Comparing the efficacy of dual Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Abstract

Purpose This study aims to compare the efficacy of a dual therapy of Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) compared with PRP-alone therapy in the treatment of knee osteoarthritis (KOA). Methods PubMed, Embase, CINAHL, SCOPUS, Cochrane Library, grey literature and bibliographic references were searched from inception to January 2021. Only randomized controlled trials (RCTs) and retrospective cohort studies comparing the effect of PRP and HA versus PRP-alone therapy for KOA were included. Literature retrieval and data extraction were conducted by three independent reviewers. Pooled analysis of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), International Knee Documentation Committee (IKDC) scores and adverse events were conducted. Results Ten studies (7 RCTs, 3 cohort studies) involving 983 patients were covered. Dual PRP and HA therapy resulted in significant reduction in VAS compared to PRP-alone therapy at 4–6 weeks (P < 0.00001) and 12 months (P < 0.00001). Dual therapy resulted in better WOMAC score improvement at 3 (P = 0.02), 6 (P = 0.05) and 12 months (P < 0.0001) compared to PRP-alone therapy. The IKDC score for dual therapy was also higher at 6 months compared to PRP-alone therapy (P = 0.007). Regarding adverse events, dual therapy was generally safer than PRP-alone therapy (P = 0.02). Conclusion While there is a paucity of large high-quality Level I studies, current best evidence suggests that dual therapy with PRP and HA for KOA may be effective at providing pain relief and improvement in function up to 1 year following administration. Level of evidence II.

Efficacy and safety of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone for knee osteoarthritis: a systematic review and meta-analysis

“…Zhao et al found that compared with PRP alone, PRP + HA may have better clinical efficacy in the treatment of KOA [ 52 ]. Aw et al found that compared with PRP alone, PRP + HA may be effective at providing pain relief and improvement in function up to 1 year following administration in the treatment of KOA [ 53 ]. However, there was a discrepancy between our conclusions and theirs.…”

“…Intra-articular injection therapy is recognized as a feasible non-operative treatment of KOA and traditionally included hyaluronic acid (HA) or glucocorticoid as means of promoting joint lubrication, reducing joint inflammation, and reducing pain [ 5 – 7 ]. Recently, clinicians have treated KOA with intra-articular injections of hyaluronic acid (HA), platelet-rich plasma (PRP) and bone marrow concentrate (BMAC) [ 8 ].…”

Platelet-Rich Plasma One Week Prior to Hyaluronic Acid vs. Platelet-Rich Plasma Alone for the Treatment of Knee Osteoarthritis

“…Knee osteoarthritis (OA) is the most recognized form of OA, responsible for approximately 4/5th of the global burden of the OA [ 1 ]. The prevalence of knee OA has continued to increase over the last few decades with no indications of deceleration [ 1 ].…”

“…Knee osteoarthritis (OA) is the most recognized form of OA, responsible for approximately 4/5th of the global burden of the OA [ 1 ]. The prevalence of knee OA has continued to increase over the last few decades with no indications of deceleration [ 1 ]. Its pathophysiology involves synovial tissue inflammation and articular cartilage deterioration, leading to debilitating pain and loss of function [ 2 , 3 ].…”

“…In addition, there are some recent studies that evaluated the feasibility of combining PRP and HA as a dual therapy and compared it with PRP-alone therapy. The results from these studies reported a significant reduction in Visual Analogue Scale (VAS), and improvement in Western Ontario and McMaster Universities Arthritis Index (WOMAC) and International Knee Documentation Committee (IKDC) scores in the PRP plus HA group compared to PRP alone up to 1 year post-injection [ 1 , 6 ]. The potential additive benefits of combining PRP with HA to treat knee OA can be attributed to their disparate biological mechanisms, i.e., the regenerative ability of PRP and rheological properties of HA, to augment the activity of signal molecules, including growth factors, cytokines, inflammatory molecules, and catabolic enzymes [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”