Comparison of clinical efficiency between intra-articular injection of platelet-rich plasma and hyaluronic acid for osteoarthritis: a meta-analysis of randomized controlled trials

Abstract

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are non-surgical treatments for osteoarthritis (OA), but the comparison of their efficiency is still inconclusive.

Objectives: The objectives of this study were to compare the efficacy of PRP and HA in the treatment of OA by meta-analysis and to explore the effects of different injection times and leukocyte concentration on the efficacy of PRP.

Design: Meta-analysis and subgroup analysis were conducted. The data were analyzed by Review Manager v5.4.1.

Data sources and methods: Articles were retrieved and screened from PubMed, the Cochrane Library, Web of Science, and Embase. The outcome included the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS), adverse events (AEs), the International Knee Documentation Committee (IKDC), and the satisfaction rate.

Results: A total of 30 articles involving 2733 patients were included. The total WOMAC score and IKDC score of the PRP group were better than those of the HA group at the last follow-up time, while there was no significant difference in AEs, satisfaction rate, and VAS between the two groups. In our subgroup analysis, there was no significant difference between single-injection PRP and triple-injection PRP. Leukocyte-poor PRP (LP-PRP) was better than leukocyte-rich PRP (LR-PRP) in IKDC, but there was no significant difference between them in the other scores.

Conclusions: In the treatment of OA, compared with HA, PRP performed better in the improvement of the patient's function. There was no significant difference in VAS and AEs between the two groups, and the safety was comparable. LP-PRP looked to be superior to LR-PRP in functional recovery, but there appeared to be no significant difference in pain relief between them. There was no significant difference between single PRP and triple PRP in the subgroup analysis.

Keywords: hyaluronic acid; intra-articular injection; meta-analysis; osteoarthritis; platelet-rich plasma.

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Figure 2.

Forest plot showing mean difference in total WOMAC score between PRP and HA autografts. HA, hyaluronic acid; PRP, platelet-rich plasma; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.

Figure 3.

Forest plot showing mean difference in VAS score between PRP and HA autografts. HA, hyaluronic acid; PRP, platelet-rich plasma; VAS, visual analog scale.

Figure 4.

Forest plot show odds ratio in AEs between PRP and HA autografts. AEs, adverse events; HA, hyaluronic acid; PRP, platelet-rich plasma.

Figure 5.

Forest plot showing mean difference in IKDC between PRP and HA autografts. HA, hyaluronic acid; IKDC, International Knee Documentation Committee; PRP, platelet-rich plasma.