Single-and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial

BACKGROUND Platelet-rich plasma(PRP) and hyaluronic acid have been shown to be useful in the treatment of knee osteoarthritis. However, investigations comparing the efficacy of these two drugs together are insufficient.AIM To compare the outcomes of PRP vs hyaluronic acid injections in three groups of patients with bilateral knee osteoarthritis.METHODS This randomized controlled trial study involved 95 patients. Thirty-one subjects received a single injection of PRP(group PRP-1), 33 subjects received two injections of PRP at an interval of 3 wk(group PRP-2) and 31 subjects received three injections of hyaluronic acid at 1-wk intervals(group hyaluronic acid). The patients were investigated prospectively at the enrollment and at 4-, 8-and 12-wk follow-up with the Western Ontario and Mc Master Universities Arthritis Index(WOMAC) and Visual Analogue Scale questionnaires.RESULTS Percentages of patients experiencing at least a 30% decrease in the total score for the WOMAC pain subscale from baseline to wk 12 of the intervention were 86%,100% and 0% in the groups PRP-1, PRP-2 and hyaluronic acid, respectively(P 0.001). The mean total WOMAC scores for groups PRP-1, PRP-2 and hyaluronic acid at baseline were 63.71, 61.57 and 63.11, respectively. The WOMAC scores were significantly improved at final follow-up to 42.5, 35.32 and 57.26,respectively. The highest efficacy of PRP was observed in both groups at wk 4 with about 50% decrease in the symptoms compared with about 25% decrease for hyaluronic acid. Group PRP-2 had higher efficacy than group PRP-1. No major adverse effects were found during the study.CONCLUSION PRP is a safe and efficient therapeutic option for treatment of knee osteoarthritis.It was demonstrated to be significantly better than hyaluronic acid. We also found that the efficacy of PRP increases after multiple injections.     

Cross-linked hyaluronic acid in the treatment of osteoarthritis of the knee--results of a prospective randomized trial

PURPOSE: The objective of this trial was to compare the effectiveness of intraarticular injection of highly cross-linked hyaluronic acid (HA) with intraarticular injection of gaseous oxygen (O 2 ) in patients with clinical symptoms of cartilage damage in the knee. METHODS: Based on arthroscopically verified diagnosis, 111 patients were randomised and treated prospectively either with HA or O 2. The treatment was completed with an exercise program. The follow up was one year. 109 patients (56 x HA, 53 x O 2 ) were statistically calculated with the Wilcoxon-test according to the results of the Lysholm-score, the Tegner-activity-index, the Womac-score for pain, stiffness, function and the VAS for pain in rest and under strain. RESULTS: Both treatments were able to attain a statistically significant reduction of pain (VAS in rest and under strain, Womac part A), a reduction of joint stiffness (Womac part B) and improvement of joint function (Womac part C, Lysholm-score) during the follow up of one year. The Tegner-activity-index showed no significant change under both treatments. The comparison of both treatments showed differences in VAS under strain (p = 0.001), the Lysholm-score (p = 0.003), Womac part A (p = 0.003) and part C (p = 0.001). As a result HA showed significant better improvements with the VAS and Lysholm-score and oxygen showed significant better changes in the Womac-score part A and C. The results with cartilage damage 2 degrees were the same as in the total (VAS strain: p = 0.029 for O 2, Lysholm-score: p = 0.003 for HA, WOMAC part A: p = 0.009 for HA, Womac part C: p = 0.006 for O 2 ). The results with cartilage damage 3 degrees showed significant differences in reduction of joint stiffness (Womac part B: p = 0.012) for O 2. For cartilage damage 4 degrees HA showed significant reduction of pain (VAS rest: p = 0.001, VAS strain: p = 0.003) and O 2 significant reduction of pain and function (Womac part A: p = 0.004, part C: p = 0.002). CONCLUSION: Both methods are suitable to improve significantly the discomfort due one year to osteoarthritis. The pain relief by HA and the improvement of joint function by O 2 treatment have been shown for higher degrees of cartilage damage.     

Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis

Intraarticular injections of hyaluronic acid have been advocated for treatment of symptomatic knee osteoarthritis. Appropriate indications and favorable patient response factors, such as radiographic disease severity and age, are not clearly defined for this therapy. The current review of 80 knees with symptomatic osteoarthritis treated with hyaluronic acid revealed that approximately 2/3 of treated knees received 2/3 relief of pain. Hyaluronic acid treatment is not appropriate for all patients with knee osteoarthritis. Overall, less than 50% of treated knees achieved satisfactory results, and only 35% reported increased activity. Twenty-two patients (28% of knees; 22 knees) underwent surgery within 7 months of their index injection, suggesting an inadequate response to treatment. The treatment is not without complication because 11 patients (15% of knees; 12 knees) experienced adverse reactions, including one case of septic arthritis. The authors recommend intraarticular hyaluronic acid only for patients with symptoms and significant surgical risk factors and for patients with mild radiographic disease in whom conservative treatment has failed (physical therapy, weight loss, nonsteroidal antiinflammatory medication, and intraarticular steroid injection). It is inadvisable to treat patients with a complete collapse of joint space or bone loss with intraarticular hyaluronic acid, given their poor clinical response.     

Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial

OBJECTIVE: To evaluate the effect of a brace intended to reduce load in patients with medial or lateral compartmental osteoarthritis (OA) and concurrent varus or valgus alignment, respectively. DESIGN: This multi-centre randomized controlled trial (performed 2001-2003) studies the additive effect of a brace intended to reduce load in conservative treatment of unicompartmental OA of the knee. Setting: Orthopedic department of a university medical centre and of one general hospital. The follow-up was 12 months. Patients: 117 patients with unicompartmental OA of the knee. Intervention group (n=60) comprising conservative treatment with additional brace treatment and a control group (n=57) comprising conservative treatment alone. Primary outcome measures: Pain severity and knee function score. Secondary outcome measures: Walking distance and quality of life. Analysis: Multiple linear regression models according to the intention-to-treat-principle were used to assess outcome differences for the entire group of patients. In addition, we performed explorative subgroup analyses on primary overall outcomes stratified for alignment, degree of OA, origin of OA, and age. RESULTS: Although the primary outcome measures were improved in the intervention group in comparison with the controls at each assessment point, the differences reached only borderline significance. The reported walking distances at 3 months, 12 months and overall were significantly longer in the brace group (P=0.03, P=0.04 and P=0.02, respectively). Subgroup analysis showed a better effect in the varus group, in patients with severe OA, in patients with secondary OA and in patients younger then 60 years. In total 25 patients in the brace group and 14 in the control group changed their initial treatment, mostly (74%) because of a lack of beneficial effect. CONCLUSIONS: The results indicate that a brace intended to reduce load shows small effects in patients with unicompartmental OA. However, many patients do not adhere in the long run to this kind of conservative treatment.     

Intra-articular hyaluronic acid compared with corticoid injections for the treatment of rhizarthrosis

OBJECTIVE: Prospective assessment of the efficacy and tolerability of intra-articular sodium hyaluronate (SH; Ostenil mini) and triamcinolone acetonide (TA; Volon A10) for treatment of osteoarthritis (OA) of the carpometacarpal (CMC) joint of the thumb in a 26-week, controlled, randomized, on an intention to treat, masked-observer study. METHODS: Patients were treated with three intra-articular injections of either SH (n = 28) or TA (n = 28). Primary assessments were pain according to a 100mm visual analogue scale and extensive clinical and functional parameters such as swelling, grip power and range of motion. The population was analysed using one- and two-sided Mann-Whitney (MW) estimators. RESULTS: Maximum pain relief occurred at 2-3 weeks for TA and at week 26 for SH after the first intra-articular injection. At weeks 2-3 TA was significantly better than SH (MW: 0.3319 and 0.3063; P = 0.9827 and 0.9929). At week 26 a slight superiority of SH could be observed (MW: 0.53; P = 0.3624) and non-inferiority could be proven. After 26 weeks lateral pinch power was significantly better in the SH-group (MW: 0.6331; P = 0.0226). In all, 88.0% of patients treated with SH and 79.1% of the TA-group described pain improvement after 26 weeks. Both agents were well tolerated. No adverse events with causal connection to the investigational products occurred. CONCLUSION: A single course of three SH injections is effective in relieving pain and improving joint function in patients with OA of the CMC joint of the thumb. Although in comparison with triamcinolone its effects are achieved more slowly, the results indicate a superior long-lasting effect of hyaluronan at 6 months after end of treatment period.     

Intraarticular injections (corticosteroid,hyaluronic acid,platelet rich plasma) for the knee osteoarthritis

Osteoarthritis (OA) is a complex “whole joint” disease pursued by inflammatory mediators, rather than purely a process of “wear and tear”. Besides cartilage degradation, synovitis, subchondral bone remodeling, degeneration of ligaments and menisci, and hypertrophy of the joint capsule take parts in the pathogenesis. Pain is the hallmark symptom of OA, but the extent to which structural pathology in OA contributes to the pain experience is still not well known. For the knee OA, intraarticular (IA) injection (corticosteroids, viscosupplements, blood-derived products) is preferred as the last nonoperative modality, if the other conservative treatment modalities are ineffective. IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA. IA hyaluronic acid (HA) injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk. But for HA injections, the cost-effectiveness is an important concern that patients must be informed about the efficacy of these preparations. Although more high-quality evidence is needed, recent studies indicate that IA platelet rich plasma injections are promising for relieving pain, improving knee function and quality of life, especially in younger patients, and in mild OA cases. The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction. But, there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.     

复方倍他米松联合玻璃酸钠治疗中重度膝关节骨性关节炎的随机对照研究

目的:比较复方倍他米松与复方倍他米松联合玻璃酸钠治疗中重度膝关节骨性关节炎(knee osteoarthri-tis,KOA)的临床疗效.方法:采用前瞻性随机对照研究方法将2017年2月至2017年11月收治的116例单侧中重度KOA患者分为观察组和对照组,每组58例.观察组男15例,女43例;年龄45～80(66.4...     

富血小板血浆与透明质酸治疗膝关节骨关节炎的meta分析

目的本研究旨在探讨富血小板血浆（PRP）与透明质酸（HA）在治疗膝关节骨关节炎（KOA）的疗效差异。 方法系统检索在线数据库，包括PubMed、Embase、Ovid、Cochrane Library，收集探讨PRP与HA治疗KOA的随机对照研究（RCTs）。主要评价指标为西安大略与麦克马斯特大学骨关节炎指数（WOMAC）疼痛和功能评分。次要评价指标为WOMAC总评分、WOMAC僵硬度评分、国际膝关节文献委员会膝关节评估表（IKDC）评分、疼痛视觉模拟（VAS）评分、EuroQol（EQ）-VAS评分、国际膝关节文献委员会膝关节评估表（KOOS）评分、Lequesne指数和不良事件。采用Review Manager 5.3软件进行数据分析。 结果本研究纳入19篇随机对照研究，共包含1 818膝。研究结果表明，PRP组患者WOMAC疼痛评分和VAS评分6个月和12个月随访时较HA组患者降低。PRP组患者EQ-VAS评分12个月随访时低于接受HA组患者。此外，1个月、3个月、6个月和12个月随访时，PRP组患者WOMAC功能评分高于HA组患者。两组WOMAC总评分在6个月和12个月随访时差异明显。3个月和6个月随访时，PRP组患者IKDC评分优于HA组患者。两组之间的Lequesne指数、KOOS评分和不良事件发生率差异无统计学意义。 结论对于膝关节骨关节炎治疗而言，PRP在早期功能康复方面似乎比HA更有效，而在远期疼痛缓解和功能康复方面前者明显优于后者。此外，与HA注射相比，PRP注射不会增加不良事件发生的风险。     

Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline

OBJECTIVE: Hyaluronic acid (HA) and corticosteroids are both widely used for intra-articular treatment of knee osteoarthritis (OA). We examined the effect of both drugs in intra-articular treatment for hip OA. METHODS: One hundred and one patients with hip OA were included in a prospective double blind study, using a randomized controlled trial with a three-armed parallel-group design. Three ultrasound-guided, intra-articular injections were given at 14 days interval. The primary outcome measure was 'pain on walking', registered on a visual analogue scale (VAS). Evaluation was performed at baseline and after 14, 28 and 90 days. The study adhered to the Consolidated Standards of Reporting Trials. All analyses were based on intention-to-treat analyses, and used 'mixed-procedures' with the baseline-observation as covariate. RESULTS: There were no significant interactions with respect to Treatment x Time for any of the analyzed outcome measures. There was a significant treatment effect for 'pain on walking' (P=0.044) due to a significant improvement following corticosteroid compared to saline with an effect-size of 0.6 (95% confidence interval: 0.1-1.1, P=0.021). By contrast, HA compared to saline had an effect size of 0.4 (-0.1 to 0.9; P=0.13). The peak-effect was obtained after 2 weeks. There was no difference between the treatment groups at endpoint. No significant side effects of the injections were observed. CONCLUSIONS: Patients treated with corticosteroids experienced significant improvement during the 3 months of intervention, with an effect size indicating a moderate clinical effect. Although a similar significant result following treatment with HA could not be shown, the effect size indicated a small clinical improvement. A higher number of patients in future HA studies would serve to clarify this point.     

Single intra-articular injection with or without intra-osseous injections of platelet-rich plasma in the treatment of osteoarthritis knee: A single-blind,randomized clinical trial

BackgroundSubchondral bony structure damage plays an essential role in the pathogenesis of osteoarthritis (OA) knee. An intra-articular injection cannot reach the damaged subchondral bony structure and treat its pathologies effectively. The objective of the study was to compare the clinical effects of single intra-articular injection with or without intra-osseous injections of PRP in the treatment of osteoarthritis (OA) knee.MethodsThis was a single-blind, parallel-group, randomized clinical trial. Fifty patients, with OA knee (K&L grade III), with ages between 50 and 65 years, were randomly allocated into ‘intra-osseous, intra-articular PRP’ (‘IO+IA-PRP’) (n = 25) or ‘intra-articular PRP’ group (‘IA-PRP’) (n = 25). Patients in the ‘IO+IA-PRP’ group received 18 ml PRP injection, and the ‘IA-PRP’ group received 8 ml PRP injection. Intra-osseous injections were given at the tibial plateau (5 ml) and femoral condyle (5 ml), along with intra-articular knee injection (8 ml), under fluoroscopic guidance. Outcomes were measured using VAS-pain, the knee injury and osteoarthritis outcome score (KOOS), and the treatment satisfaction scale. All patients (n = 50) were followed up till six months.ResultsThe mean age was 57.12(4.27) years and 57.00(4.96) years in the ‘IO+IA-PRP’ and ‘IA-PRP’ groups. Both groups showed significant improvement in pain relief (VAS pain) and KOOS parameters: pain, symptoms, ADL function, sport and recreation function, and quality of life. Compared to the ‘IA-PRP’ group, the ‘IO+IA-PRP’ group showed a greater reduction of VAS pain at six months. However, no significant difference was obtained in VAS pain-relief between these two groups (p = 0.422) at six months. Similarly, at 6 months, in inter-group comparison, except ‘sport and recreation function’ (p < 0.05), no significant differences were obtained in mean-scores of KOOS parameters: pain (p = 0.514); symptom (p = 0.148), ADL-function (p = 0.991), QoL-(p = 0.376). Patients in the ‘IO+IA-PRP’ group complained of significant ‘injection-associated’ adverse events and consumed a greater number of Acetaphenomen.ConclusionsBoth groups showed significant improvement following the intervention. Intra-osseous PRP injections did not provide any additional benefit over intra-articular PRP injection until six months regarding pain relief and functional improvement.     

富血小板血浆与透明质酸治疗膝骨性关节炎的荟萃分析

[目的]比较关节腔内注射富血小板血浆(platelet-rich plasma,PRP)和透明质酸(hyahronic acid,HA)治疗膝关节骨性关节炎(knee osteoarthritis,KOA)的临床疗效.[方法]系统检索Cochrane、PubMed和Embase数据库中截至2020年12月所有关节腔内注...     

Early effect of hyaluronic acid intra-articular injections on serum and urine biomarkers in patients with knee osteoarthritis: An open-label observational prospective study

The aim of the study was to investigate the effect of hyaluronic acid (HA) intra articular injections (IA) on osteoarthritis (OA) biomarkers in patients with knee OA. Prospective open label study. Fifty‐one patients with unilateral symptomatic K‐OA received IA injections of 2mL of HA on days (D) 1, 7, 14 and were followed 3 months. At D‐15 patients were examined and X‐rays performed, to exclude patients with bilateral K‐OA, or those with more than three symptomatic OA joints. From 15 days (D‐15) before the first injection to D90 concomitant therapies were unchanged. Walking pain (WP) on VAS was obtained at each visit. Urine (U) and serum (S) samples were obtained at D‐15, D1, D30, and D90. S‐C2C, S‐Cartilage oligomeric matrix protein, S‐HA, S‐CS 846 epitope, S‐type II collagen propeptide, and U‐type II collagen C telopeptide (U‐CTX II/creatinin) were assayed. Predictive factors of response were analyzed using logistic regression. Correlations between variables were obtained using Spearman test. Forty‐five patients were analyzed. Between D‐15 and D1 there was no difference for any biomarkers At D1, WP (SD) was correlated with U‐CTX II/creat (p = 0.006). Between D1 and D90: U‐CTX II/creat decreased significantly. After adjustment for confounding variables there was a significant correlation between clinical response and U‐CTX II/creat variation. U‐CTX II and S‐HA at baseline were independently predictive of clinical response. This study showed that 90 days after HA IA injections, U‐CTX II levels significantly decrease compared to baseline, suggesting a slowdown of type II collagen degradation. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:679–685, 2012