Comparing the efficacy of dual Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Abstract

Purpose: This study aims to compare the efficacy of a dual therapy of Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) compared with PRP-alone therapy in the treatment of knee osteoarthritis (KOA).

Methods: PubMed, Embase, CINAHL, SCOPUS, Cochrane Library, grey literature and bibliographic references were searched from inception to January 2021. Only randomized controlled trials (RCTs) and retrospective cohort studies comparing the effect of PRP and HA versus PRP-alone therapy for KOA were included. Literature retrieval and data extraction were conducted by three independent reviewers. Pooled analysis of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), International Knee Documentation Committee (IKDC) scores and adverse events were conducted.

Results: Ten studies (7 RCTs, 3 cohort studies) involving 983 patients were covered. Dual PRP and HA therapy resulted in significant reduction in VAS compared to PRP-alone therapy at 4-6 weeks (P < 0.00001) and 12 months (P < 0.00001). Dual therapy resulted in better WOMAC score improvement at 3 (P = 0.02), 6 (P = 0.05) and 12 months (P < 0.0001) compared to PRP-alone therapy. The IKDC score for dual therapy was also higher at 6 months compared to PRP-alone therapy (P = 0.007). Regarding adverse events, dual therapy was generally safer than PRP-alone therapy (P = 0.02).

Conclusion: While there is a paucity of large high-quality Level I studies, current best evidence suggests that dual therapy with PRP and HA for KOA may be effective at providing pain relief and improvement in function up to 1 year following administration.

Level of evidence: II.

Keywords: Hyaluronic acid; Knee osteoarthritis; Platelet-rich plasma.

Fig. 1

Showing the PRISMA flowchart of the study search process

Fig. 2

Detailing the quality assessment of the 7 RCTs using the Cochrane ROB tool

Fig. 3

Detailing the quality assessment of the 3 cohort studies using the ROBINS-I tool. Green: Low risk, Yellow: Moderate risk, Orange: Serious risk, Red: Critical risk

Fig. 4

Showing the Forest plot comparing the VAS scores between PRP + HA and PRP at baseline

Fig. 5

Showing the Forest plot comparing the VAS scores between PRP + HA and PRP at 4–6 weeks after treatment

Fig. 6

Showing the Forest plot comparing the VAS scores between PRP + HA and PRP at 3 months after treatment

Fig. 7

Showing the Forest plot comparing the VAS scores between PRP + HA and PRP at 6 months after treatment

Fig. 8

Showing the Forest plot comparing the VAS scores between PRP + HA and PRP at 12 months after treatment

Fig. 9

Showing the Forest plot comparing the change in VAS scores between PRP + HA and PRP post-treatment

Fig. 10

Showing the Forest plot comparing the WOMAC function scores between PRP + HA and PRP at baseline

Fig. 11

Showing the Forest plot comparing the WOMAC function scores between PRP + HA and PRP at 3 months after treatment

Fig. 12

Showing the Forest plot comparing the WOMAC function scores between PRP + HA and PRP at 6 months after treatment

Fig. 13

Showing the Forest plot comparing the WOMAC function scores between PRP + HA and PRP at 12 months after treatment

Fig. 14

Showing the Forest plot comparing the change in WOMAC function scores between PRP + HA and PRP post treatment

Fig. 15

Showing the Forest plot comparing the IKDC scores between PRP + HA and PRP at baseline

Fig. 16

Showing the Forest plot comparing the IKDC scores between PRP + HA and PRP at 6 months after treatment

Fig. 17

Showing the Forest plot comparing the change in IKDC scores between PRP + HA and PRP post-treatment

Fig. 18

Showing the Forest plot comparing the incidence of adverse events between PRP+ HA and PRP