Single shot of knee intraarticular injection of Platelets rich plasma versus hyaluronic acid injections for symptomatic knee osteoarthritis. An observational prospective study

Abstract

Background: A very common degenerative joint disorders is knee osteoarthritis (KOA) which slow articular cartilage damage, the inflammation of the synovial membranes, and alterations in the bones beneath the cartilage characterize [1 ,2 ,3 , 4].Osteoarthritis of the knee affects 10–18% of people, and if left untreated, it can cause considerable physical impairment [5 ,6 , 7]. Currently less Invasive interventions attract more and more attention, like steroid, hyaluronic acid (HA), stem cell injections and plasma injections which is rich with platelet (PRP). Yet, whether treating with PRP vs. HA is the most effective for knee OA is still controversial. The current work assessed the effectiveness and safety of intra-articular PRP and HA in those with KOA. Patients & Methods: The current work was prospective randomized observational. Suitable patients with knee discomfort were pre-screened completing an informed consent and satisfied the inclusion criteria. Thus, they were eligible and split into two groups in a 1:1 ratio. Group1; 72 patients were injected with 1 intra-articular of PRP. The drawn blood mean amount was 15 mL. We used noncommercial double syringe PRP Kit for infiltring 1 mL anticoagulant (sodium citrate). We centrifuged the citrated blood at 3000 rpm for 10 min. Plasmatic fraction produced 3-5 mL pure PRP solutions and utilized for the injections of intra-articular PRP. Group 2; 72 patients received single intra-articular injections of HA (80 mg/4 mL). All of the patients were assessed prior to the infiltration as well as 1, 3, and 6 and 12 months following the injection. Pain, articular stiffness, and functional restriction were examined by the McMaster (WOMAC) osteoarthritis and Western Ontario and index questionnaires. The same physicians were in charge of this stage. Results: The PRP group was 27 men and 45 women with a mean age of 62.5 years. The score of mean of WOMAC before therapy was 72.8. The Kellgren-Lawrence radiographic classification was used to classify the patients: 31had grade II OA changes, 41 had grade III. In 47 cases, the right knee was afflicted, while in 25 individuals, the left knee was affected. The HA group included 30 men and 42 women with a mean age (60.8) years. In this group, the score of mean of WOMAC before therapy was 76.3. The Kellgren-Lawrence classification was used to assess the patients again: 33 had grade II, 39 had grade III. The disease afflicted 49 patients' right knees and 23 individuals' left knees. The total WOMAC score was significantly lower at one month when relative to the reference in the HA group with a score of WOMAC mean 48.8 with p<0.05 against no significant change in PRP groups with score of mean of WOMAC of 68.9. At 3 months, each group significantly reduced the general WOMAC score in comparison the references in both groups. The score of mean of WOMAC was 48.2 in the HA vs. 47.9 in the PRP group. The PRP and the HA groups statistically differe(P< 0.05) at this time point. At 6 moths, a reversal of pattern was noted, with patients treated with PRP continuing to improve and those treated with HA slightly worsening. The PRP group had a score of mean of WOMAC of 39.4 compared 56.3 in the HA group. There was a statistically significant difference between the two groups (P< 0.05). PRP group exhibited a steady worsening whereas those treated with HA showed a rapid deterioration at 12 months. The WOMAC scores of most participants in the HA group relapsed to their baseline levels. Despite the fact that the PRP group's score of mean of WOMAC was 58.9, the HA group reacher74.1 and the both groups differ statistically and significantly (P < 0.05). Conclusion and recommendations: The overall PRP improvement outweighs HA injections. Additional RCTs (randomized controlled trials) are required of determining the best PRP and HA dosages and intervals.