Efficacy of Platelet-Rich Plasma versus Hyaluronic Acid for treatment of Knee Osteoarthritis
A systematic review and meta-analysis
Keywords:
platelet-rich plasma; hyaluronic acid; efficacy, meta-analysisAbstract
Introduction: Knee osteoarthritis is a very common chronic degenerative disease that could impose significant costs to the health system. Although osteoarthritis can affect all joints, knee osteoarthritis is the most common type among adolescents. Non-surgical treatments include corticosteroids injection, hyaluronic acid, and platelet-rich plasma. The aim of this study was to investigate the efficiency of platelet-rich plasma versus hyaluronic acid for the treatment of knee osteoarthritis.
Methods: Pubmed, Cochran library, Scopus and Ovid databases were investigated to identify related studies from 2000 through August 2015. To study the efficiency, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) outcome using the Standard Mean Difference (SMD) index was calculated using a random model and a confidence interval of 95%. In addition, sensitivity and cumulative analysis were conducted. The data were analyzed using RevMan 5.3.5 and Stata 12 software.
Results: Seven studies with 722 subjects (364 participants in PRP and 358 participants in the HA group) were analyzed. The WOMAC PRP compared to HA, SMD = -0.75 (95% CI: -1.33 to -0.18, I2 = 92.6%) in treatment of knee osteoarthritis was statistically significant and PRP was more effective.
Conclusion: The results of this meta-analysis two years after PRP injection showed the efficacy of PRP versus HA. However, further studies are required to determine the longer-term effects.
References
Wong LY, Yiu RL, Chiu CK, Lee WK, Lee YL, Kwong PK, et al. Prevalence of Psychiatric Morbidity in
Chinese Subjects with Knee Osteoarthritis in a Hong Kong Orthopaedic Clinic. East Asian Arch Psychiatry
; 25: 150-8.
Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis
Cartilage 2013; 21: 16-21. doi: 10.1016/j.joca.2012.11.012, PMid: 23194896
Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ.
Arthritis Rheum 2012; 64: 1697-707. doi: 10.1002/art.34453, PMid:22392533, PMCid: PMC3366018
Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone 2012; 51: 249-57.
doi: 10.1016/j.bone.2012.02.012, PMid: 22387238, PMCid: PMC3372675
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013; 21: 1145-53.
doi: 10.1016/j.joca.2013.03.018, PMid: 23973124, PMCid: PMC3753584
Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis and treat¬ment of
osteoarthritis of the knee. Dtsch Arztebl Int 2010; 107: 152-62. PMid: 20305774, PMCid: PMC2841860
Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, et al. Comparison of the prevalence of knee
osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The
Beijing Osteoarthritis Study Arthritis Rheum 2001; 44: 2065-71. doi: 10.1002/1529- 0131(200109)44:9<2065::AID-ART356>3.0.CO;2-Z
Woo J, Lau E, Lee P, Kwok T, Lau WC, Chan C, et al. Impact of osteoarthritis on quality of life in a Hong
Kong Chinese population. J Rheumatol 2004; 31: 2433-8. PMid: 15570647
Sinusas K. Osteoarthritis: diagnosis and treat¬ment. Am Fam Physician 2012; 85: 49-56. PMid: 22230308
Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-Based knee injections for the man¬agement
of arthritis. Pain Med 2012; 13: 740-53. doi: 10.1111/j.1526-4637.2012.01394.x, PMid: 22621287, PMCid:
PMC3376243
Frizziero A, Giannotti E, Ferraro C, Masiero S. Platelet rich plasma intra-articular injections: a new
therapeutic strategy for the treatment of knee osteoarthritis in sport rehabilitation. A systematic review.
Sport Sci Health 2012; 8: 15-22. doi: 10.1007/s11332-012-0126-5
Petrella RJ. Hyaluronic acid for the treatment of knee osteoarthritis: long-term outcomes from a naturalistic
primary care experience. Am J Phys Med Rehabil 2005; 84: 278–83. doi:
1097/01.PHM.0000156899.18885.06, PMid: 15785261
Rodriguez-Merchan EC. Intraarticular injections of platelet-rich plasma (PRP) in the management of knee
osteoarthritis. Arch Bone Jt Surg 2013; 1: 5–8. PMid: 25207275, PMCid: PMC4151401
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA Statement
for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care
Interventions:Explanation and Elaboration. PLoS Medicine 2009; 6: e1000100. doi: 10.1136/bmj.d5928,
PMid: 22008217, PMCid: PMC3196245
McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis
Index (WOMAC): A review of its utility and measurement properties. Arthritis Rheum 2001; 45: 453-61.
doi: 10.1002/1529-0131(200110)45:5<453::AID-ART365>3.0.CO;2-W
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's
tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of
reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1-12. doi:
1016/0197-2456(95)00134-4
Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation
rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol
; 26: 910-3. PMid: 19032827
Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, et al. Comparison Between Hyaluronic
Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis. Am J Sports
Med 2012; 40: 2822-7. doi: 10.1177/0363546512461902, PMid: 23104611
Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, et al. Knee Osteoarthritis
Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical
trial). Clin Med Insights Arthritis Musculoskelet Disord 2015; 8: 1-8. PMid: 25624776, PMCid:
PMC4287055
Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, et al. A Randomized
Clinical Trial Evaluating Plasma Rich in Growth Factors (PRGF-Endoret) Versus Hyaluronic Acid in the
Short-Term Treatment of Symptomatic Knee Osteoarthritis. Arthroscopy 2012; 28: 1070-8. doi:
1016/j.arthro.2012.05.011, PMid: 22840987
Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A. Treatment of Knee Joint Osteoarthritis with
Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid. Am J Phys Med Rehabil 2012; 91:
-7. doi: 10.1097/PHM.0b013e3182aab72, PMid: 22513879
Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of Intra-Articular
Injections of Plasma Rich in Growth Factors (PRGF-Endoret) Versus Durolane Hyaluronic Acid in the
Treatment of Patients With Symptomatic Osteoarthritis: A Randomized Controlled Trial. Arthroscopy
; 29: 1635-43. doi: 10.1016/j.arthro.2013.07.264, PMid: 24075613
Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, et al. The efficacy of
platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with
quantitative synthesis. Arthroscopy 2013; 29: 2037-48. doi: 10.1016/j.arthro.2013.09.006, PMid: 24286802
Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich
Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy 2015; S0749-8063: 00659-3.
Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of plateletrich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and
meta-analysis. Arch Phys Med Rehabil 2014; 95: 562-75. doi: 10.1016/j.apmr.2013.11.006, PMid:
Gobbi A, Karnatzikos G, Mahajan V, Malchira S. lateletrich plasma treatment in symptomatic patients with
knee osteoarthritis: preliminary results in a group of active patients. Sports Health 2012; 4: 162-72. doi:
1177/1941738111431801, PMid: 23016084, PMCid: PMC3435904
Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, et al. Platelet intra-articular
injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early
degenerations to osteoarthritis. Arthroscopy 2011; 27: 1490-501. doi: 10.1016/j.arthro.2011.05.011, PMid:
Martin P, D'Souza D, Martin J, Grose R, Cooper L, Maki R, et al. Wound healing in the PU.1 null mouse--
tissue repair is not dependent on inflammatory cells. Curr Biol 2003; 13: 1122-8. doi: 10.1016/S0960- 9822(03)00396-8
Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, et al. Platelet-Rich Plasma
Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized
Controlled Trial. Am J Sports Med 2015; 43: 1575-82. doi: 10.1177/0363546515582027, PMid: 25952818
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, al e. Surgical vs
nonoperative treatment for lumbar disk herniationd The Spine Patient Outcomes Research Trial (SPORT):
A randomized trial. JAMA 2006; 269: 2441-50. doi: 10.1001/jama.296.20.2441, PMid: 17119140, PMCid:
PMC2553805
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