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Both HA and PRP linked with significantly improved pain relief in patients with knee OA
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Patients with knee osteoarthritis who received either platelet-rich plasma or hyaluronic acid injections experienced a significant improvement in pain relief at early follow-up, according to results.
“The findings of this study support a significant improvement in pain and function up to 24 weeks with a decline thereafter with the use of [platelet-rich plasma] PRP as well as [hyaluronic acid] HA for the treatment of [osteoarthritis] OA. PRP demonstrated a statistically significant improvement over HA at 24 [weeks] and 52 weeks after treatment. Our findings further suggest that both HA and PRP may be a superior treatment for patients with mild OA and low BMI,” the authors wrote.
In this level 1 study, researchers randomly assigned 111 patients with symptomatic, unilateral OA to receive either leukocyte-poor PRP (n=49) or HA (n=50) injections under ultrasound guidance. Researchers collected clinical data at baseline and at 2 weeks, 3 weeks, 6 weeks, 12 weeks, 24 weeks and 52 weeks. In addition, they collected synovial fluid before treatment and at 12 weeks and 24 weeks. Researchers assessed results using the WOMAC pain subscale, IKDC subjective knee evaluation, VAS for pain, Lysholm knee score and differences in intra-articular biochemical marker concentrations.
Although results showed no differences in the primary outcome of the WOMAC pain score between the groups, patients in the PRP group had a significantly higher IKDC score at 24 weeks and 52 weeks compared with patients in the HA group. Researchers noted patients in the PRP group also had a statistically lower VAS score at 24 weeks and 52 weeks. Researchers found an examination of fixed effects showed a statistically significant improvement in outcomes among patients with mild OA and a lower BMI. At 12-week follow-up, a biochemical analysis showed differences in interleukin-1beta and tumor necrosis factor-alpha approached significance between groups.
“Significant improvements were seen in other patient-reported outcome measures, with results favoring PRP over HA. Preceding a significant difference in subjective outcomes favoring PRP, there was a trend toward a decrease in two proinflammatory cytokines, which suggest that the anti-inflammatory properties of PRP may contribute to an improvement of symptoms,” the researchers wrote. – by Casey Tingle
Disclosures: Cole reports that he receives research support and material support from Aesculap/B. Braun, Arthrex, Athletico, Cytori, Medipost, NIH, Ossur, Smith & Nephew, Tornier and Zimmer; receives intellectual property royalties from and is a paid consultant for Arthrex, DJ Orthopaedics, Regentis, Zimmer, Smith & Nephew and Tornier; and owns stock or stock options in Carticept. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopAndrew D. Pearle, MD
This trial demonstrates modest improvement in pain and function with PRP. The investigators performed a prospective, randomized, blinded clinical study comparing low leukocyte PRP vs. Synvisc (Sanofi Biosurgery) in patients with knee OA. Ultrasound-guided intra-articular injections were given weekly for 3 weeks and patient-reported outcome measures (PROMS) were recorded up to 1 year after treatment.
Both the PRP and HA groups demonstrated an improvement in PROMs at 24 weeks that declined to near baseline levels at 1 year follow-up. No difference was noted between the HA and the PRP group using the WOMAC pain scale. The PRP group did demonstrate a significantly higher IKDC and lower VAS score at both 24 weeks and 1 year after treatment. The biochemical assay suggested the PRP group demonstrated greater interleukin-1beta and tumor necrosis factor-alpha in the synovial fluid at 12 weeks follow-up. Patients with lower grade OA and low BMI responded more favorably to intra-articular injections (HA or PRP).
This study provides further support for the use of low-leukocyte PRP intra-articular injections for management of symptoms in early stage OA. As the effect of PRP compared to HA appears to be modest and temporary, it remains unclear whether the benefits outweigh the cost to the patient, particularly if multiple PRP injections are required to produce the desired effects.
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