Plasma vs. Hyaluronic Acid Injections for Knee Osteoarthritis

by | Jun 23, 2020 | 2019, Arthritis, Joint Health

Written by Jessica Patella, ND. Injections of platelet-rich plasma or hyaluronic acid were equally effective treatments in the 192 study participants with knee osteoarthritis.

joint healthOsteoarthritis is the most common form of arthritis in the United States and is more common in women 1.  Osteoarthritis is also one of the causes of work disability, with an annual cost of $304 billion 1.  Since it is so common and is associated with large costs, many seek alternative treatments, but the questions is how effective are these alternatives compared to the standard treatments?  A recent study over 5-years evaluated the long-term effects of both platelet-rich plasma and hyaluronic acid injections for knee osteoarthritis 2.

Platelet-rich plasma has gained interest in the last decade for musculoskeletal diseases because it can deliver platelet-derived growth factor to the tissues, which could reduce inflammation and improve the healing of the local tissues, without the side effects because it’s from the individuals own cells 2,3.  Despite the lack of studies, platelet-rich plasma has been used instead of more traditional injections of hyaluronic acid and corticosteroids 2,4.

The research included 192 participants with knee osteoarthritis.  The participants had to have symptomatic knee pain that was verified by imaging showing degenerating of cartilage in the knee.  The participants were then randomly assigned to either the platelet-rich plasma group (3 weekly intra-articular injections) or the hyaluronic acid group (3 weekly administrations).  To keep the study double blinded, all patients underwent blood collection to obtain platelet-rich plasma.  The syringe was covered to prevent patients from discovering which injection they were receiving 2.

Patients were evaluated before the injection and again at 2, 6, 12, and 24 months after the last injection.  The following results were observed:

  • Both the platelet-rich plasma and hyaluronic acid improved knee functioning and symptoms over time (p<0.0005, based on International Knee Documentation Committee, evaluation tools)
  • Sport activity level showed an improvement from pretreatment to 2 months (P<0.0005), then values stabilized, until the 2-year follow-up which showed a gradual return to pretreatment levels (Via Tegner score) with both the platelet-rich plasma and hyaluronic acid groups
  • The median duration of subjective symptom relief was 9 months for hyaluronic acid and 12 months for platelet-rich plasma.
  • The only statistically significant difference between the groups was reintervention rate at 24 months, which is the number of participants that underwent an additional injection or surgical treatment. The hyaluronic acid group had a higher percentage of reintervention (37.1%) compared with the platelet-rich plasma group (22.6%) (P=0.036)

In conclusion, there was no significant difference clinically between platelet-rich plasma and hyaluronic acid injections for long-term treatment of osteoarthritis of the knee, therefore both treatment types were effective.

Source: Di Martino, Alessandro, Berardo Di Matteo, Tiziana Papio, Francesco Tentoni, Filippo Selleri, Annarita Cenacchi, Elizaveta Kon, and Giuseppe Filardo. “Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial.” The American journal of sports medicine 47, no. 2 (2019): 347-354.

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© 2018 The Author(s)

Posted June 23, 2020.

Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health. She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at www.awarenesswellness.com.

References:

  1. Centers for Disease Control and Prevention. Arthritis-Related Statistics. 2018; https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm. Accessed June 14, 2020.
  2. Di Martino A, Di Matteo B, Papio T, et al. Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial. The American journal of sports medicine. 2019;47(2):347-354.
  3. Grassi A, Napoli F, Romandini I, et al. Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis. Sports medicine (Auckland, NZ). 2018;48(4):971-989.
  4. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46-54.