Superior clinical outcomes with combined intra-articular platelet-rich plasma and hyaluronic acid compared with hyaluronic acid alone in knee osteoarthritis: A prospective comparative study

IF 3.2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2026-09-24 DOI:10.1002/jeo2.70909

Trifon Totlis, Vlasiοs Achlatis, Panagiotis-Konstantinos Emfietzis, Dimitris Tsigenopoulos, Mikail Chatzivasiliadis, Vassilis Ediaroglou, Stavros Savvakis, Efthymios Papasoulis, Ioannis Terzidis

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Abstract

Purpose

Although platelet-rich plasma (PRP) and hyaluronic acid (HA) are widely used for knee osteoarthritis (KOA), it remains unclear whether combining them provides greater benefit than HA alone. This study compared the efficacy and safety of three combined injections of PRP and high molecular weight (HMW) HA to three injections of HMW HA alone in patients with KOA.

Methods

A prospective comparative analysis was conducted in patients with Kellgren–Lawrence (KL) Grade II–IV KOA who underwent either three intra-articular PRP-HA injections (Group A) or three intra-articular injections of HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and subscales, the visual analogue scale (VAS) and the EuroQuality of Life–5 Dimensions–5 Levels (EQ-5D-5L) were assessed at baseline, 3, 6 and 12 months post-injection. Statistical analysis was applied to compare the outcomes between the two groups. The HA used in both groups had a concentration of 1% (20 mg/2 mL) and a molecular weight of 2.8–3.2 MDa. The PRP used had been previously analysed and classified according to the Dose of injected Platelets, Efficiency of production, Purity of the PRP, Activation of the PRP (DEPA) classification as CCA.

Results

The study included 150 knees from 150 patients (Group A: 75 and Group B: 75). The VAS, KOOS total and EQ-5D-5L scores significantly improved within each group at every time point compared to baseline (p < 0.05). The PRP-HA group achieved significantly superior outcomes than the HMW-HA group in VAS, KOOS total and EQ-5D-5L scores at 6- and 12-month follow-up post-injection (p < 0.05). No serious adverse events were reported in either group.

Conclusion

Both PRP-HA and HA only injections significantly improved pain, function and quality of life in patients with KOA. The PRP-HA group achieved significantly better outcomes than the HA group in all three patient-reported outcome measures at 6- and 12-month follow-up, and in the proportion of patients who achieved Patient Acceptable Symptom State and minimum clinically important difference, especially at 12 months post-injection.

Level of Evidence

Level II.

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与单独应用透明质酸相比，关节内富血小板血浆和透明质酸联合应用治疗膝骨关节炎的临床效果更好：一项前瞻性比较研究。

目的：虽然富血小板血浆（PRP）和透明质酸（HA）被广泛用于治疗膝骨关节炎（KOA），但目前尚不清楚它们联合使用是否比单独使用HA更有益处。本研究比较了PRP联合高分子量（HMW） HA三次注射与单独注射HMW HA三次注射对KOA患者的疗效和安全性。方法：对kellgreen - lawrence (KL) II-IV级KOA患者进行前瞻性比较分析，分别接受三次关节内PRP-HA注射（A组）和三次关节内HA注射（B组）。在基线、注射后3、6和12个月评估膝关节损伤和骨关节炎结局评分（kos）和亚量表、视觉模拟量表（VAS）和欧洲生活质量5维度5水平（EQ-5D-5L）。采用统计学方法对两组结果进行比较。两组使用的透明质酸浓度为1% (20mg / 2ml)，分子量为2.8-3.2 MDa。使用的PRP先前已根据注射血小板剂量、生产效率、PRP纯度、PRP活化（DEPA）分类为CCA进行了分析和分类。结果：研究纳入150例患者的150个膝关节（A组75例，B组75例）。各组患者VAS、KOOS总分及EQ-5D-5L评分在各时间点均较基线有显著改善（p < 0.05）。结论：单纯注射PRP-HA及单纯注射HA均可显著改善KOA患者的疼痛、功能及生活质量。在6个月和12个月的随访中，PRP-HA组在所有三个患者报告的结果测量中取得了明显优于HA组的结果，在达到患者可接受症状状态的患者比例和最小的临床重要差异方面，特别是在注射后12个月。证据等级：二级。

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