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07-07-2024 | Knee Osteoarthritis | Knee Arthroplasty

Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis

Authors: Jiahao Gao, Yang Ma, Jinshuo Tang, Jinrui Zhang, Jianlin Zuo

Published in: Archives of Orthopaedic and Trauma Surgery

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Abstract

Background

This study aimed to evaluate whether a combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) is more effective and safer than injection alone for treating KOA.

Materials and methods

MEDLINE (PubMed), the Cochrane Library, EMBASE, and Web of Science databases were systematically searched for articles published until January 2024, and gray literature and bibliographic references were searched. All published randomized controlled trials (RCTs) compared pain, functional outcomes, and adverse events (AEs) associated with PRP + HA therapy vs. PRP or HA treatments. Two independent researchers extracted the pertinent data and evaluated the methodological quality following the PRISMA guidelines. The primary outcomes were pain, functional outcomes, and AEs. A fixed-effects model was used for data analysis in cases with low heterogeneity (P > 0.10 and I2 < 50%). Otherwise, a random effects model was used.

Results

Ten RCTs involving 943 patients were included in the analysis. The statistical findings did not differ between the treatment of PRP + HA and PRP alone, while a discernible enhancement in treatment efficacy was observed when compared to HA monotherapy: the visual analog scale scores at 1- (mean difference[MD], −1.00; 95% CI: −1.37 − −0.62; P < .001), 6- (MD, −1.87; 95% CI: −3.46 − −0.28; P = .02), 12-months (MD, −2.07; 95% CI: −3.77 − −0.38; P = .02), and the Western Ontario and McMaster Universities Arthritis Index total scores at 12-months (MD, −8.82; 95% CI: −14.48 − −3.16; P = .002). The incidence of adverse events was notably lower with PRP + HA than with HA alone (OR, 0.37; 95% CI: 0.19 − 0.69; P = .00) or PRP alone (OR, 0.51; 95% CI, 0.30 − 0.87; P = .01).

Conclusions

PRP + HA therapy resulted in more pronounced pain and functional improvement in symptomatic KOA patients than HA treatments, and combination therapy may have higher clinical safety than PRP or HA monotherapy.
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Metadata
Title
Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis
Authors
Jiahao Gao
Yang Ma
Jinshuo Tang
Jinrui Zhang
Jianlin Zuo
Publication date
07-07-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05442-y