The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Role of Intraarticular Injections of Hyaluronic Acid and Platelet Rich Plasma for the Treatment of Articular Pain in Knee Osteoarthritis

Document Type : In Brief

Authors
E. Carlos RODRIGUEZ-MERCHAN 1
Hortensia De la Corte-Rodriguez 2
1 Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
2 Department of Physical Medicine and Rehabilitation, La Paz University Hospital-IdiPaz, Madrid, Spain
10.22038/abjs.2024.78852.3621
Abstract
The purpose of this in brief article was to determine the current role of intraarticular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for the treatment of painful KOA. It has been reported that the average duration of effectiveness (pain relief) of one injection of extended-release HA is around one year. Kellgren-Lawrence grade (I-II versus III-IV), male gender, and older age are associated with a longer duration of effectiveness. Cartilage degeneration might be improved with a higher number of injections of HA. Intraarticular injections of HA alleviate pain, function, and diminish non-steroidal anti-inflammatory drugs (NSAIDs) consumption. In addition, several studies have indicated that the combination of HA and PRP is more effective than HA alone. Finally, other studies seemed to demonstrate that PRP was more effective than HA.
        Level of evidence: III
Keywords
Efficacy
Hyaluronic acid
Intraarticular injections
Knee osteoarthritis
Platelet-rich plasma
Subjects
  1. Langworthy M, Dasa V, Spitzer AI. Knee osteoarthritis: disease burden, available treatments, and emerging options. Ther Adv Musculoskelet Dis. 2024; 16:1759720X241273009. doi: 10.1177/1759720X241273009.
  2. Kang Y, Liu C, Ji Y, et al. The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities. Arch Orthop Trauma Surg. 2024; 144(6):2731-2743. doi: 10.1007/s00402-024-05250-4.
  3. Hummer CD, Angst F, Ngai W, et al. High molecular weight Intraarticular hyaluronic acid for the treatment of knee osteoarthritis: a network meta-analysis. BMC Musculoskelet Disord. 2020; 21(1):702. doi: 10.1186/s12891-020-03729-w.
  4. Bahrami MH, Raeissadat SA, Cheraghi M, Rahimi-Dehgolan S, Ebrahimpour A. Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients. BMC Musculoskelet Disord. 2020; 21(1):550. doi: 10.1186/s12891-020-03577-8.
  5. Ikuta F, Takahashi K, Kiuchi S, et al. Effects of repeated intra-articular hyaluronic acid on cartilage degeneration evaluated by T1ρ mapping in knee osteoarthritis. Mod Rheumatol. 2021; 31(4):912-918. doi: 10.1080/14397595.2020.1830483.
  6. Park YG, Ha CW, Yoo JH, et al. Intra-articular injection of a novel DVS cross-linked hyaluronic acid manufactured by biological fermentation (YYD302) in patients with knee osteoarthritis: a double-blind, randomized, multicenter, noninferiority study. Clin Ther. 2021; 43(11):1843-1860. doi: 10.1016/j.clinthera.2021.09.005.
  7. Webner D, Huang Y, Hummer CD 3rd. Intraarticular hyaluronic acid preparations for knee osteoarthritis: are some better than others? Cartilage. 2021; 13(Suppl 1):1619S-1636S. doi: 10.1177/19476035211017320.
  8. Miller LE, Bhattacharyya S, Parrish WR, Fredericson M, Bisson B, Altman RD. Safety of intra-articular hyaluronic acid for knee osteoarthritis: systematic review and meta-analysis of randomized trials involving more than 8,000 patients. Cartilage. 2021; 13(Suppl 1):351S-363S. doi: 10.1177/1947603519888783.
  9. Onuma H, Sugihara T. Comparison of the efficacy of two high-molecular-weight hyaluronic acid products for patients with knee osteoarthritis. Orthopedics. 2022; 45(1):13-18. doi: 10.3928/01477447-20211229-01.
  10. Lee CL, Wang YC, Huang HT, Chen CH, Chang KL, Tien YC. Efficacy of intra-articular injection of biofermentation-derived high-molecular hyaluronic acid in knee osteoarthritis: an ultrasonographic study. Cartilage. 2022; 13(1):19476035221077404.doi: 10.1177/19476035221077404.
  11. Kim JG, Kim KI, Park KB, et al. Safety and effectiveness of intra-articular injection of a highly cross-linked hyaluronic acid, LBSA0103 (Synovian): results from a post-marketing surveillance study in South Korea. PLoS One. 2023; 18(6):e0287222. doi: 10.1371/journal.pone.0287222.
  12. Perruchet S, Balblanc JC, Rapp C, et al. The association between radiographic features and the duration of effectiveness of a single injection of extended-release hyaluronic acid (HANOX-M-XL) in patients with knee osteoarthritis: preliminary results of a prospective trial. Cartilage. 2023; 14(2):136-143. doi: 10.1177/19476035221109230.
  13. Conrozier T, Diraçoglù D, Monfort J, et al. EUROVISCO good practice recommendations for a first viscosupplementation in patients with knee osteoarthritis. Cartilage. 2023; 14(2):125-135. doi: 10.1177/19476035221138958.
  14. Mousaei Ghasroldasht M, Moayednia A, Shahrezaee M. Effectiveness of platelet-rich plasma based on gene expression in knee osteoarthritis. Arch Bone Jt Surg. 2019; 7(5):435-440.
  15. Prost D, Bardot T, Baud A, et al. Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: a retrospective analysis of patients optimally managed in dedicated centers. Regen Ther. 2024; 25:203-212.doi: 10.1016/j.reth.2023.12.006.
  16. Berrigan WA, Bailowitz Z, Park A, Reddy A, Liu R, Lansdown D. A greater platelet dose may yield better clinical outcomes for platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review. Arthroscopy. 2024:S0749-8063(24)00206-8. doi: 10.1016/j.arthro.2024.03.018.
  17. Zhuang W, Li T, Li Y, et al. The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis. J Orthop Surg Res.19 (1):284. doi: 10.1186/s13018-024-04736-6.
  18. Kon E, de Girolamo L, Laver L, et al. Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surg Sports Traumatol Arthrosc. 2024; 32(11):2938-2949. doi: 10.1002/ksa.12320.
  19. Stagni C, Rocchi M, Mazzotta A, et al. Randomised, double-blind comparison of a fixed co-formulation of intra-articular polynucleotides and hyaluronic acid versus hyaluronic acid alone in the treatment of knee osteoarthritis: two-year follow-up. BMC Musculoskelet Disord. 2021; 22(1):773. doi: 10.1186/s12891-021-04648-0.
  20. Karasavvidis T, Totlis T, Gilat R, Cole BJ. Platelet-rich plasma combined with hyaluronic acid improves pain and function compared with hyaluronic acid alone in knee osteoarthritis: a systematic review and meta-analysis. Arthroscopy. 2021; 37(4):1277-1287.e1. doi: 10.1016/j.arthro.2020.11.052.
  21. Ciapini G, Simonettii M, Giuntoli M, et al. Is the combination of platelet-rich plasma and hyaluronic acid the best injective treatment for grade II-III knee osteoarthritis? A prospective

 

        study. Adv Orthop. 2023:2023:1868943. doi: 10.1155/2023/1868943.

  1. Jalali Jivan S, Monzavi SM, Zargaran B, et al. Comparative Analysis of the effectiveness of intra-articular injection of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: results of an open-babel trial. Arch Bone Jt Surg. 2021; 9(5):487-495. doi: 10.22038/abjs.2021.52003.2569.
  2. Huang Y, Lascarides P, Ngai W, Steele K, Hummer CD. Three weekly intra-articular injections of hylan G-F 20 vs arthrocentesis in patients with chronic idiopathic knee osteoarthritis: a multicenter, evaluator- and patient-blinded, randomized controlled trial. Curr Ther Res Clin Exp. 2023; 99:100707. doi: 10.1016/j.curtheres.2023.100707.
  3. Kim TW, Chang MJ, Shin CY, Chang CB, Kang SB. A randomized controlled trial for comparing efficacy and safety between intraarticular polynucleotide and hyaluronic acid for knee osteoarthritis treatment. Sci Rep. 2023; 13(1):9419. doi: 10.1038/s41598-023-35982-z.
  4. Belk JW, Lim JJ, Keeter C, et al. Patients with knee osteoarthritis who receive platelet-rich plasma or bone marrow aspirate concentrate injections have better outcomes than patients who receive hyaluronic acid: systematic review and meta-analysis. Arthroscopy. 2023; 39(7):1714-1734. doi: 10.1016/j.arthro.2023.03.001.
  5. Kim JH, Park YB, Ha CW. Are leukocyte-poor or multiple injections of platelet-rich plasma more effective than hyaluronic acid for knee osteoarthritis? A systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2023; 143(7):3879-3897. doi: 10.1007/s00402-022-04637-5.
  6. Gobbi A, Dallo I, D'Ambrosi R. Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial. Eur J Orthop Surg Traumatol. 2023; 33(5):1895-1904. doi: 10.1007/s00590-022-03356-2.

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 1
January 2025
Pages 54-61

  • Receive Date 17 April 2024
  • Revise Date 02 November 2024
  • Accept Date 15 October 2024