Intra-articular platelet-rich plasma combined with hyaluronic acid injection for knee osteoarthritis is superior to PRP or HA alone in inhibiting inflammation and improving pain and function

Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang 550004, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang 550004, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang 550004, China. Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang 550004, China. Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang 550004, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang 550004, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang 550004, China. Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang 550004, China. Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang 550004, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang 550004, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang 550004, China; China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou 310000, China. Electronic address: yechuanchina@hotmail.com.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2020
Abstract
PURPOSE The goal of this study was to evaluate the effectiveness and explore the therapeutic mechanisms of PRP combined with HA as a treatment for knee osteoarthritis (KOA). METHODS In total, 122 knees were randomly divided into HA (34 knees), PRP (40 knees), and PRP+HA (48 knees) groups. Platelet densities in whole blood and PRP were examined using Wright-Giemsa staining. Visual Analogue Scale (VAS), Lequesne, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm scores and postoperative complications were evaluated. High-frequency color Doppler imaging was used to observe the synovium and cartilage. Enzyme-linked immunosorbent assays (ELISAs) were used to quantify interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in synovial fluid. RESULTS The platelet density in PRP was 5.13-times that in whole blood (P = .002). At 24 months, pain and function scores in the PRP+HA group were better than those in the HA and PRP alone groups (P(pain) = .000; P(function) = .000). At 6 and 12 months, synovial hyperplasia in the PRP and PRP+HA groups was improved (P < .05). After 6 and 12 months, the synovial peak systolic velocity (PSV), synovial end diastolic velocity (EDV), systolic/diastolic ratio (S/D) and resistance index (RI) were improved in the PRP+HA group (P < .05). Complications were highest in the PRP group (P = .008). After 6 and 12 months, IL-1β, TNF-α, MMP-3, and TIMP-1 in the PRP and PRP+HA groups decreased (P < .05), with more apparent inhibition in the PRP+HA group (P < .05). CONCLUSIONS PRP combined with HA is more effective than PRP or HA alone at inhibiting synovial inflammation and can effectively improve pain and function and reduce adverse reactions. Its mechanism involves changes in the synovium and cytokine content.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine