A comparative analysis of the efficacy of intra-articular injections of corticosteroid, hyaluronic acid and platelet-rich plasma for the treatment of osteoarthritis knee

Abstract

Background: Osteoarthritis (OA) of the knee is the most common chronic degenerative joint disease characterized by pain, stiffness, swelling and progressive functional limitation in elderly. Non-surgical management modalities like physical therapy, lifestyle modification and oral non-steroidal anti-inflammatory drugs, are often ineffective or do not alleviate symptoms adequately. Intra-articular corticosteroid (CS) and hyaluronic acid (HA) injections have been used for long to alleviate the symptoms of knee OA. Recently platelet-rich plasma (PRP) therapy has also been tried widely. Very few researches involving a comparison of the three have been conducted. The purpose of the present study was to evaluate the therapeutic effect, efficacy and safety of intra-articular corticosteroid, hyaluronic acid and platelet-rich plasma for knee osteoarthritis. Methods: 90 patients (132 knees) with primary knee osteoarthritis were randomized to receive one injection of intra-articular corticosteroid, hyaluronic acid or platelet-rich plasma and were followed for 3 months. The two groups were compared as regards pain and functional improvement using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), and the visual analog pain scale (VAS), by assessing the patients three times. Results: VAS scale showed that all three modalities were effective in pain reduction. Both WOMAC and KOOS score represented variably improved symptoms i.e. decrease in pain and stiffness along with improvement in daily activity after 3 months in all 3 groups. Conclusion: As the degree of pain relief achieved by the respective modalities was almost similar, the most important difference between the three intervention groups was the duration of their effectiveness. HA is suggested to be superior in the duration of pain relief when compared to CS and PRP. We can propose that HA can be administered less often as compared to CS and PRP for knee joint OA. Therefore, it will be more convenient to use HA.