injection.

The mechanism of action of platelet-rich plasma for knee osteoarthritis: a systematic review

“…Therefore, intra-articular injections of PRP might be considered as a disease-modifying effects therapy. Furthermore, a clinical superiority of PRP injections over other intra-articular therapies such as hyaluronic acid has been described 64,65 . Despite the above, the controversy regarding the use of PRP also lies in the results of some well-conducted controlled clinical trials.…”

Role of Platelets in Osteoarthritis—Updated Systematic Review and Meta-Analysis on the Role of Platelet-Rich Plasma in Osteoarthritis

“…In the 20 randomized controlled trials (RCTs) enrolled in their meta-analysis in 2020, it was shown that PRP has a better analgesic effect than HA in long-term recovery (at the 6-month and 12-month follow-ups) and also leads to better functional recovery in 12 months. The risk of adverse events was not increased compared with HA [ 95 ]. Similar observations were noted by Trams et al in their meta-analysis [ 96 ].…”

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

“…Two meta-analyses, of 12 and 10 studies, respectively, comparing the effects of PRP and HA, found that patients in the PRP group showed a statistically significant difference in pain reduction (measured by VAS and WOMAC pain scales) at 6 and 12 months’ follow-up, while there was no observed difference for clinical outcomes measured by KOOS and other WOMAC scales [ 76 , 81 ]. Meta-analyses, including 20 and 15 studies respectively, comparing PRP to HA by Tang et al and Han et al demonstrated a positive effect for both pain and function scores, and a meta-analysis by Zhang et al reported an improvement in the WOMAC function score at 12 months’ follow-up, while there was no significant difference between methods at 6 months after the treatment [ 82 , 83 , 84 ]. A meta-analysis by Chen et al found that WOMAC total scores superiorly improved in patients treated with PRP compared with patients treated with HA [ 85 ].…”