An exploratory comparison of single intra‐articular injection of platelet‐rich plasma vs hyaluronic acid in treatment of haemophilic arthropathy of the knee

Abstract

Introduction Intra‐articular platelet‐rich plasma (PRP) injection therapy has been extensively applied in clinical practice to treat musculoskeletal disorders such as osteoarthritis, but the treatment for haemophilic arthropathy is rarely reported. Aims This study aimed to compare the efficacy of intra‐articular PRP vs hyaluronic acid (HA) injections in treating haemophilic arthropathy of knee joints. Patients Twenty‐two haemophilia patients (mean age, 41.1 ± 1.7 [range, 20‐50] years) with painful haemophilic arthropathy of the knee were enrolled for this open‐label and observer‐blind study. Methods Eleven patients were treated with a single intra‐articular injection of PRP and the other 11 received five consecutively weekly intra‐articular injections of HA. Outcome assessment included pain by visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Chinese Version and synovial change determined by ultrasonography. Results Platelet‐rich plasma and HA intra‐articular injection showed statistically significant reduction in VAS, WOMAC total score and hyperaemia score from baseline to 6‐month post‐treatment. Inter‐group comparison showed statistically significant difference in the change in VAS score, WOMAC pain score, physical function score and total score at 6 months, wherein PRP group showed sustained beneficial effect than HA group at 6 months. Conclusion Our study demonstrates that, in comparison with five weekly injections of HA, a single PRP injection resulted in better improvement in pain relief and knee joint function, and greater reduction in synovial hyperaemia for up to 6 months. Our results suggest that PRP may be practical and effective for haemophilic knee arthropathy, and further investigation is warranted.

Age‐related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia

“…In this regard, regular prophylactic therapy should be the most effective treatment for synovial hyperplasia in patients aged ≤10 years, but insufficient for older patients, who may benefit from extra-local therapies, such as radiosynovectomy 19 and intra-articular drug injection. [20][21][22][23][24] Unlike synovial hypertrophy, the osteochondral subscores increased with age in the knee, elbow and overall joints mainly before 30 years of age, then elevated slightly or remained stable. Although not distinct, a similar tendency of ankle osteochondral progression could be concluded.…”

“…tissue and osteochondral alterations in HA [15][16][17][18]. In this regard, regular prophylactic therapy should be the most effective treatment for synovial hyperplasia in patients aged ≤10 years, but insufficient for older patients, who may benefit from extra-local therapies, such as radiosynovectomy19 and intra-articular drug injection [20][21][22][23][24]. Synovial hyperplasia is thought to be a reversible pathological process caused by joint bleeding, 1 but repeated haemarthroses or occult subclinical bleeding tend to cause chronic synovitis, which is harder to eliminate.…”

Inhibition of Fenton reaction is a novel mechanism to explain the therapeutic effect of intra‐articular injection of PRP in patients with chronic haemophilic synovitis

“…25 Alternatively, the intra-articular injection of blood-derived autologous PRP has emerged as a novel therapeutic approach for CHS. [11][12][13][14] Regenerative treatments with platelets are used in several medical fields including orthopaedic and traumatology for the treatment of joint pathologies such us rheumatoid arthritis and osteoarthritis, where platelets-derived growth factors reduce joint inflammation and improve several biological responses mediated by synoviocytes, chondrocytes and osteoblasts. 26,27 Unlike the biological mechanisms stablished for these pathologies, the therapeutic mechanisms underlying PRP in haemophilic joint damage has been never studied leading to questioning the use of PRP in this pathology.…”

“…In this context, different clinical groups including us have recently reported that intra-articular injection of blood-derived autologous platelet-rich plasma (PRP) improves the Health Joint Haemophilia Score (HJHS) and reduces bleeding episodes and pain in patients with chronic haemophilic synovitis (CHS). [11][12][13][14] Local administration of PRP is a simple and accessible regenerative protocol based on the action of platelet-derived growth factors, and it is used for several clinical conditions including diabetic foot ulcers, burns, and muscle, bone and joint injuries. [15][16][17] Unlike these pathologies, the therapeutic mechanisms underlying PRP in CHS have been never studied leading to questioning the use of PRP in this pathology.…”

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

“…demonstrated that joint lavage followed by injections of triamcinolone and Hylan G-F 20 (viscosupplement) improved balance, function, and bleeding events in patients with severe HA 73 , and Li et al . suggest that a single intra-articular platelet-rich plasma injection results in better improvement in pain relief, joint function, and reduced synovial hyperemia when compared with five weekly intra-articular injections of hyaluronic acid in patients with HA of the knee 74 .…”