Comparison between the effect of platelet rich plasma (PRP) and hyaluronic acid local injection in treatment of thumb carpometacarpal joint osteoarthritis

Abstract

Base of the thumb OA represents one of challenges to clinicians due to limited efficacy of treatment options. Resulting in OA pain, in addition it can cause deformity, stiffness with decreased range of motion and strength. The conservative therapeutic approach is the main line in management. Local injection treatment could be a good choice because of low systemic side effects and rapid improvement. Objectives to compare the effectiveness of PRP versus hyaluronic acid injection in osteoarthritis of thumb carpometacarpal joint based on clinical and functional outcome measures. Patients and Methods Prospective interventional study conducted on thirty patients with thumb CMC OA. Patient was assessed by joint Palpation for tenderness with grading from I-IV, Provocative tests (Grind test and Lever test), VAS for pain, AUSCAN score, grip and pinch strength. The patients were randomly divided into two equal groups, Group 1: received single Platelet-Rich Plasma (PRP) intra-articular injection. Group 2 received single hyaluronic acid injection. Re-evaluation at 4 and 12 weeks was done for tenderness, VAS, AUSCAN index, Grip and pinch strength. Results This study was conducted on thirty patients with ages ranged from 40 to 70 years (mean: 52.77 ± 8.59). Our results revealed that both groups showed a highly significant improvement after 4 weeks regarding pain relief assessed by VAS, tenderness grading, AUSCAN hand function score, grip and pinch strength after injection in comparison to before injection (P = 0.000). However, these improvement couldn’t be sustained for the PRP group after 12 weeks, there was a highly statistically significant increase (deterioration) in hand functional score from 4 to 12 weeks follow up (P = 0.000) and total score (P = 0.004) , highly statistically increase in VAS(P = 0.000) and decrease in grip & pinch strength (P = 0.000) , while HA group showed a highly statistically significant improvement regarding pain, hand function score , grip and pinch strength after 12 weeks of injection. Conclusion We observed clinical improvement in both groups of CMC OA treated either with single dose of HA or PRP at 4 and 12 weeks follow up. However, HA provide a superior improvement with respect to PRP at 12 weeks follow up regarding VAS for pain, joint tenderness, AUSCAN hand function score, grip and pinch strength. So we support the use of a single hyaluronic acid injection as therapy for thumb CMC OA in preference to PRP injection.