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

Abstract

Purpose To systematically evaluate the curative efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA), comparing with platelet-rich plasma alone. Methods Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) and Embase were searched for randomized controlled trials (RCTs) and cohort studies regarding the efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA) comparing with platelet-rich plasma alone before January 15, 2022. The methodological quality of the ultimately included studies was assessed comprehensively, and meta-analysis was implemented using RevMan 5.3 software. Results Thirteen articles (9 RCTs, 4 cohort studies), including 1118 patients, were covered. There was no significant difference between the PRP + HA therapy and PRP-alone therapy in VAS scores at 3 months, 6 months and 12 months, WOMAC total scores at 3 months and KOOS at 1 month and 6 months. Compared with PRP-alone therapy, PRP + HA therapy was associated with significantly better improvement in VAS scores at 1 month, WOMAC total scores at 6 months, KOOS at 3 months, IKDC scores at 6 months and Lequesne index scores at 3 and 6 months. However, the smallest treatment effect of VAS scores, WOMAC total scores, KOOS and IKDC scores did not exceed the minimum clinically important difference (MCID). However, PRP + HA therapy got a greater reduction in the rate of adverse events, compared with PRP-alone therapy. Conclusion The results of this meta-analysis indicated that PRP + HA therapy was not found to be superior to PRP-alone therapy in pain relief and function improvement for patients with KOA. However, combined PRP with HA injections was generally safer than PRP injections alone, by assessing the incidence of adverse events.

Arthroscopically assisted versus open reduction internal fixation for ankle fractures: a systematic review and meta-analysis

“…3 B). Zhang et al determined the MCID for the VAS score to be 1.16 in a systematic review [ 23 ]. The pooled results in our meta-analysis showed that the smallest improvement seen in the VAS score (− 0.36) did not exceed the MCID (1.16), indicating that although the VAS score was statistically significant, it may not have a meaningful clinical impact.…”

“…The VAS score was to quantitatively evaluate the pain intensity, with lower scores indicating less pain [ 29 ]. The pooled MD in the VAS score (− 0.36) was also below the MCID (1.16), suggesting that the improvement in pain intensity was not deemed to be clinically significant [ 23 ].…”

Research trends of platelet-rich plasma therapy on knee osteoarthritis from 2011 to 2021: A review

“…However, in the incidence of adverse events, PRP combined with HA is usually safer than PRP injection alone. [ 22 ] In a review by Brian J. Cole, it was shown that there are various devices used to centrifuge PRP and that differences in centrifugation speed and duration result in differences in platelet and leukocyte concentrations, and it was suggested that treating the knee with leukocyte-depleted PRP early in KOA could prevent or slow the onset of advanced KOA. [ 23 ] The second-ranked author, Giuseppe Filardo, from the IRCCS Rizzoli Orthopaedic Institute in Bologna, Italy, showed in a 5-year double-blind, randomized controlled trial with Elizaveta Kon that both PRP and HA were effective in improving knee function, but follow-up failed to show that PRP had a clinical effect was better than that of HA.…”

SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma

“…These results could be explained by better inflammation downregulation, particularly on the infrapatellar fat pad and the synovial membrane [29]. Nevertheless, other meta-analyses did not prove any superiority of PRP combined with HA compared to PRP alone [30]. Cellular analyses demonstrated a twofold increase in platelet concentration.…”