PLATELET-RICH PLASMA VERSUS HYALURONIC ACID FOR TREATMENT OF KNEE OSTEOARTHRITIS
Main Article Content
Keywords
Platelet-rich plasma, Hyaluronic acid, Osteoarthritis, Knee, Pain
Abstract
BACKGROUND: Platelet-rich plasma (PRP) and hyaluronic acid have been shown to be useful in the treatment of knee osteoarthritis. However, investigations comparing the efficacy of these two drugs together are insufficient.
AIM: To compare the outcomes of PRP vs hyaluronic acid injections in three groups of patients with bilateral knee osteoarthritis.
METHODS: This randomized controlled trial study involved 95 patients. Thirty-one subjects received a single injection of PRP (group PRP-1), 33 subjects received two injections of PRP at an interval of 3 wk (group PRP-2) and 31 subjects received three injections of hyaluronic acid at 1-wk intervals (group hyaluronic acid). The patients were investigated prospectively at the enrollment and at 4-, 8- and 12-wk follow-up with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale questionnaires.
RESULTS: Percentages of patients experiencing at least a 30% decrease in the total score for the WOMAC pain subscale from baseline to wk 12 of the intervention were 86%, 100% and 0% in the groups PRP-1, PRP-2 and hyaluronic acid, respectively (P < 0.001). The mean total WOMAC scores for groups PRP-1, PRP-2 and hyaluronic acid at baseline were 63.71, 61.57 and 63.11, respectively. The WOMAC scores were significantly improved at final follow-up to 42.5, 35.32 and 57.26, respectively. The highest efficacy of PRP was observed in both groups at wk 4 with about 50% decrease in the symptoms compared with about 25% decrease for hyaluronic acid. Group PRP-2 had higher efficacy than group PRP-1. No major adverse effects were found during the study.
CONCLUSION: PRP is a safe and efficient therapeutic option for treatment of knee osteoarthritis. It was demonstrated to be significantly better than hyaluronic acid. We also found that the efficacy of PRP increases after multiple injections.
References
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13. Ringdahl E, Pandit S. Treatment of knee osteoarthritis. Am Fam Physician. 2011;83:1287–1292. [PubMed] [Google Scholar]
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15. Say F, Gürler D, Yener K, Bülbül M, Malkoc M. Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis. Acta Chir Orthop Traumatol Cech. 2013;80:278–283. [PubMed] [Google Scholar]
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17. Glynn LG, Mustafa A, Casey M, Krawczyk J, Blom J, Galvin R, Hannigan A, Dunne CP, Murphy AW, Mallen C. Platelet-rich plasma (PRP) therapy for knee arthritis: a feasibility study in primary care. Pilot Feasibility Stud. 2018;4:93. [PMC free article] [PubMed] [Google Scholar]
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19. Knop E, Paula LE, Fuller R. Platelet-rich plasma for osteoarthritis treatment. Rev Bras Reumatol Engl Ed. 2016;56:152–164. [PubMed] [Google Scholar]
20. Hamid MS, Yusof A, Mohamed Ali MR. Platelet-rich plasma (PRP) for acute muscle injury: a systematic review. PLoS One. 2014;9:e90538. [PMC free article] [PubMed] [Google Scholar]
21. Blanke F, Vavken P, Haenle M, von Wehren L, Pagenstert G, Majewski M. Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions. Muscles Ligaments Tendons J. 2015;5:162–166. [PMC free article] [PubMed] [Google Scholar]
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24. Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012;20:2082–2091. [PubMed] [Google Scholar]
25. Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016;32:495–505. [PubMed] [Google Scholar]
26. Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25:958–965. [PubMed] [Google Scholar]
27. Rubio-Azpeitia E, Andia I. Partnership between platelet-rich plasma and mesenchymal stem cells: in vitro experience. Muscles Ligaments Tendons J. 2014;4:52–62. [PMC free article] [PubMed] [Google Scholar]
28. Stessuk T, Puzzi MB, Chaim EA, Alves PC, de Paula EV, Forte A, Izumizawa JM, Oliveira CC, Frei F, Ribeiro-Paes JT. Platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells: stimulatory effects on proliferation and migration of fibroblasts and keratinocytes in vitro. Arch Dermatol Res. 2016;308:511–520. [PubMed] [Google Scholar]
29. Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321. [PMC free article] [PubMed] [Google Scholar]
30. Montañez-Heredia E, Irízar S, Huertas PJ, Otero E, Del Valle M, Prat I, Díaz-Gallardo MS, Perán M, Marchal JA, Hernandez-Lamas Mdel C. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System. Int J Mol Sci. 2016;17 [PMC free article] [PubMed] [Google Scholar]
31. McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence. 2012;6:905–910. [PMC free article] [PubMed] [Google Scholar]
32. Bowman EN, Hallock JD, Throckmorton TW, Azar FM. Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment. Int Orthop. 2018;42:733–740. [PubMed] [Google Scholar]
33. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049. [PubMed] [Google Scholar]
34. Köse Ö, Acar B, Çay F, Yilmaz B, Güler F, Yüksel HY. Inter- and Intraobserver Reliabilities of Four Different Radiographic Grading Scales of Osteoarthritis of the Knee Joint. J Knee Surg. 2018;31:247–253. [PubMed] [Google Scholar]
35. Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968;Suppl 277:7–72. [PubMed] [Google Scholar]
36. Nadrian H, Moghimi N, Nadrian E, Moradzadeh R, Bahmanpour K, Iranpour A, Bellamy N. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol. 2012;31:1097–1102. [PubMed] [Google Scholar]
37. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis. Arch Bone Jt Surg. 2014;2:57–62. [PMC free article] [PubMed] [Google Scholar]
38. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240–S252. [PubMed] [Google Scholar]
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Published
Nov 26, 2024
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Dr. Gaurav singh, Dr Vikas Mittal, & Dr Ajay Kumar Yadav. (2024). PLATELET-RICH PLASMA VERSUS HYALURONIC ACID FOR TREATMENT OF KNEE OSTEOARTHRITIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 588-595. https://doi.org/10.53555/r74sac39
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Author Biographies
Dr. Gaurav singh
Associate professor , department of orthopaedics, Maharshi Devraha Baba Autonomous state medical college, Deoria, Uttar pradesh
Dr Vikas Mittal
Assistant professor , department of orthpaedics, Maharshi Devraha Baba Autonomous state medical college, Deoria, Uttar Pradesh
Dr Ajay Kumar Yadav
Assistant professor , department of orthpaedics, Maharshi Devraha Baba Autonomous state medical college, Deoria, Uttar Pradesh
How to Cite
Dr. Gaurav singh, Dr Vikas Mittal, & Dr Ajay Kumar Yadav. (2024). PLATELET-RICH PLASMA VERSUS HYALURONIC ACID FOR TREATMENT OF KNEE OSTEOARTHRITIS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 588-595. https://doi.org/10.53555/r74sac39