Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis

Abstract

Purpose: The benefit of adjuvant medications, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), following arthrocentesis remains controversial. The purpose of this study was to evaluate the efficacy of PRP and HA injection following arthrocentesis in subjects with symptomatic temporomandibular joint osteoarthritis (TMJ-OA).

Methods and materials: The authors implemented a prospective randomized single-blinded pilot clinical study. Healthy adults diagnosed with TMJ-OA who were treated with nonsurgical treatments initially, but failed to respond, participated in this study. Subjects were randomly allocated to HA, PRP, or combined HA+PRP groups following arthrocentesis. The primary outcome variable was the change in pain at 1 and 6 months postoperatively, using the Visual Analogue Scale (VAS). The secondary outcome variables were the changes in maximum mouth opening (MMO), lateral and protrusive mandibular movements, and pathologic TMJ sounds at 1 and 6 months postoperatively. Descriptive and bivariate statistics were computed. The significance level was set at P value < .05, using SPSS 19.

Results: A total of 30 consecutive patients (15 males and 15 females) with a mean age of 29.63 ± 8.34 years were followed for 6 months in this study. The mean reduction in pain at 6 months was 4.1 ± 0.9, 4.1 ± 1.1, and 5.1 ± 1.0 for HA, PRP, and HA/PRP, respectively (P < .05). In all 3 treatment groups, mean VAS parameters had significantly reduced after treatment and these postoperative values were significantly lower in the PRP+HA group (P < .001). The mean increase of MMO after 6 months was 8.0 ± 2.8, 8.0 ± 3.0, and 10.1 ± 3.3 for HA, PRP, and HA/PRP, respectively (P < .05). MMO, lateral, and protrusive mandibular movements significantly improved after treatment in all 3 groups (P < .001). TMJ noises were significantly reduced in all treatment groups (P < .001), but the PRP+HA group exhibited a greater reduction.

Conclusion: Combined HA and PRP injection following arthrocentesis is more effective than HA or PRP alone in the management of TMJ-OA.