Platelet-rich plasma vs platelet-rich plasma plus hyaluronic acid for haemophilic knee arthropathy treatment

Abstract

Repeated joint bleeding leads to chronic synovitis, cartilage damage and bone alterations which result in haemophilic arthropathy and are associated with pain, functional impairment and poor quality of life. There are evidence that Hyaluronic Acid (HA) and Platelet-rich Plasma (PRP) have different mechanisms of action in the treatment of arthropathy for this reason we decided to use both components. The aim of this study is to compare, the efficacy, safety and duration of a single intra-articular injection of PRP against PRP+HA for pain, bleeding episodes and joint health, in the same patient with bilateral hemophilic knee arthropathy. Twenty-one men patients (42 knee joints) were treated with intra- articular injections of PRP or PRP+HA. All of them were haemophilia type A severe. The mean age was 36.6 years (21-72). All patients were evaluated for: Haemophilia Joint Health Score (HJHS), pain (VAS), the number of bleeding episodes (BE) in the last 30 days, before treatment, at three and six months after treatment. Statistically significant improvement were shown for both knee joints at three and six months after treatment for VAS and BE (P < 0.00001). The HJHS score did not significantly improve for either knee in the 6-month period after injection. A single PRP or PRP+HA injection is safe and effective in treating haemophilic arthropathy of the knee for up to 6 months follow-up, reducing pain, bleeding episodes and delaying total knee arthroplasty.

Intraarticular management of chronic haemophilic arthropathy (Review)

“…A prospective, non-randomized and parallel study on 21 patients with bilateral knee involvement compared one knee receiving PRP with the contralateral knee receiving PRP + HA. At 3 and 6 months, both knees improved significantly (pain relief, function, bleeding episodes and quality of life); there was no difference between them, while there was a subjective better evolution in the PRP + HA knees ( 23 ).…”

“…As for the involved joints, most of the cited papers addressed a variety of affected joints in the same approach (knee, ankle, shoulder, wrist). A total of 7 papers focused on the knee ( 7 , 9 , 11 , 19 , 20 , 22 , 23 ) and 3 papers on the ankle ( 13 , 18 , 24 ).…”

Pediatric Hemophilic Arthropathy of the Knee: Treatment With Circular External Fixator and Intra-articular Injection of Platelet-Rich Plasma

“…These patients would develop severe arthropathy early in their adolescence, affecting mobility and quality of life, with the knees and ankles most frequently affected. The conservative treatment of fixed flexion deformities of the knee includes physiotherapy and orthotic devices [ 5 ]. However, in cases such as the one presented above, surgical intervention is indicated, as the fixed contracture of the knee had greatly deteriorated the quality of life of the patient.…”

Blood-Induced Arthropathy: A Major Disabling Complication of Haemophilia

“…Recently, the effectiveness of intra-articular injections of PRP or hyaluronic acid, both of which are already used in other rheumatological conditions, has been investigated [ 79 ]. This showed that, in the presence of growth factors from the PRP administered to an inflamed joint, synovial fibroblasts increase their production and secretion of hyaluronic acid and VEGF, which could enhance hyaluronic acid levels and better regulate angiogenesis in joints affected by HA [ 80 ].…”