Iain Duncan 2018
We have now successfully undertaken a series of platelet rich plasma (PRP) and hyaluronic acid injections for OA knee and many have had more advanced disease than is ideal (the best responders have the least radiological changes), but ~80% have had longer and better responses to PRP or viscosupplementation than earlier intra-articulator corticosteroid treatments. This is a similar response rate to tendon tears.
One recent review and one recent trial has prompted me to do this brief update on PRP and viscosupplementation therapy for knees.
The review in Arthroscopy1 concluded PRP “is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months”. Furthermore intra-articular PRP therapy “offers better symptomatic relief to patients with early knee degenerative changes, and its use should be considered in patients with knee OA”.
This late 2017 randomised double blind placebo controlled trail has shown unequivocal benefit of PRP for OA knees2.
- A total of 162 patients with different stages of knee OA were randomly divided into four groups: each had 3 injections each: 3 IA doses of PRP, one dose of PRP, 3 inj of HA (hyaluronic acid) or a saline injection (control).
- Two subgroups: early OA (Kellgren–Lawrence grade 0 with cartilage degeneration or grade I–III) and advanced OA (Kellgren–Lawrence grade IV).
- The patients were evaluated before the injection and at the 6-month follow- ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores.
- There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group.
- The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA.
- In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups.
The clinical results of this study suggest intra-articular PRP and HA treatment for all stages of knee OA.
For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results.
For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group.
- Sheth U; Dwyer T; Smith I; Wasserstein D; Theodoropoulos J; Takhar S; Chahal J. Does Platelet-Rich Plasma Lead to Earlier Return to Sport When Compared With Conservative Treatment in Acute Muscle Injuries? A Systematic Review and Meta-analysis. Arthroscopy. 2015; 31(11):2213-21
- Görmeli et al (2017). Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy,25(3), 958–965. https://doi.org/10.1007/s00167-015-3705-6